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Sample records for angina unstable

  1. Emergency coronary angioplasty in refractory unstable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); M.J.B.M. van den Brand (Marcel); K. Balakumaran (Kulasekaram); A.L. Soward; P.G. Hugenholtz (Paul); A.E.R. Arnold (Alfred); B. Mochtar (Bas)

    1985-01-01

    textabstractWe performed percutaneous transluminal coronary angioplasty as an emergency procedure in 60 patients with unstable angina pectoris that was refractory to treatment with maximally tolerated doses of beta-blockers, calcium antagonists, and intravenous nitroglycerin. The initial success

  2. Unstable angina and exposure to carbon monoxide.

    Science.gov (United States)

    Balzan, M V; Cacciottolo, J M; Mifsud, S

    1994-10-01

    Inhalation of small amounts of carbon monoxide diminishes the pain threshold in patients with stable angina pectoris. The aim of this study was to identify and describe patients who had been exposed unknowingly to toxic inhalations of this gas and subsequently presented to hospital with a clinical picture of unstable angina. Blood carboxyhaemoglobin levels of 104 patients referred with unstable angina to a coronary care unit were determined on admission. The likely source of carbon monoxide was identified in all patients. Three patients had definite carbon monoxide intoxication. Another five patients had evidence of minor exposure. When the three cases with carbon monoxide poisoning were excluded, the mean carboxyhaemoglobin level was 2.5% (+/- 1.3) for smokers (n = 30) and 0.6% (+/- 0.5) for non-smokers (n = 71). Use of fossil fuel combustion in an enclosed environment was responsible for the three most serious intoxications and one of the minor cases. We suggest that a number of patients admitted for coronary care with unstable angina may have significant carbon monoxide poisoning. This intoxication is often overlooked by attending physicians with the result that high concentration oxygen therapy is not administered, when it is in fact a necessary part of treatment.

  3. Coronary angioplasty early after diagnosis of unstable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); K.J. Beatt (Kevin); M.J.B.M. van den Brand (Marcel)

    1987-01-01

    textabstractCoronary angioplasty (PTCA) was performed early after diagnosis of unstable angina in 71 patients who responded favorably with initial pharmacologic treatment and who also had persistent exertional angina. The patients selected for PTCA had predominantly single-vessel disease and a

  4. Angina (Chest Pain)

    Science.gov (United States)

    ... angina, including microvascular angina, Prinzmetal's angina, stable angina, unstable angina and variant angina. View an animation of angina . ... they differ is important. Stable Angina / Angina Pectoris Unstable Angina Variant (Prinzmetal) Angina Microvascular Angina Understand Your Risk ...

  5. Long-term effects of electrical neurostimulation in patients with unstable angina : Refractory to conventional therapies

    NARCIS (Netherlands)

    de Vries, Jessica; DeJongste, Mike J. L.; Zijlstra, Felix; Staal, Michiel

    2007-01-01

    Background. Patients with unstable angina pectoris may become refractory to conventional therapies. Electrical neurostimulation with transcutaneous electrical stimulation and/or spinal cord stimulation has been shown to be effective for patients with refractory unstable angina pectoris in hospital

  6. Incidence and follow-up of Braunwald subgroups in unstable angina pectoris

    NARCIS (Netherlands)

    A.J.M. van Miltenburg-van Zijl (Addy); M.L. Simoons (Maarten); R.J. Veerhoek (Rinus); P.M.M. Bossuyt (Patrick)

    1995-01-01

    textabstractObjectives. This study was performed to establish the prognosis of patients with unstable angina within the subgroups of the Braunwald classification. Background. Among many classifications of unstable angina, the Braunwald classification is frequently used. However, the incidence

  7. Histological patterns of atherosclerotic plaques in unstable angina patients vary according to clinical presentation

    OpenAIRE

    Mann, J; Kaski, J; Pereira, W; Arie, S; Ramires, J; Pileggi, F

    1998-01-01

    Background—Unstable angina is a heterogeneous clinical syndrome. The diverse clinical presentations of unstable angina may reflect different pathogenic mechanisms within the plaque.
Objective—To investigate the cellular constituents of culprit coronary atheromatous plaques in patients with stable angina pectoris and patients with diverse clinical presentations of unstable angina.
Methods—48 patients who underwent coronary atherectomy for management of ischaemic heart disease: 23 had stable an...

  8. Diagnostic possibilities of radionuclide investigation in patterns with stable and unstable angina pectoris

    International Nuclear Information System (INIS)

    Ponomareva, A.G.; Zudbinov, Yu.I.; Sokolov, O.K.; Kudinov, V.I.

    1986-01-01

    Myocardial radiocardiography and scintigraphy with 99m Tc-pyrophosphate was performed in 58 patients with stable angina and 60 patients with unstable angina. In patients with stable angina, positive scintigrams were mostly recorded after anginal attacks. Their central hemodynamic parameters deteriorated progressively as angina increased in severity. Patients with unstable angina typically showed myocardial accumulation of the label that was unrelated to anginal attacks and recordable by direct-projection scintigraphy. The assessment of myocardial radiocardiographic and scintigraphic data allows one to differentiate between stable and unstable angina

  9. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P. van den Heuvel; F. Unger (Felix); R. Beyar; W.K. Lindeboom (Wietze); V. de Valk (Vincent); S. Milo; R. Simon (Rudiger); G.F.O. Tyers (Frank); D. Regensburger; P.A. Crean (Peter); I.M. Penn (Ian); E. McGovern; C. van Cauwelaert; P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the

  10. Incidence and follow-up of Braunwald subgroups in unstable angina pectoris

    NARCIS (Netherlands)

    van Miltenburg-van Zijl, A. J.; Simoons, M. L.; Veerhoek, R. J.; Bossuyt, P. M.

    1995-01-01

    OBJECTIVES. This study was performed to establish the prognosis of patients with unstable angina within the subgroups of the Braunwald classification. BACKGROUND. Among many classifications of unstable angina, the Braunwald classification is frequently used. However, the incidence and risk for each

  11. Acute and long-term outcome of directional coronary atherectomy for stable and unstable angina

    NARCIS (Netherlands)

    V.A.W.M. Umans (Victor); P.J. de Feyter (Pim); D.C. MacLeod (Donald); M.J.B.M. van den Brand (Marcel); P.P.T. de Jaegere (Peter); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

    1994-01-01

    textabstractThe clinical efficacy and safety of directional coronary atherectomy for the treatment of stable and unstable angina were assessed in 82 patients with stable and 68 patients with unstable angina. Therefore, clinical and angiographic follow-up was obtained in a prospectively collected

  12. Salvianolate injection in the treatment of unstable angina pectoris

    Science.gov (United States)

    Zhang, Dan; Wu, Jiarui; Liu, Shi; Zhang, Xiaomeng; Zhang, Bing

    2016-01-01

    Abstract Background: To systematically evaluate the clinical efficacy and safety of Salvianolate injection in the treatment of unstable angina pectoris (UAP). Methods: Using literature databases, we conducted a thorough and systematic retrieval of randomized controlled trials (RCTs) that using Salvianolate injection for treating UAP. The Cochrane Risk of Bias Assessment Tool was used to evaluate the methodological quality of the RCTs, and then the data were extracted and meta-analyzed by RevMan5.2 software. Results: A total of 22 RCTs with 2050 participants were included. The meta-analysis indicated that the combined use of Salvianolate injection and western medicine (WM) in the treatment of UAP can achieve a superior effect in angina pectoris total effective rate (risk ratio [RR] = 1.22, 95% confidence interval [CI] (1.17, 1.27), Z = 10.15, P < 0.00001], and the total effectiveness rate of electrocardiogram [RR = 1.26, 95% CI (1.19,1.34), Z = 7.77, P < 0.00001]. In addition, Salvianolate injection can improve the nitroglycerin withdrawal rate and the serum level of NO, decrease high-sensitivity C-reactive protein. Adverse drug reactions (ADRs) or adverse drug events (ADEs) were reported in 6 RCTs involving 15 cases; however, there were no serious ADRs/ADEs. Conclusion: Based on the systematic review, the combined use of Salvianolate injection and WM in the treatment of UAP can achieve a better effect; however, there was no definitive conclusion about its safety. More the large-sample and multicenter RCTs are needed to support its clinical usage. PMID:28002341

  13. Unstable Angina Treatment in Various Periods of Geomagnetic Activity

    Science.gov (United States)

    Parshina, S. S.; Tokayeva, L. K.; Afanasiyeva, T. N.; Samsonov, S. N.; Petrova, V. D.; Dolgova, E. M.; Manykina, V. I.; Vodolagina, E. S.

    In 145 patients with unstable angina (UA) there was analized an efficiency of a drug therapy at different types of heliogeophysical activity (HA) during the 23th solar cycle. 83 patients were examined at the period of a lower HA (Kp-index 16,19±0,18), and 62 patients - at the period of a higher HA (Kp-index 17,25±0,21, p<0,05). Baseline severity of patients' condition with UA at the moment of hospitalization at the studied periods did not differ, but the effectiveness of the therapy depended on the period of HA. At the period of a higher HA antianginal effect was stronger than at the lower period of HA (2,27±0,16 points and 1,75±0,12 points, p<0,05), and the need in nitroglycerin on the background of a drug therapy disappeared for 5-7 days quicker than at the period of a lower HA. Maximal hypotensive effect at a higher HA was achieved quicker - on the 3rd day of the treatment, and at a lower HA - only up to hospital discharge (p<0,05). Blood viscosity did not normalize in both of the studied periods, but in small vessels there was noted a decrease of a BV (p<0,05). So, at a higher HA the effectiveness of a drug therapy in patients with UA is higher than at the period of a lower HA.

  14. Transient Giant R Wave as a Marker for Ischemia in Unstable Angina.

    Science.gov (United States)

    Chugh, Yashasvi; Maraboto, Carola; Christia, Panagiota; Faillace, Robert

    2017-04-28

    Unstable angina is a clinical diagnosis that may present with or without electrocardiographic changes. The "giant R wave" on electrocardiogram has been reported as a manifestation of acute ischemia; however, it is a rare finding in current clinical practice. We describe a case of a patient with unstable angina and a transient "giant R wave" pattern with a culprit lesion in the right coronary artery.

  15. Magnetic resonance imaging in patients with unstable angina: comparison with acute myocardial infarction and normals

    International Nuclear Information System (INIS)

    Ahmad, M.; Johnson, R.F. Jr.; Fawcett, H.D.; Schreiber, M.H.

    1988-01-01

    The role of magnetic resonance imaging in characterizing normal, ischemic and infarcted segments of myocardium was examined in 8 patients with unstable angina, 11 patients with acute myocardial infarction, and 7 patients with stable angina. Eleven normal volunteers were imaged for comparison. Myocardial segments in short axis magnetic resonance images were classified as normal or abnormal on the basis of perfusion changes observed in thallium-201 images in 22 patients and according to the electrocariographic localization of infarction in 4 patients. T2 relaxation time was measured in 57 myocardial segments with abnormal perfusion (24 with reversible and 33 with irreversible perfusion changes) and in 25 normally perfused segments. T2 measurements in normally perfused segments of patients with acute myocardial infarction, unstable angina and stable angina were within normal range derived from T2 measurements in 48 myocardial segments of 11 normal volunteers (42 +/- 10 ms). T2 in abnormal myocardial segments of patients with stable angina also was not significantly different from normal. T2 of abnormal segments in patients with unstable angina (64 +/- 14 in reversibly ischemic and 67 +/- 21 in the irreversibly ischemic segments) was prolonged when compared to normal (p less than 0.0001) and was not significantly different from T2 in abnormal segments of patients with acute myocardial infarction (62 +/- 18 for reversibly and 66 +/- 11 for irreversibly ischemic segments). The data indicate that T2 prolongation is not specific for acute myocardial infarction and may be observed in abnormally perfused segments of patients with unstable angina

  16. Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays.

    Science.gov (United States)

    D'Souza, Maria; Sarkisian, Laura; Saaby, Lotte; Poulsen, Tina S; Gerke, Oke; Larsen, Torben B; Diederichsen, Axel C P; Jangaard, Nikolaj; Diederichsen, Søren Z; Hosbond, Susanne; Hove, Jens; Thygesen, Kristian; Mickley, Hans

    2015-08-01

    Since the arrival of the universal definition of myocardial infarction more sensitive troponin assays have been developed. How these occurrences have influenced the proportions and clinical features of the components of acute coronary syndrome have not been studied prospectively in unselected hospital patients. During 2010 we evaluated all patients in whom cardiac troponin I had been measured at a single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST-elevation myocardial infarction [NSTEMI]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary syndrome included unstable angina pectoris, NSTEMI, and STEMI. Mortality data were obtained from the Danish Civil Personal Registration System. Of 3762 consecutive patients, 516 had acute coronary syndrome. Unstable angina pectoris was present in 7%, NSTEMI in 67%, and STEMI in 26%. The NSTEMI patients were older, more frequently women, and had more comorbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI, and 25% of STEMI patients. Age-adjusted log-rank statistics revealed differences in mortality: NSTEMI vs unstable angina pectoris (P = .0091) and NSTEMI vs STEMI (P = .0045). The application of the universal definition together with the use of a contemporary troponin assay seems to have reduced the proportion of patients with unstable angina pectoris to the benefit of patients with NSTEMI. Despite this, NSTEMI patients have a sustained higher mortality than patients with STEMI. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Diagnosis of unstable angina pectoris has declined markedly with the advent of more sensitive troponin assays

    DEFF Research Database (Denmark)

    D'Souza, Maria; Sarkisian, Laura; Saaby, Lotte

    2015-01-01

    in unselected hospital patients. METHODS: During 2010 we evaluated all patients in whom cardiac troponin I had been measured at a single university hospital. The diagnosis of acute myocardial infarction (ST-elevation myocardial infarction [STEMI] or non-ST-elevation myocardial infarction [NSTEMI......]) was established in cases of a rise and/or fall of cardiac troponin I together with cardiac ischemic features. Patients with unstable chest discomfort and cardiac troponin I values below the decision limit of myocardial infarction were diagnosed as having unstable angina pectoris. The definition of acute coronary...... patients were older, more frequently women, and had more comorbidities than patients with unstable angina pectoris and STEMI. At median follow-up of 3.2 years 195 patients had died: 14% of unstable angina pectoris, 45% of NSTEMI, and 25% of STEMI patients. Age-adjusted log-rank statistics revealed...

  18. Relationship between the serologic status of helicobacter pylori with the presence of unstable angina

    International Nuclear Information System (INIS)

    Alavi, S.M.; Adel, S. M. H.; Rajabzadeh, A.

    2008-01-01

    To determine whether unstable angina is co-related to seropositivity to chronic Helicobacter pylori (HP) infection. It is a case control, descriptive study conducted at CCU in Razi Hospital in Ahwaz a city southwest Iran, from 2004 to 2005. We measured serum HP- lgG levels of participants in CCU in a hospital. Blood samples were drawn during study period from 96 patients (mean age 56 years) with Unstable Angina (UA) according to American Heart Association criteria and from 96 participants free of cardiovascular disease (mean age 58 years) and stored at 20 degree C. Serology results were studied in relation to UA. Using chi squared test, odds ratios (OR) and 95% confidence intervals (CI) were calculated, adjusting for age, gender, and established risk factors. Seventy nine (82.3%) of patients with unstable angina and 55(61.1%) in the control group presented a positive anti HP-lgG. Odds ratio was 3 with 95% CI: 1.9 to 4.3. There was significant relation between HP-lgG positivity and unstable angina (P 0.05). Our study revealed relationship between seropositivity of HP-lgG and unstable angina. (author)

  19. Coronary angioplasty of the unstable angina related vessel in patients with multivessel disease

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); M.L. Simoons (Maarten); W. Wijns (William); R. Geuskens; A. Soward; M.J.B.M. van den Brand (Marcel); P.G. Hugenholtz (Paul); A.E.R. Arnold (Alfred)

    1986-01-01

    textabstractThis study is a retrospective analysis of the efficacy of percutaneous transluminal coronary angioplasty of the ischaemia-related vessel in patients with unstable angina. Forty-three patients had multivessel disease with dilatation of the ischaemia-related vessel only (group I; partial

  20. Serum potassium values in relation to the use of diuretics in patients with unstable angina pectoris

    NARCIS (Netherlands)

    van Gilst, W. H.; Tijssen, J. G.; van Es, G. A.; Lubsen, J.

    1988-01-01

    Transient hypokalaemia may occur in acutely ill patients and is associated with an increased incidence of life-threatening arrhythmias. Therefore, we performed a retrospective analysis of the serum potassium values of 538 patients with unstable angina included in the Holland Interuniversity

  1. Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center.

    Science.gov (United States)

    Wu, Suo-Wei; Pan, Qi; Chen, Tong; Wei, Liang-Yu; Xuan, Yong; Wang, Qin; Li, Chao; Song, Jing-Chen

    2017-07-05

    With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups (DRGs) among patients with unstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis. Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital (China) whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure, and decision tree method was adopted to establish the model of DRGs grouping combinations. The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications (CCs) of the disease, and the 3933 cases were divided into ten DRGs by four factors: age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant (P unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

  2. [Effect of clopidogrel and aspigrel on ectopic cardiac activity in patients with unstable angina pectoris].

    Science.gov (United States)

    Zaval's'ka, T V

    2013-01-01

    The coronary circulation dysfunction in patients with unstable angina pectoris causes development of ventricular and supraventricular cardiac rhythm disorders. Findings from the current study suggest that antianginal therapy of patients with acute coronary syndrome which includes antiaggregant and anticoagulant is effective in the treatment of extrasystolic arrhythmias.

  3. Early treatment of unstable angina with nifedipine and metoprolol--the HINT trial

    NARCIS (Netherlands)

    Tijssen, J. G.; Lubsen, J.

    1988-01-01

    A multicenter, double-blind, placebo-controlled, randomized trial of nifedipine, metoprolol, and their combination was conducted in a group of 338 patients with unstable angina not pretreated with a beta-blocker and of nifedipine in 177 patients who were. The main outcome event was recurrent

  4. Randomised, double-blind trial of intravenous diltiazem versus glyceryl trinitrate for unstable angina pectoris

    NARCIS (Netherlands)

    Gobel, EJAM; Hautvast, RWM; vanGilst, WH; Spanjaard, JN; Hillege, HL; DeJongste, MJL; Molhoek, GP; Lie, KI

    1995-01-01

    The effect of dihydropyridines in patients with unstable angina is discouraging. To find out the effect of the non- dihydropyridine-like calcium-channel blocker diltiazem, a randomised, double-blind trial was conducted comparing diltiazem with glyceryl trinitrate. both given intravenously, in 129

  5. Unstable Angina Pectoris in a 22-year-old Female Patient.

    Science.gov (United States)

    Yoshimura, Hanae; Oba, Toyoharu; Nagata, Takanobu; Kumagai, Eita; Itaya, Naoki; Yoshikawa, Naohiro; Akagaki, Daiki; Ohshima, Hideki; Nishihara, Michihide; Ueno, Takafumi; Fukumoto, Yoshihiro

    2017-04-13

    Because of the protective effect of estrogen for atherosclerosis, the prevalence of acute coronary syndrome in women before menopause is low. We report a rare case of unstable angina in a young Japanese female who had a history of cigarette smoking and contraceptive use. Her coronary stenosis was successfully treated by percutaneous coronary intervention.

  6. Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center

    Directory of Open Access Journals (Sweden)

    Suo-Wei Wu

    2017-01-01

    Conclusions: The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

  7. An evidence against the effect of chronic cytomegalovirus infection in unstable angina pectoris.

    Science.gov (United States)

    Alavi, Seyed Mohammad; Adel, Seyed Mohammad Hasan; Rajabzadeh, Ali Reza

    2011-01-01

    Recent reports have suggested that cytomegalovirus (CMV) infection may contribute to risk of cardiovascular disease. However, relationship between CMV infection and unstable angina (UA) is controversial and studies about this subject in Iran and even region are lacking. The aim of this study was to determine whether unstable angina is related to seropositivity to chronic cytomegalovirus infection. We measured serum CMV IgG levels in a case control study participants in CCU in Razi Hospital, Ahvaz, Iran, from 2004 to 2005. Blood samples were drawn during study period from 96 patients (mean age 56 years) with UA according to American Heart Association Criteria and from 96 participants free of cardiovascular disease (mean age 58 years) and stored at -20°C. Blood samples of patients were undertaken for investigating the specific anti CMV-IgG by ELISA method. Data were analyzed in SPSS 11.5 by using chi square test, odds ratios (OR) with 95% confidence intervals (CI). Ninety three percent of patients with unstable angina and 96.7% in the control group presented a positive anti CMV-IgG. Odds ratio was 0.52 with 95% CI: 0.10 to 2.42. There was no significant correlation between CMV-IgG positivity and unstable angina (P>0.05). There was also no differences in CMV-IgG positivity in clinical groups of UA (P>0.05). The relationship between seropositivity of CMV-IgG and unstable angina has been restituted by the results of this study. However, further population based cohort studies for relationship between CMV infection and coronary artery disease must be conducted.

  8. Safflower yellow injection combined with conventional therapy in treating unstable angina pectoris: a meta-analysis.

    Science.gov (United States)

    Kong, Dezhao; Xia, Wei; Zhang, Zhe; Xiao, Lei; Yuan, Dongchao; Liu, Yue; Yang, Guanlin

    2013-10-01

    To evaluate the clinical efficacy of safflower yellow injection combined with conventional therapy in treating unstable angina pectoris. We searched online databases: Chinese journal full-text database, China National Knowledge Infrastructure, Wanfang database, Chinese journal full-text database, Pubmed, ScienceDirect, Embase, and the Cochrane Library with manual-screening of relevant literature. Eligible randomized controlled trials (RCT) on angina pectoris were included. We conducted meta-analysis using the RevMan 5.1 software from The Cochrane Collaboration. We treated the relief rate of angina symptoms and electrocardiograph (ECG) as evaluation. Seven articles, including in 1134 patients, were enrolled after the evaluation. There was no significant heterogeneity among the studies (chi2 = 1.08, df = 6, P = 0.98, I2 = 0%). The safflower yellow injection with conventional therapy has a higher effective rate than the control group in relieving the symptoms of angina pectoris [odds ratio (OR)= 2.95, 95% (CI) (1.81, 4.81)] and improving ischemic ECG [OR = 2.85, 95% CI (1.67, 4.86)]. The difference was statistically significant in the "80 mg dosage" and "100 mg dosage" subgroups (P unstable angina and improving ECG over basic therapy alone. However, the conclusions should be interpreted with care until more high-quality RCTs are reported.

  9. A comparative study of dalteparin and unfractionated heparin in patients with unstable angina pectoris.

    Science.gov (United States)

    Amane, Hanmant S; Burte, N P

    2011-11-01

    To compare the efficacy and safety profile of dalteparin, a low-molecular-weight heparin with a standard unfractionated heparin in patients with unstable angina pectoris. This was a 6-month, prospective, parallel, randomized and open-labeled study. Patients of angina pectoris were randomized to receive either unfractionated heparin or dalteparin for 5 days. They were followed for 21 days during three visits on 1(st), 5(th) and 21(st) days. A series of resting electrocardiogram were undertaken in all patients on each visit. The frequency of the combined clinical outcome of death, myocardial infarction and recurrence of angina was similar during 21 days of follow-up with either dalteparin or intravenous unfractionated heparin. In patients who received dalteparin 2.43% patients developed minor bleeding in the form of epistaxis and 2.5% patients who received unfractionated heparin developed minor bleeding in the form of macroscopic hematuria. Dalteparin is as effective and safe as unfractionated heparin in the treatment of unstable angina. Dalteparin does not require routine laboratory monitoring as with unfractionated heparin.

  10. Coronary artery bypass grafting in a patient with unstable angina pectoris and bronchiectasis.

    Science.gov (United States)

    Oda, Takeshi; Yasunaga, Hiroshi; Matsuura, Yasuo; Watanabe, Genki; Zaima, Yasuyuki; Takaseya, Tohru; Wada, Yoshihiro

    2014-01-01

    Bronchiectasis is characterized by the abnormal and permanent dilatation of bronchi. Clinical manifestations of bronchiectasis include persistent or recurrent cough, purulent sputum, hemosputum, and hemoptysis. A 75-year-old man with bronchiectasis required coronary bypass grafting for unstable angina pectoris with severe stenosis of the left main trunk. Computed tomography showed fistulae between the dilated bronchial arteries and the left pulmonary artery. Cardiac catheter examination showed significant left-right shunt and left ventricular dilatation. To avoid perioperative massive hemoptysis, embolizations of 2 bronchial arteries and an inferior phrenic artery were performed preceding the coronary artery bypass grafting. Both transcatheter embolization and coronary artery bypass grafting were successfully performed without any complications. Herein, we illustrate a very rare case of bronchiectasis in a patient with unstable angina pectoris who underwent transcatheter embolization for a systemic-pulmonary shunt preceding coronary artery bypass grafting with cardiopulmonary bypass.

  11. Logistic regression analysis of syndrome essential factors in patients with unstable angina pectoris.

    Science.gov (United States)

    Yao, Kui-Wu; He, Qing-Yong; Teng, Fei; Wang, Jie

    2011-12-01

    To explore the correlation between common syndrome essential factors and the symptoms and signs of unstable angina (UA). Eight hundred and fifteen patients with UA confirmed by coronary angiography were identified from several centers. Common syndrome essential factors were selected on the basis of expert experience. The correlations between common syndrome essential factors and symptoms and signs of UA were analyzed using binary logistic regression analysis. The common syndrome essential factors in unstable angina were blood stasis, qi stagnation, phlegm turbidity, heat stagnancy, qi deficiency, yin deficiency, and yang deficiency. Symptoms such as chest pain, hypochondriac distention, ecchymosis, dark orbits, dark and purplish tongue, and tongue with ecchymosis and petechiae were significant diagnostic features of "blood stasis". Aversion to cold and cool limbs, weakness in the waist and knees, and clear abundant urine were significant diagnostic features of"yang deficiency". These results were in accordance with the understanding of traditional clinical Chinese medical practice. This clinical study analyzed the correlations between common syndrome essential factors and the symptoms and signs of unstable angina. The results provide the basis for establishing diagnostic criteria for syndrome essential factors.

  12. [Meta-analysis of Dengzhanxixin injection treatment for unstable angina pectoris].

    Science.gov (United States)

    Nie, Xiao-Lu; Shen, Hao; Xie, Yan-Ming; Hu, Jing; Zhang, Yue-Lun; Li, Yuan-Yuan

    2012-09-01

    To assess the efficacy and safety of Dengzhanxixin injection for unstable angina pectoris. All clinical studies of Dengzhanxixin injection for unstable angina pectoris (UAP) were searched from Cochrane library, Medline, EM-base, CBM, CNKI, Wanfang and VIP. Quality assessment and information extraction were done by two independent screening . The quality of the included documents was evaluated by the Cochrane Collaboration's tool for assessing risk of bias and allocation concealment. Revman 5.1.4 software was used for data analysis. A total of 17 randomized controlled trials were included (1 644 patients), in which, only 2 studies were true RCT, 1 study used single blind method, while other studies did not mention allocation concealment, blind and loss-up information. Meta-analysis showed that the Dengzhanxixin injection group was better than the conventional treatment group in efficiency (OR = 3.54, 95% CI [2.60-4.82]) and ECG (OR = 2.36, 95% CI[1.88-2.96]). Researches with ADR/AE information of Dengzhanxixin injection showed that the symptoms of ADR/AE were slight. This study may exist publication bias. Dengzhanxixin injection on the basis of conventional treatment can improve the efficacy of the treatment of unstable angina pectoris. However, due to the sample size of included studies were small and of lower quality, conclusions above still need high-qualitied randomized, double-blind, controlled trials be confirmed.

  13. Case management does not decrease mortality of patients with myocardial infarction or unstable angina: Evidence from a systematic review

    Directory of Open Access Journals (Sweden)

    Li-Juan Yi

    2016-06-01

    Conclusion: Case management is not beneficial to all-cause mortality after myocardial infarction or unstable angina compared to routine care. Additional, prospective RCTs of high quality and large scale are warranted to verify these results.

  14. Variability in lipid profile among patients presented with acute myocardial infarction, unstable angina and stable angina pectoris.

    Science.gov (United States)

    Yang, N; Feng, J-P; Chen, G; Kou, L; Li, Y; Ren, P; Zhao, L-L; Qin, Q

    2014-01-01

    Despite the amply evidence and guidelines in treating coronary artery disease (CAD) with lipid-lowering therapy, physicians still have concerns in treating acute myocardial infarction (AMI) patients who have the low serum lipid level. We explored the adequacy of lipid-lowering therapy in treating AMI patients. Over 3000 CAD lipid profile data were collected, their data were divided into 3 groups (AMI; stable angina pectoris (SAP) and unstable angina pectoris (UAP) group) based their clinical characteristics. Statistical analyses were performed to compare their baseline lipid levels and clinical feature. The total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) level in AMI patients were the lowest, followed by UAP patient group and SAP patient group. There were significant differences in white blood count (WBC) and ejection fraction (EF) between 3 groups. A good correlation was confirmed between EF% and the lipid parameters of TC, LDL-c, HDL-c, non-HDL-c. WBC did not correlate with the lipid except HDL-c. AMI is an acute inflammatory reaction that is accompanied with the change of lipid level. Although the level of TC, LDL-c and HDL-c are lower in AMI, but it is related with acute inflammatory reaction during the rupture of atherosclerotic plaques. Lipid-lowering therapy should not be delayed in treating AMI patients with lower lipid level.

  15. [Clinical effect and mechanismn of xuefu zhuyu capsule in treating unstable angina pectoris].

    Science.gov (United States)

    Zheng, Guo-ling; Wang, Sheng-hua

    2009-01-01

    To observe the clinical effect of Xuefu Zhuyu Capsule (XFZYC) in treating unstable angina pectoris (UAP) and to investigate its mechanism of protection on vascular endothelia. Sixty UAP patients were randomly assigned to two groups, the 30 in the treated group were treated by conventional therapy plus XFZYC, and the 30 in the control group treated by conventional therapy alone. The frequency and persistent time of angina pectois, dosage of nitroglycerin used, changes of electrocardiogram (ECG) were observed, and the plasma levels of endothelin (ET), nitric oxide (NO), von Willebrand factor (vWF), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1) were tested before and after the two-month therapeutic course. (1) The clinical symptoms as frequency and persistent time of angina pectoris in the treated group were bettered significantly after treatment and the dosage of nitroglycerin used decreased (all P angina pectoris partially by decreasing the plasma levels of ET, vWF, sVCAM-1 and sICAM-1 and elevating the level of NO.

  16. [Concentration of plasma vascular endothelial growth factor and related factors in patients with unstable angina pectoris].

    Science.gov (United States)

    He, Wenfang; Wang, Zhe; Cai, Jun; Chi, Hongjie; Yang, Xinchun

    2015-12-01

    To observe plasma vascular endothelial growth factor(VEGF) levels and related factors in patients with unstable angina pectoris(UAP). A total of 108 consecutive patients with chest pain hospitalized in our department from October to December 2014 were included. They were divided into UAP (n=78) and non-CHD group (n=30) by the result of coronary angiography(CAG). Coronary artery lesion was assessed according to the Gensini score, serum lipids, homocysteine(Hcy) levels and other biochemical indicators were also determined. The peripheral arterial tonometry was evaluated by reactive hyperemia index(RHI) measured by Endo-PAT2000 Noninvasive Diagnostic System.The level of plasma VEGF was detected in patients with unstable angina pectoris. Multiple linear regression analysis was used to analyze the correlations between VEGF and various related factors. Percent of male gender, triglyceride (TG) and Hcy levels were significantly higher in UAP group than in no-CHD group(all Punstable angina pectoris, and VEGF level is significantly associated with the degree of coronary artery stenosis, Gensini score and RHI. V EGF level might serve as a new biochemical indicator for coronary artery lesion in patients with UAP.

  17. Unstable angina

    Science.gov (United States)

    ... pain that you may also feel in the shoulder, arm, jaw, neck, back, or other area Discomfort that feels like tightness, squeezing, crushing, burning, choking, or aching Discomfort that occurs at rest and does not easily go away when you ...

  18. [Unstable angina pectoris--combination of an epicardial stenosis and a Prinzmetal spasm].

    Science.gov (United States)

    Bentz, K; Ong, P; Sechtem, U

    2013-12-01

    A 61-year-old man presented with recurrent angina pectoris at rest for 3 days. The medical history revealed hypertension and an elevated cholesterol level as cardiovascular risk factors. The physical examination revealed no pathological findings. ECG at admission showed no signs of ischemia, while high-sensitive Troponin T was slightly elevated. Echocardiography showed diastolic dysfunction and biatrial dilatation. During another episode of angina at rest, ECG showed T-wave inversion in lead aVL. Therefore, coronary angiography was performed. At the beginning of the examination the patient complained of angina at rest and ECG showed ST-elevation in the inferior leads. Coronary angiography revealed a subtotal stenosis in the middle part of the RCA. After intracoronary nitroglycerin injection there was a high-grade stenosis in this region. An intracoronary acetycholin provocation test was performed which reproduced a focal spasm in the area of the RCA stenosis with simultaneous changes in the ECG and reproduction of the patient's unusual angina. After implantation of a bare metal stent a subsequent ACH-test did not elicit any further coronary spasm. Four weeks after the procedure the patient had no further complaints under medical treatment. This case illustrates a patient with a focal Prinzmetal-type spasm with ST-elevation on top of a high-grade stenosis of the right coronary artery as an explanation for the unstable angina. Coronary spasm of the Prinzmetal-type can occur in vessels with epicardial stenosis as well as in vessels without stenosis. In some cases focal coronary spasm can be prevented by the implantation of a stent. © Georg Thieme Verlag KG Stuttgart · New York.

  19. [Characterization of atherosclerotic plaque in patients with unstable angina pectoris and stable angina pectoris by optical coherence tomography].

    Science.gov (United States)

    Chen, Bu-xing; Ma, Feng-yun; Luo, Wei; Ruan, Jian-hong; Zhao, Xi-zhe; Xie, Wen-li; Sun, Shu-hong; Guo, Xu-mei; Wang, Feng; Tian, Ting; Chu, Xiao-wen

    2009-05-01

    To compare the characterization of coronary atherosclerotic plaques in patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) by optical coherence tomography (OCT). OCT was performed in 47 patients (23 UAP and 24 SAP) undergoing coronary angiography. Lipid-rich plaque (defined by > or = 2 quadrants of the cross-section area), thin cap fibroatheroma (TCFA), thickness of fibrous cap, plaque rupture, calcification and thrombus visualized by OCT were compared between UAP and SAP patients. OCT imaging was successfully in 44 out of 47 patients (22 UAP, 22 SAP). Proportion of lipid-rich plaques was similar between UAP and SAP groups [91% (20/22) vs. 73% (16/22), P = 0.741]. The minimum thickness of fibrous cap in the UAP group was significantly thinner than that in SAP group [(69.5 +/- 34.7) microm vs. (141.1 +/- 68.5) microm, P = 0.000] and the rate of fibrous cap erosion in the UAP group was significantly higher than that in the SAP group [59% (13/22) vs. 9% (2/22), P = 0.000]. Percents of TCFA [73% (16/22) vs. 14% (3/22), P = 0.000] and plaque rupture [50% (11/22) vs. 9% (2/22), P = 0.003] were significantly higher in UAP group compared those in SAP group. Incidence of thrombus and calcification were similar between two groups. OCT imaging can clearly define plaque characterization of coronary atherosclerosis. UAP patients have thinner fibrous cap, higher incidences of fibrous cap erosion, plaque rupture and TCFA compared patients with SAP.

  20. Patients with unstable angina pectoris show an increased frequency of the Fc gamma RIIa R131 allele.

    Science.gov (United States)

    Raaz-Schrauder, Dorette; Ekici, Arif B; Munoz, Luis E; Klinghammer, Lutz; Voll, Reinhard E; Leusen, Jeanette H W; van de Winkel, Jan G J; Reis, André; Schett, Georg; Garlichs, Christoph D; Herrmann, Martin

    2012-11-01

    Patients with Systemic Lupus Erythematosus (SLE) carry an increased risk for the development of coronary artery disease (CAD). The R131 allele of the Fc gamma receptor IIa (FcγRIIa) is associated with SLE incidence and disease severity but also with CAD. Compared to stable angina pectoris (SAP) the unstable angina (UAP), as a manifestation of destabilizing CAD, is associated with increased risk of persistent instability, myocardial infarction, and death. Identification of clinically relevant determinants for unstable angina promises reduction of UAP-associated mortality in patients with SLE. We conducted a clinical study among 553 consecutive patients with stable angina pectoris (n = 330) and unstable angina pectoris (n = 223). All patients were genotyped for a frequent functional variant at position 131 of the mature FcγRIIa. UAP, but not SAP was significantly associated with the R/R131 genotype (P angina carrying the R/R131 genotype the odds ratio for suffering from UAP was 4.02 (95% confidence interval, 2.52-6.41) compared to those with non-R/R131 genotypes. In a multivariable analysis, the R/R131 genotype independently predicted the risk for development of UAP in a model adjusted for classical atherogenic risk factors. Our data imply that risk stratification of SLE- and other high risk patients with troponin-negative angina could be significantly improved by FcγRIIa genotyping.

  1. [Personality self-actualization: an independent additional risk factor of myocardial infarction and unstable angina].

    Science.gov (United States)

    Sharobaro, V I; Zhenchevskaia, Iu V; Ivanova, T M

    2011-01-01

    It is shown for the first time that changes of self-actualization (SA) in patients with CHD are the main risk factor of myocardial infarction (MI) and unstable angina (UA). The clinical course and prognosis of MI correlate with SA prior to the development of an acute coronary event. Isolated correlations exist between CHD risk factors and results of SA questionnaire studies. SA personality peculiarities in patients with MI and UA account for more than 50% dispersion of the results of linear factor analysis.

  2. Study of C-reactive protein and C3 complement as acute phase reactants in unstable angina.

    Science.gov (United States)

    Sharma, Barnali; Gupta, B; Sharma, D K; Talib, V H

    2013-06-01

    Prevalence rates of coronary artery disease are reported to be very high in Asian Indians. Traditional risk factors alone fail to explain the high rates of coronary artery disease in Indians. Acute phase reactants C-reactive protein and C3 in Indian subjects with unstable angina were evaluated and compared them with suitable controls to test the hypothesis that a relationship exists between acute phase reactants and unstable angina. Forty cases of unstable angina and forty suitable controls were enrolled for the study. Cases of unstable angina had significantly increased level of CRP as compared to control group (p = 0.01098). Statistically significant difference was found between case and control groups in TLC (p = 0.0037) and ESR (p = 0.0368), TLC and ESR being more in case group as compared to control group. C-reactive protein was significantly correlated with TLC, ESR and C3 in case group and TLC and ESR in control group. C3 was significantly correlated with all the other three inflammatory markers. C-reactive protein, TLC and ESR in case group while no correlation was observed with any variable in control group. The present study concludes that a relationship exists between acute phase reactants studied and unstable angina.

  3. Puerarin injection for treatment of unstable angina pectoris: a meta-analysis and systematic review.

    Science.gov (United States)

    Gao, Zhisheng; Wei, Baozhu; Qian, Cheng

    2015-01-01

    Puerarin is an effective ingredient isolated from Radix Puerariae, a leguminous plant. In China, a large number of early studies suggest that puerarin may be used in the treatment of coronary heart disease. In recent years, puerarin injection has been widely used to treat coronary heart disease and angina pectoris. To systematically evaluate the clinical efficacy and safety of puerarin injection in the treatment of unstable angina pectoris (UAP). Data were retrieved from digital databases, including PubMed, Excerpt Medica Database (EMBASE), China Biology Medicine (CBM), the Cochrane Library, and Chinese databases. Compared with patients who were treated with conventional Western medicines alone, the patients who were treated with conventional Western medicines in combination with puerarin injection exhibited significant improvements in the incidence of angina pectoris, electrocardiogram findings, nitroglycerin consumption and plasma endothelin levels. Strong evidence suggests that, the use of puerarin in combination with conventional Western medicines is a better treatment option for treating UAP, compared with the use of conventional Western medicines alone.

  4. Left atrial area index predicts adverse cardiovascular events in patients with unstable angina pectoris.

    Science.gov (United States)

    Li, Yi-Fan; Li, Wei-Hong; Li, Zhao-Ping; Feng, Xin-Heng; Xu, Wei-Xian; Chen, Shao-Min; Gao, Wei

    2016-08-01

    The left atrial size has been considered as a useful marker of adverse cardiovascular outcomes. However, it is not well known whether left atrial area index (LAAI) has predictive value for prognosis in patients with unstable angina pectoris (UAP). This study was aimed to assess the association between LAAI and outcomes in UAP patients. We enrolled a total of 391 in-hospital patients diagnosed as UAP. Clinical and echocardiographic data at baseline were collected. The patients were followed for the development of adverse cardiovascular (CV) events, including hospital readmission for angina pectoris, acute myocardial infarction (AMI), congestive heart failure (CHF), stroke and all-cause mortality. During a mean follow-up time of 26.3 ± 8.6 months, 98 adverse CV events occurred (84 hospital readmission for angina pectoris, four AMI, four CHF, one stroke and five all-cause mortality). In a multivariate Cox model, LAAI [OR: 1.140, 95% CI: 1.016-1.279, P = 0.026], diastolic blood pressure (OR: 0.976, 95% CI: 0.956-0.996, P = 0.020) and pulse pressure (OR: 1.020, 95% CI: 1.007-1.034, P = 0.004) were independent predictors for adverse CV events in UAP patients. LAAI is a predictor of adverse CV events independent of clinical and other echocardiographic parameters in UAP patients.

  5. Detection of culprit lesion in patients with unstable angina pectoris by using ATP thallium-201 myocardial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Kasai, Tokuo; Mori, Yutaka [Jikei Univ., Tokyo (Japan). School of Medicine; Yamashina, Akira; Kubo, Toru; Usui, Yasuhiro

    1999-10-01

    The purpose of this study is to determine the diagnostic accuracy for detection of culprit lesions in patients with unstable angina. Both ATP {sup 201}Tl SPECT and coronary angiography were performed in 51 patients with unstable angina pectoris within a week since the last attack. SPECT images were divided into 17 segments and the regional uptakes were scored semiquantitatively (0=normal to 3=no activity) and compared with the coronary angiographic findings. ATP {sup 201}Tl SPECT revealed decreased uptakes in 54 of 56 culprit lesions. The sensitivity, specificity and accuracy for detection of culprit lesions were 96.4%, 89.5% and 92.4%, respectively. Although adverse effects during ATP administration were complicated in 28 (54.9%) patients, all the complications were mild and resolved within two minutes. ATP {sup 201}Tl SPECT is sensitive and reliable method for detecting culprit lesions and can be performed safely even at acute phase in patients with unstable angina pectoris. (author)

  6. Impact of Intracoronary Adenosine on Myonecrosis in Patients with Unstable Angina Pectoris Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Kizilirmak, Filiz; Gunes, Haci Murat; Demir, Gultekin Gunhan; Gokdeniz, Tayyar; Guler, Ekrem; Cakal, Beytullah; Omaygenç, Mehmet Onur; Yılmaz, Fatih; Savur, Umeyir; Barutcu, Irfan

    2015-12-01

    In this study, we aimed to investigate the impact of prophylactic intracoronary adenosine administered during percutaneous coronary intervention (PCI) due to unstable angina pectoris on myonecrosis by measuring post-procedural levels of cardiac troponin I (cTnI) and creatine kinase-myocardial band (CK-MB). A total of 122 patients with unstable angina undergoing PCI were included in this single-center, double-blind, randomized study. The patients were randomly allocated to adenosine and placebo groups. In the adenosine group, a single-dose of intracoronary adenosine (100 μg for the right coronary artery and 150 μg for the left coronary artery) was administered. Primary endpoint was post-PCI myonecrosis, which was defined as abnormal levels of periprocedural cTnI. Secondary endpoints were defined as elevated cTnI levels [5 × upper limit of normal (ULN)], abnormal CK-MB levels, angiographic coronary flow measured by Thrombolysis In Myocardial Infarction (TIMI) frame count (TFC), the cumulative incidence of in-hospital death and in-hospital urgent target vessel revascularization (TVR). Clinical and angiographic characteristics of both adenosine (61 patients, 61 ± 9 years) and placebo (61 patients, 59 ± 10 years) groups were similar (p > 0.05 for all). Post-procedural abnormal cTnI levels in the adenosine group were significantly lower than the placebo group (32 % vs. 55 %, p: 0.011). cTnI >5 × ULN (21 % vs. 31 %, p: 0.217) and abnormal CK-MB levels (11 % vs. 19 %, p: 0.263) were similar in both groups. Post-procedural TFCs in the adenosine group were significantly lower than the placebo group (24 ± 4 vs. 27 ± 5, p: 0.004). In-hospital events including death and urgent TVR were not observed in either group. Intracoronary administration of single-dose adenosine in patients with unstable angina undergoing PCI is associated with decreased periprocedural myonecrosis and improved coronary blood flow.

  7. Correction of aggregative thrombocytes activity in patients with unstable angina by THz irradiation of nitrogen oxide occurrence at in vitro conditions

    Directory of Open Access Journals (Sweden)

    Vyacheslav F. Kirichuk

    2013-11-01

    Full Text Available There had been shown a normalizing effect of THz radiation of MEAS (molecular emission and absorption spectrum of 400 GHz nitrogen oxide occurrence on aggregation parameters of thrombocytes in patients with unstable angina at in vitro conditions. 180 patients with an unstable angina had been involved in to the research.

  8. Effect of Yiqi Yangyin Decoction on the quality of life of patients with unstable angina pectoris.

    Science.gov (United States)

    He, Qing-yong; Wang, Jie; Zhang, Yun-ling; Tang, Yan-li; Chu, Fu-yong; Xiong, Xing-jiang

    2010-02-01

    To observe the effect of Yiqi Yangyin Decoction (, YQYYD) on the quality of life (QOL) of patients with unstable angina pectoris (UAP). A total of 108 patients with UAP of qi-yin deficiency syndrome confirmed by coronary angiography were enrolled and assigned to the treated group (treated with YQYYD and conventional therapy of Western medicine) and the control group (treated with conventional therapy of Western medicine), by the use of the PROC PLAN of the SAS 6.12 software, in a prospective, randomized, controlled design. The clinical total effective rate, symptom score, QOL scale [Seattle Angina Questionnaire (SAQ)] and incidence of important clinical events were defined as the observation indices to evaluate the interventional effect of YQYYD on the QOL of patients with UAP of the qi-yin deficiency syndrome. During the study, three cases dropped out in the treated group, one case dropped out in the control group, and 104 cases, including 51 cases in the treatment group and 53 cases in the control group, finished the trial. After four weeks of treatment, the total clinical effective rates in the treated group and the control group were 80.4% and 75.5% respectively, and there was no obvious difference between them (P>0.05). However, the symptom score of the treated group (9.31 + or - 2.02) was significantly lesser than that of the control group (11.62 + or - 3.04, Pangina stability, angina frequency, and treatment satisfaction were significantly ameliorated when compared with the control group after treatment (P0.05). YQYYD could improve the clinical symptoms of patients with UAP of qi-yin deficiency syndrome and greatly improve their QOL.

  9. Angina

    Science.gov (United States)

    ... is usually similar to previous types of chest pain you've had Lasts a short time, perhaps five minutes or less Disappears sooner if you rest or use your angina medication The severity, duration and type of angina can vary. New or different symptoms may signal a more dangerous ...

  10. Lipoprotein(a Is the Best Single Marker in Assessing Unstable Angina Pectoris

    Directory of Open Access Journals (Sweden)

    Vidosava B. Djordjević

    2011-01-01

    Full Text Available This study evaluated whether statin therapy changed a diagnostic validity of lipid and inflammatory markers in ischemic heart disease (IHD patients. Levels of lipids, lipoproteins, apolipoproteins, inflammatory markers, and atherogenic indexes were determined in 49 apparently healthy men and women, 82 patients having stable angina pectoris (SAP, 80 patients with unstable angina (USAP, and 106 patients with acute ST-elevation myocardial infarction (STEMI treated or not treated with statins. Diagnostic accuracy of markers was determined by ROC curve analysis. Significantly lower apoA-I in all statin-treated groups and significantly higher apoB in statin-treated STEMI group compared to non-statin-treated groups were observed. CRP showed the best ROC characteristics in the assessment of STEMI patients. Lp(a is better in the evaluation of SAP and USAP patients, considering that Lp(a showed the highest area under the curve (AUC. Regarding atherogenic indexes, the highest AUC in SAP group was obtained for TG/apoB and in USAP and STEMI patients for TG/HDL-c. Statins lowered total cholesterol, LDL-c, and TG but fail to normalize apoA-I in patients with IHD.

  11. Biomarkers of unstable angina pectoris and yangxin decoction intervention: An exploratory metabonomics study of blood plasma.

    Science.gov (United States)

    Yu, Xiao-Hong; Sun, Jing; Wang, Yan; Zhou, Ya-Bin

    2017-05-01

    This study aimed to explore the related metabolic biomarkers and to observe the effects of Yangxin Decoction (YXD) on plasma metabolism of patients with unstable angina (UA). In total, 10 patients with UA (intervention group) and 10 healthy participants (control group) were recruited for this study from January 2009 to December 2010. Plasma samples from both groups were analyzed using liquid chromatography mass spectrometry (LC-MS). Principle component analysis (PCA) and partial least squares (PLS) were used to explore the correlations between metabolic markers in patients with UA. The LC-MS results indicated that the serum levels of 5 potential metabolic markers, namely, ceramide, glycocholic acid, allocholic acid, lithocholic acid, and leukotriene (LT) B4, were significantly higher in the intervention group than those in the control group. The results of this study demonstrated potential metabolic markers that can be used to distinguish and diagnose patients with UA.

  12. Endothelial Dysfunction and Blood Viscosity Inpatients with Unstable Angina in Different Periods of a Solar Activity

    Science.gov (United States)

    Parshina, S. S.; Tokaeva, L. K.; Dolgova, E. M.; Afanas'yeva, T. N.; Strelnikova, O. A.

    The origin of hemorheologic and endothelial defects in patients with unstable angina (comparing with healthy persons) is determined by a solar activity period: the blood viscosity increases in a period of high solar activity in the vessels of small, medium and macro diameters, a local decompensate dysfunction of small vessels endothelium had been fixed (microcirculation area). In the period of a low solar activity there is an increase of a blood viscosity in vessels of all diameters, generalized subcompensated endothelial dysfunction is developed (on the background of the III phase blood clotting activating). In the period of a high solar activity a higher blood viscosity had been fixed, comparing with the period of a low solar activity.

  13. Association between ABO blood group and severity of coronary artery disease in unstable angina.

    Science.gov (United States)

    Omidi, Negar; Rafie Khorgami, Mohammad; Effatpanah, Mohammad; Khatami, Farnaz; Mashhadizadeh, Mehrpouya; Jalali, Arash; Hekmat, Hamidreza

    2017-07-01

    ABO blood groups are genetically transmitted through chromosome 9 at locus 9q34. It is supposed that there is a locus on 9p21, which has a role in developing coronary artery disease. Our study population consisted of 309 patients with unstable angina admitted to the Ziaeian Hospital, Tehran, Iran, who underwent coronary angiography. The association between types of blood group (O and non-O) with the severity of coronary artery disease was investigated. Compared to the non-O groups, the O group had more severe coronary artery involvement (P = 0.004). Our study supports recent suggestions on the association between blood group and coronary artery disease. Further studies are needed to evaluate the effect of blood group on atherosclerosis.

  14. The short-term prognostic value of thrombus precursor protein in patients with unstable angina

    International Nuclear Information System (INIS)

    Shen Yanbo; Yu Yan; Tang Jianzhong; Yuan Dingshan; Cai Danlei

    2005-01-01

    Objective: To investigate the short-term prognostic value of thrombus precursor protein (TpP) in patients with unstable angina (UA). Methods: One hundred and ten cases of UA were selected. The TpP was measured by enzyme linked immunosorbent assay (ELISA). The cardiovascular events were observed in 6 months. Results: In the 100 cases of UA, the cardiovascular events were observed in 17 cases. There was an significant difference in three levels of TpP (P<0.05). The risk level was increasing as the increasing of the plasma level of TpP. Conclusion: The level of TpP has certain reference value and plays a role in forecasting of the short-term prognosis of the patients with UA. When the plasma level of TpP increases there is also an increase in OR. (authors)

  15. Paradoxical effect of smoking in the Spanish population with acute myocardial infarction or unstable angina: results of the ARIAM Register.

    Science.gov (United States)

    Ruiz-Bailén, Manuel; de Hoyos, Eduardo Aguayo; Reina-Toral, Antonio; Torres-Ruiz, Juan Miguel; Alvarez-Bueno, Miguel; Gómez Jiménez, Francisco Javier

    2004-03-01

    The paradoxical effect of smoking after acute myocardial infarction (AMI) is a phenomenon consisting of a reduction in the mortality of smokers compared to nonsmokers. However, it is not known whether the benefit of this reduction in mortality is due to smoking itself or to other covariables. Despite acceptance of the paradoxical effect of smoking in AMI, it is not known whether a similar phenomenon occurs in unstable angina. The objective of this study was to investigate the paradoxical effect of smoking in AMI and unstable angina, and to study specifically whether smoking is an independent prognostic variable. The study population was selected from the multicentric ARIAM (Análisis del Retraso en el Infarto Agudo de Miocardio [analysis of delay in AMI]) Register, a register of 29,532 patients with a diagnosis of unstable angina or AMI. Tobacco smokers were younger, presented fewer cardiovascular risk factors such as diabetes or hypertension, fewer previous infarcts, a lower Killip and Kimball class, and a lower crude and adjusted mortality in AMI (odds ratio, 0.774; 95% confidence interval, 0.660 to 0.909; p = 0.002). Smokers with unstable angina were younger, with less hypertension or diabetes. In the multivariate analysis, no statistically significant difference in mortality was found. The reduced mortality observed in smokers with AMI during their stay in the ICU cannot be explained solely by clinical covariables such as age, sex, other cardiovascular factors, Killip and Kimball class, or treatment received. Therefore, smoking may have a direct beneficial effect on reduced mortality in the AMI population. The lower mortality rates found in smokers with unstable angina are not supported by the multivariate analysis. In this case, the difference in mortality can be explained by the other covariables.

  16. Decreased soluble cell adhesion molecules after tirofiban infusion in patients with unstable angina pectoris

    Directory of Open Access Journals (Sweden)

    Aliyev Emil

    2004-04-01

    Full Text Available Abstract Aim The inflammatory response, initiated by neutrophil and monocyte adhesion to endothelial cells, is important in the pathogenesis of acute coronary syndromes. Platelets play an important role in inflammatory process by interacting with monocytes and neutrophils. In this study, we investigated the effect of tirofiban on the levels of cell adhesion molecules (soluble intercellular adhesion molecule-1, sICAM-1, and vascular cell adhesion molecule-1, sVCAM-1 in patients with unstable angina pectoris (AP. Methods Thirty-five patients with unstable AP (Group I, ten patients with stable AP (Group II and ten subjects who had angiographycally normal coronary arteries (Group III were included the study. Group I was divided into two subgroups for the specific treatment regimens: Group IA (n = 15 received tirofiban and Group IB (n = 20 did not. Blood samples for investigating the cell adhesion molecules were drawn at zero time (baseline; 0 h in all patients and at 72 h in Group I. Results The baseline levels of sICAM-1 and sVCAM-1 were higher in Group I than in Groups II and III. They were higher in Group IA than in Group IB. However, the sICAM-1 and sVCAM-1 levels decreased significantly in Group IA after tirofiban infusion. In contrast, these levels remained unchanged or were increased above the baseline value in Group IB at 72 h. Conclusion The levels of cell adhesion molecules in patients with unstable AP decreased significantly after tirofiban infusion. Inhibition of platelet function by specific glycoprotein IIb/IIIa antagonists may decrease platelet-mediated inflammation and the ischemic end-point.

  17. Danshen injection as adjuvant treatment for unstable angina pectoris: A systematic review and meta-analysis.

    Science.gov (United States)

    Wu, Jia-Rui; Liu, Shi; Zhang, Xiao-Meng; Zhang, Bing

    2017-04-01

    To systematically evaluate the clinical effectiveness and safety of Danshen Injection (, DS) as one adjuvant treatment for conventional therapy with Western medicine (WM) for unstable angina pectoris (UAP). Using literature databases, a thorough and systematic retrieval of randomized controlled trials (RCTs) comparing DS plus WM with WM was conducted from inception to April 2015. The extracted data from included studies was analyzed by Review Manager 5.2 software. The Cochrane risk of bias tool was used to assess the quality of included studies, and Begg's and Egger's tests conducted by Stata 12.0 were used to evaluate the potential presence of publication bias. A total of 17 RCTs, which involving 1,433 participants, were identified and reviewed. The meta-analysis indicated that the combined use of DS and WM was significantly superior to WM alone for UAP in terms of the total effectiveness rate of angina pectoris [risk ratio (RR) =1.23, 95% confidence interval (CI): 1.17, 1.29, P<0.01] and the total effectiveness rate of electrocardiogram (ECG) [RR=1.18, 95%CI: 1.06, 1.30, P=0.001]. Additionally, DS could also further reduce the content of fibrinogen, adjust blood lipid level, correct T wave inversion, and so on. Fifteen adverse drug reactions were reported in two studies, Four of which appeared in the experimental group. Based on the systematic review, the combined use of DS and WM was more effective than WM alone, it can be further widely used in clinic, however, there was no exact conclusion for its safety.

  18. Salvianolate injection in the treatment of unstable angina pectoris: A systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Dan; Wu, Jiarui; Liu, Shi; Zhang, Xiaomeng; Zhang, Bing

    2016-12-01

    To systematically evaluate the clinical efficacy and safety of Salvianolate injection in the treatment of unstable angina pectoris (UAP). Using literature databases, we conducted a thorough and systematic retrieval of randomized controlled trials (RCTs) that using Salvianolate injection for treating UAP. The Cochrane Risk of Bias Assessment Tool was used to evaluate the methodological quality of the RCTs, and then the data were extracted and meta-analyzed by RevMan5.2 software. A total of 22 RCTs with 2050 participants were included. The meta-analysis indicated that the combined use of Salvianolate injection and western medicine (WM) in the treatment of UAP can achieve a superior effect in angina pectoris total effective rate (risk ratio [RR] = 1.22, 95% confidence interval [CI] (1.17, 1.27), Z = 10.15, P < 0.00001], and the total effectiveness rate of electrocardiogram [RR = 1.26, 95% CI (1.19,1.34), Z = 7.77, P < 0.00001]. In addition, Salvianolate injection can improve the nitroglycerin withdrawal rate and the serum level of NO, decrease high-sensitivity C-reactive protein. Adverse drug reactions (ADRs) or adverse drug events (ADEs) were reported in 6 RCTs involving 15 cases; however, there were no serious ADRs/ADEs. Based on the systematic review, the combined use of Salvianolate injection and WM in the treatment of UAP can achieve a better effect; however, there was no definitive conclusion about its safety. More the large-sample and multicenter RCTs are needed to support its clinical usage.

  19. Vaspin plasma concentrations and mRNA expressions in patients with stable and unstable angina pectoris.

    Science.gov (United States)

    Li, Hai Ling; Peng, Wen Hui; Cui, Shi Tao; Lei, Hou; Wei, Yi Dong; Li, Wei Ming; Xu, Ya Wei

    2011-09-01

    Vaspin was a recently identified adipokine, playing a protective role in many metabolic diseases. The present study aimed to investigate the association between vaspin plasma level and stable angina pectoris (SAP) and unstable angina pectoris (UAP). A total of 88 patients with angiographically-proved coronary artery disease (CAD) (SAP 47, UAP 41) and 103 control subjects without cardiovascular diseases were enrolled in this study. Circulating vaspin, mRNA expression of vaspin in peripheral blood mononuclear cells (PBMC), clinical parameters, lipid profile and high-sensitivity C-reactive protein (hsCRP) were assayed. The severity of CAD was also assessed according to the number of vessels diseased. There are significant differences in circulating vaspin levels and mRNA levels of PBMC between SAP and UAP groups (SAP 0.91±0.95 ng/mL and UAP 0.43±0.38 ng/mL, p<0.01 in circulating vaspin level; SAP 1.19±0.85 and UAP 0.82±0.56, p<0.05 in mRNA level of PBMC). An inverse correlation between the number of diseased vessels and plasma vaspin concentration was observed (r=-0.350, p<0.01) in the CAD group. Construction of receiver operating characteristic curves confirmed that vaspin plasma concentrations significantly differentiated CAD patients (area under the curve=0.684, p<0.001), as well as UAP (area under the curve=0.640, p<0.05). Decreased vaspin plasma levels and mRNA levels in PBMC were observed in patients with UAP. Low vaspin concentrations correlate with CAD severity. The findings suggested that vaspin could serve as a novel biomarker of CAD as well as UAP.

  20. Comparison of percutaneous coronary intervention versus conservative treatment in unstable angina pectoris

    International Nuclear Information System (INIS)

    Hu Chunyan; Lv Bei; Shen Weifeng; Lu Guoping

    2002-01-01

    Objective: To evaluate the efficacies of percutaneous coronary intervention (PCI) and drug treatment in patients with unstable angina (UAP). Methods: 248 patients with UAP were divided into two groups: conservative group of 123 patients who received antiplatelet, anticoagulant and antianginal therapies only and invasive group of 125 patients who underwent additional PCI 4.4 days after admission. The occurrence of death, AMI, recurrent angina, readmission were assessed during the first hospitalization year. Results: There was no difference in the incidence of composite endpoint of death or AMI between the two groups during the hospitalization (0.8 % vs 1.6 %, P > 0.05 ), but hospitalization duration was shorter in the invasive group than in the conservative group (10.3 ± 5.6 days vs 14.6 ± 10.7 days, P < 0.01 ). In duration of one year, the incidence of AMI (2.4% vs 8.9%, P<0.03), death (1.6% vs 6.5%, P<0.05), composite endpoint of death or AMI (4.0 % vs 13.0 % P < 0.02), recurrent angina pectoris (26.4 % vs 48.7, P <0.001), CABG (1.6% vs 10.5%, P<0.01) and readmission (24.8% vs 45.5%, P<0.01) were also lower in the invasive group than in the conservative group. Survival rate free of composite death or AMI for 1 year was higher in the invasive group than in the conservative group(96.0 % vs 86.9 %, P < 0.02). There was a definite benefit of the invasive treatment in reducing the risk of composite endpoint of death or AMI in patients with chest pain at rest, troponin T positive and three vessel diseases. Old age, three vessel diseases, LAD disease, lower LVEF, ST-segment depression, diabetes and hypertension were the independent factors associated with composite of death or AMI. Conclusions: In patients with UAP, PCI associated with routine antiplatelet, anticoagulant and antiischemic treatment significantly decreases the incidence of adverse cardiac events and improves the survival rate in one year. Such beneficial effects can be more obvious for high-risk patients

  1. Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

    DEFF Research Database (Denmark)

    Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe

    2015-01-01

    ,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST...

  2. Optimizing Prescription of Chinese Herbal Medicine for Unstable Angina Based on Partially Observable Markov Decision Process

    Directory of Open Access Journals (Sweden)

    Yan Feng

    2013-01-01

    Full Text Available Objective. Initial optimized prescription of Chinese herb medicine for unstable angina (UA. Methods. Based on partially observable Markov decision process model (POMDP, we choose hospitalized patients of 3 syndrome elements, such as qi deficiency, blood stasis, and turbid phlegm for the data mining, analysis, and objective evaluation of the diagnosis and treatment of UA at a deep level in order to optimize the prescription of Chinese herb medicine for UA. Results. The recommended treatment options of UA for qi deficiency, blood stasis, and phlegm syndrome patients were as follows: Milkvetch Root + Tangshen + Indian Bread + Largehead Atractylodes Rhizome (ADR=0.96630; Danshen Root + Chinese Angelica + Safflower + Red Peony Root + Szechwan Lovage Rhizome Orange Fruit (ADR=0.76; Snakegourd Fruit + Longstamen Onion Bulb + Pinellia Tuber + Dried Tangerine peel + Largehead Atractylodes Rhizome + Platycodon Root (ADR=0.658568. Conclusion. This study initially optimized prescriptions for UA based on POMDP, which can be used as a reference for further development of UA prescription in Chinese herb medicine.

  3. [Optimized treatment program for unstable angina by integrative medicine based on partially observable Markov decision process].

    Science.gov (United States)

    Feng, Yan; Xu, Hao; Liu, Kai; Zhou, Xue-Zhong; Chen, Ke-Ji

    2013-07-01

    To initially optimize comprehensive treatment program for treating and preventing unstable angina (UA) by integrative medicine (IM). Based on partially observable Markov decision process model (POMDP), we chose 3 syndrome elements, i.e., qi deficiency, blood stasis, and phlegm turbidity from UA inpatients. The efficacy of treating UA by IM was objectively assessed by in-depth data mining and analyses. The treatment programs for UA patients of qi deficiency syndrome, blood stasis syndrome, and phlegm turbidity syndrome were recommended as follows: nitrates +statins +clopidogrel +angiotensin II receptor blockers +heparins +Astragalus membranaceus +Condonopsis + poria and large-head atractylodes rhizome (ADR = 0.85077869); nitrates + aspirin + clopidogrel + statins + heparins + Astragalus membranaceus + safflower + peach seed + red peony root (ADR = 0.70773000); nitrates + aspirin + statins + angiotensin-converting inhibitors + snakegourd fruit + onion bulb + ternate pinellia + tangerine peel (ADR = 0.72509600). As a POMDP based optimized treatment programs for UA, it can be used as a reference for further standardization and formulation of UA program by integrative medicine.

  4. Relationship of coronary collateral circulation with eosinophils in patients with unstable angina pectoris.

    Science.gov (United States)

    Wang, Jun; Li, Qun; Li, Shi-jing; Wang, De-zhao; Chen, Bu-xing

    2016-01-01

    Eosinophils (EOS) have been associated with prognosis of patients with coronary artery disease, and those who showed plenitudinous coronary collateral circulation (CCC) often have good clinical consequences. However, the relationship between EOS and CCC was seldom reported. To investigate the relationship between EOS and CCC development in patients with unstable angina pectoris (UAP). The study population consisted of 502 consecutive patients with UAP who underwent coronary angiography and coronary stenosis ≥80%. CCC was graded according to the Rentrop grading system of 0-3. Rentrop grades of 0 and 1 indicated low-grade CCC group, whereas grades 2 and 3 indicated high-grade CCC group. The EOS was significantly higher in the high-grade CCC group compared with the low-grade CCC group. In multiple logistic regression analysis, EOS (odds ratio: 1.969; 95% confidence interval [CI]: 1.210-3.3205; P=0.006) and neutrophil count (odds ratio: 0.757; 95% CI: 0.584-0.981; P=0.035) were predictors of high-grade CCC development. EOS of >0.12×10(9)/L could independently predict high-grade CCC with 72.5% sensitivity and 58.4% specificity (area under the curve: 0.681; 95% CI: 0.632-0.729). EOS were associated with high-grade CCC in patients with UAP with coronary stenosis ≥80%. Increased EOS count may play an important role in the development of CCC in patients with UAP.

  5. Analysis of urinary metabolomic profiling for unstable angina pectoris disease based on nuclear magnetic resonance spectroscopy.

    Science.gov (United States)

    Li, Zhongfeng; Liu, Xinfeng; Wang, Juan; Gao, Jian; Guo, Shuzhen; Gao, Kuo; Man, Hongxue; Wang, Yingfeng; Chen, Jianxin; Wang, Wei

    2015-12-01

    (1)H NMR-based urinary metabolic profiling is used for investigating the unstable angina pectoris (UAP) metabolic signatures, in order to find out candidate biomarkers to facilitate medical diagnosis. In this work, 27 urine samples from UAP patients and 20 healthy controls were used. The metabolic profiles of the samples were analyzed by multivariate statistics analysis, including PCA, PLS-DA and OPLS-DA. The PCA analysis exhibited slight separation with R(2)X of 0.681 and Q2 of 0.251, while the PLS-DA (R(2)X = 0.121, R(2)Y = 0.931, and Q(2) = 0.661) and the OPLS-DA (R(2)X = 0.121, R(2)Y = 0.931, Q(2) = 0.653) demonstrated that the model showed good performance. By OPLS-DA, 20 metabolites were identified. A diagnostic model was further constructed using the receiver-operator characteristic (ROC) curves (AUC = 0.953), which exhibited a satisfying sensitivity of 92.6%, specificity of 90% and accuracy of 89.1%. The results demonstrated that the NMR-based metabolomics approach showed good performance in identifying diagnostic urinary biomarkers, providing new insights into the metabolic process related to UAP.

  6. Sodium tanshinone IIA silate as an add-on therapy in patients with unstable angina pectoris.

    Science.gov (United States)

    Zhang, Haiyan; Long, Mingzhi; Wu, Zhiwen; Han, Xu; Yu, Yichao

    2014-12-01

    To investigate whether sodium tanshinone IIA silate (STS) as an add-on therapy to conventional treatment may provide additional benefits for patients with unstable angina pectoris (UAP) and is associated with changes in profiles of serum inflammatory factors. Eighty patients diagnosed with UAP were randomly divided into two groups for the 2-week treatment. The control group received conventional therapy, while the treatment group was given intravenous STS (0.06 mg in 250 mL, once daily) as an add-on therapy to the conventional medications. The therapeutic efficacy and changes in serum levels of several inflammatory cytokines, including monocyte chemotactic protein 1 (MCP-1), tumor necrosis factor alpha (TNF-α), peroxisome proliferator-activated receptor (PPAR-γ), and high-sensitivity C-reactive protein (hs-CRP) from baseline were determined and compared between the two group. The clinical symptoms of all patients in both groups were improved after treatment. The overall rate of effectiveness was 97.5% in the treatment group vs. 80.0% in the control group. Serum levels of MCP-1, TNF-α, and hs-CRP levels were significantly reduced in both groups (P<0.01), whereas the reduction was greater in patients receiving additional STS (P<0.05). PPAR-γ was significantly elevated in both groups (P<0.01). STS in combination with conventional treatment may be associated with better outcomes in patients with UAP.

  7. Assessment of microRNAs in patients with unstable angina pectoris.

    Science.gov (United States)

    Zeller, Tanja; Keller, Till; Ojeda, Francisco; Reichlin, Tobias; Twerenbold, Raphael; Tzikas, Stergios; Wild, Philipp S; Reiter, Miriam; Czyz, Ewa; Lackner, Karl J; Munzel, Thomas; Mueller, Christian; Blankenberg, Stefan

    2014-08-14

    While cardiac troponin measurements have significantly improved the early diagnosis of myocardial infarction, the timely biomarker-based diagnosis of unstable angina pectoris (UAP) remains a major unmet clinical challenge. The aim of this study was to assess levels of circulating microRNAs (miRNAs) as possible novel biomarkers in patients with UAP. A three-phase approach was conducted, comprising (i) profiling of miRNAs in patients with UAP and controls groups; (ii) replication of significant miRNAs in an independent patient cohort, (iii) validation of a multi-miRNAs panel in a third cohort. Out of 25 miRNAs selected for replication, 8 miRNAs remained significantly associated with UAP. In a validation phase, a miRNA panel including miR-132, miR-150, and miR-186 showed the highest discriminatory power [area under the receiver-operating-characteristic curve (AUC): 0.91; CI: 0.84-0.98]. Using a profiling-replication-validation model, we identified eight miRNAs, which may facilitate the diagnosis of UAP. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  8. CLINICAL EFFECTIVENESS AND SAFETY OF IVABRADINE USE IN PATIENTS WITH UNSTABLE ANGINA AND DIABETES MELLITUS TYPE 2

    Directory of Open Access Journals (Sweden)

    A. I. Kondratiev

    2011-01-01

    Full Text Available Aim – to estimate the clinical and pharmacological effects of ivabradine in complex treatment of patients with acute coronary syndrome anddiabetes mellitus type 2 (DM 2.Materials and methods. The study included 36 patients with acute coronary insufficiency (unstable angina and acute left ventricular failure(Killip class I–III during concomitant type 2 diabetes.Results. Prescribing ivabradine in treatment of unstable angina pectoris complicated by type 2 diabetes led to decrease in clinical symptoms,heart rate and reduce in number of myocardial ischemia episodes. Patients treated with ivabradine, showed a significant tendency to increase left ventricular ejection fraction (12.3 %. Mo adverse reactions were recorded, including hypotensive complications.Conclusion. Ivabradine therapy was characterized by high ischemic and antianginal efficacy, good tolerability, did not lead to the developmentof tolerance and was not accompanied by the appearance of withdrawal syndrome.

  9. CLINICAL EFFECTIVENESS AND SAFETY OF IVABRADINE USE IN PATIENTS WITH UNSTABLE ANGINA AND DIABETES MELLITUS TYPE 2

    Directory of Open Access Journals (Sweden)

    A. I. Kondratiev

    2014-07-01

    Full Text Available Aim – to estimate the clinical and pharmacological effects of ivabradine in complex treatment of patients with acute coronary syndrome anddiabetes mellitus type 2 (DM 2.Materials and methods. The study included 36 patients with acute coronary insufficiency (unstable angina and acute left ventricular failure(Killip class I–III during concomitant type 2 diabetes.Results. Prescribing ivabradine in treatment of unstable angina pectoris complicated by type 2 diabetes led to decrease in clinical symptoms,heart rate and reduce in number of myocardial ischemia episodes. Patients treated with ivabradine, showed a significant tendency to increase left ventricular ejection fraction (12.3 %. Mo adverse reactions were recorded, including hypotensive complications.Conclusion. Ivabradine therapy was characterized by high ischemic and antianginal efficacy, good tolerability, did not lead to the developmentof tolerance and was not accompanied by the appearance of withdrawal syndrome.

  10. Monocyte to HDL ratio in prediction of BMS restenosis in subjects with stable and unstable angina pectoris.

    Science.gov (United States)

    Tok, Derya; Turak, Osman; Yayla, Çağrı; Ozcan, Fırat; Tok, Duran; Çağlı, Kumral

    2016-08-01

    This study aims to assess the predictive role of the preprocedural circulating monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) on the occurrence of stent restenosis (SR) in patients with stable and unstable angina pectoris undergoing successful bare-metal stenting (BMS). Between February 2008 and June 2014, a total of 831 patients with stable and unstable angina pectoris who underwent successful BMS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. Left ventricular ejection fraction and laboratory data were also noted. In the receiver operating characteristics curve analysis, MHR >14 had 71% sensitivity and 69% specificity in predicting SR. Our study results show that preprocedural MHR is an independent predictor of SR in this patient population.

  11. Xuesaitong Soft Capsule (Chinese Patent Medicine for the Treatment of Unstable Angina Pectoris: A Meta-Analysis and Systematic Review

    Directory of Open Access Journals (Sweden)

    Xiaochen Yang

    2013-01-01

    Full Text Available Objective. To provide a systematic review to evaluate the effectiveness and safety of Xuesaitong soft capsule (XST in treating unstable angina (UA. Methods. An extensive search of 6 medical databases was performed up to August 2013. Randomized controlled trials (RCTs involving XST alone or combined with conventional drugs versus conventional drugs were included. A meta-analysis of reduction of angina symptoms and electrocardiogram (ECG improvement was performed to evaluate the effects of XST on UA. Results. After researching, a total of 6 RCTs with 716 participants were included. Our review showed that XST combined with conventional drugs had significant effect on relieving angina symptoms (RR: 1.14 [1.07,1.22]; P=0.0001 and improving ECG (RR: 1.26 [1.12,1.42]; P=0.0001 compared with conventional drugs alone. Conclusions. XST appears to have beneficial effects on improvement of ECG, reduction of angina symptoms, and decreasing the frequency and duration of angina attack in participants with UA. However, the findings should be interpreted with caution due to the poor methodological quality of the included trials.

  12. Epidemiologic study of use of resources in patients with unstable angina: the EARISA registry. On behalf on the EARISA Investigators (Epidemiologia dell'Assorbimento di Risorse nell'Ischemia, Scompenso e Angina).

    Science.gov (United States)

    Maggioni, A P; Schweiger, C; Tavazzi, L; Langiano, T; Lucci, D; Ramponi, C; Repetto, F; De Vita, C

    2000-08-01

    The EARISA Registry was designed to describe diagnostic and therapeutic resources used in Italian cardiology centers for patients with the epidemiologically most relevant cardiac diseases. This article focuses on patients with unstable angina; characteristics associated with invasive procedures were specifically analyzed. Information was collected over a 2-week period on 1420 patients with unstable angina discharged from 308 cardiology centers. The mean length of stay was 9 +/- 6 days; 51% of patients were admitted to a coronary care unit (mean length of stay, 4 +/- 3 days). Noninvasive procedures included echocardiography (64%), Holter monitoring (25%), exercise stress testing (24%), and echocardiographic stress testing or nuclear imaging (7%). Invasive procedures were coronary angiography (39%) and percutaneous transluminal coronary angioplasty or coronary artery bypass grafting (13%). Unstable angina had a greater impact on invasive procedures than acute myocardial infarction. Variables independently associated with a higher rate of coronary angiographic procedures were younger age, higher technologic level of the hospital, and need for intravenous therapy. In Italy, approximately half the patients with unstable angina are admitted to hospitals without catheterization laboratories or cardiac surgery facilities. This fact supports the concept that treatments that can be administered in all types of hospitals are more likely to affect the outcome of patients with unstable angina. Overall, the rates of coronary angiography and revascularization procedures appeared low, and the setting where cardiologists practice, rather than patient characteristics, is the major determinant of the care given to patients with unstable angina.

  13. Screening of plasma biomarkers in patients with unstable angina pectoris with proteomics analysis

    Directory of Open Access Journals (Sweden)

    Shui-wang HU

    2017-08-01

    Full Text Available Objective To analyze and compare the differentially expressed plasma proteins between patients with stable angina pectoris (SAP and unstable angina pectoris (UAP, and search for the biomarkers that maybe used for early diagnosis of UAP. Methods Sixty plasma samples were collected respectively from normal controls group (N group, SAP group and UAP group during Jun. 2014 to Apr. 2015 from the Third Affiliated Hospital of Southern Medical University. Ten samples (100μl of each group were selected randomly to pool into 3 groups severally. After removing high-abundance proteins from plasma, two- dimensional difference gel electrophoresis (DIGE was used to isolate the total proteins, and then the protein spots with more than 2-fold changes between UAP and SAP were picked up after the differential software analysis. Afterward, the varied proteins were identified by matrix assisted laser desorption ionization-time of flight/time of flight (MALDI-TOF/TOF mass spectrometry (MS. Finally, 40 plasma samples were collected respectively from N, SAP and UAP group, and the UAP specific differential proteins were selected to be verified by ELISA. Results A total of 10 varied protein spots with more than 2-fold changes in UAP and SAP were found including 9 up-regulated proteins and 1 down-regulated one. MS identification indicated that the up-regulated proteins included fibrinogen gamma chain (FGG, complement C4-B (C4B, immunoglobulin (Ig kappa chain C region (IGKC and hemoglobin subunit alpha (HBA1, whereas the down-regulated one was haptoglobin (HP. After comparing the varied proteins with that in N group, 2 specifically UAP-related proteins, IGKC and HP, were detected totally. IGKC was selected to validate by ELISA, and the corresponding results showed that IGKC was increased specifically in UAP plasma (P<0.05 when compared with N and SAP group, which was consistent with DIGE. Conclusion IGKC and HP have been detected as specifically related proteins to UAP

  14. Role of multi-slice CT coronary angiography in evaluating the different patterns of coronary artery disease in patients with unstable angina

    OpenAIRE

    Niazi, Gamal Eldine M.; Elia, Remon Z.

    2015-01-01

    Objective: To evaluate the different patterns of coronary artery disease among patients with unstable angina by the role of multislice CT coronary angiography. Patients and methods: From September 2013 to May 2014, 40 patients complaining from unstable angina showing initial negative ECG and troponin enzyme underwent a multi-slice CT coronary angiography. Each patient underwent a non-contrast scan to determine the calcium score, then a contrast enhanced ECG gated scan, then the obtained ax...

  15. Geogagnetic Activity and Effectiveness of Millimeter Electromagnetic Radiation in Unstable Angina Treatment

    Science.gov (United States)

    Parshina, S. S.; Samsonov, S. N.; Afanasiyeva, T. N.; Tokayeva, L. K.; Petrova, V. D.; Dolgova, E. M.; Manykina, V. I.; Vodolagina, E. S.

    There had been performed a research of an effectiveness of millimeter electromagnetic radiation (MM EMR) use in patients with an unstable angina (UA) at periods of a lower (daily value of Kp-index 16,19±0,18) and a higher (daily value of Kp-index 17,25±0,21, p<0,05) gemagnetic activity (GA). It was found that involving of the MM EMR (the wave length 7.1 mm) into the treatment of the patients with an UA, enhances an antianginal effect of a drug therapy independently on the period of GA. The MM EMR at the period of a lower geomagnetic activity (LGA) enhances the decrease of diastolic blood pressure (BP), and at the period of a higher geomagnetic activity (HGA) - the decrease of systolic BP. At a HGA there were noted: a quick and more serious antianginal effect, maximal antihypertensive effect was achieved quicker, but (as opposed to the period of a LGA) there was no a pulse slowing effect of a MM EMR. Including the MM EMR into the treatment accelerates stabilization of the patients' condition only at a LGA. Positive effect on blood rheological properties is an independent effect of MM EMR, and it is in blood viscosity reduce in microcirculatory at both of the periods of GA. Normalization of blood viscosity under the MM EMR is only at the period of a LGA. So, the effect of MM EMR on a clinical condition of the patients is more evident at the period of a HGA, blood viscosity - at the period of a LGA.

  16. Hospitalizations Due to Unstable Angina Pectoris in Diastolic and Systolic Heart Failure

    Science.gov (United States)

    Ahmed, Ali; Zile, Michael R.; Rich, Michael W.; Fleg, Jerome L.; Adams, Kirkwood F.; Love, Thomas E.; Young, James B.; Aronow, Wilbert S.; Kitzman, Dalane W.; Gheorghiade, Mihai; Dell’Italia, Louis J.

    2008-01-01

    Patients with diastolic heart failure (HF) i.e. clinical HF with normal or near normal left ventricular ejection fraction (LVEF) may experience unstable angina pectoris (UAP) due to epicardial atherosclerotic coronary artery disease (CAD) and/or to subendocardial ischemia, even in the absence of CAD. However, the risk of UAP among ambulatory diastolic HF patients has not been well studied. We examined incident hospitalizations due to UAP among 916 diastolic HF (LVEF >45%) patients without significant valvular heart disease and 6800 systolic HF (LVEF ≤45%) patients in the Digitalis Investigation Group trial. During a 38-month median follow-up, 12% (797/6,800) of systolic HF patients (incidence rate, 435/10,000 person-years) and 15% (138/916) of diastolic HF patients (incidence rate, 536/10,000 person-years) were hospitalized for UAP (adjusted hazard ratio for diastolic HF, 1.22; 95% confidence interval, 1.02–1.47; p=0.032). There was a graded increase in incident hospital admissions for UAP with increasing LVEF. Hospitalizations for UAP occurred in 11% (520/4,808; incidence rate, 407/10,000 person-years), 14% (355/2556; incidence rate, 496/10,000 person-years) and 17% (60/352; incidence rate, 613/10,000 person-years) of HF patients, respectively, with LVEF 55%. Compared with HF patients with LVEF 55% were respectively 1.17 (1.02–1.34; p=0.028) and 1.57 (1.20–2.07; p=0.026). In conclusion, in ambulatory chronic HF patients, higher LVEF was associated with increased risk of hospitalizations due to UAP. As in patients with systolic HF, those with diastolic HF should be routinely evaluated for myocardial ischemia and managed accordingly. PMID:17293184

  17. Danshenchuanxiongqin injection in the treatment of unstable angina pectoris: a systematic review and Meta-analysis.

    Science.gov (United States)

    Zhang, Xiaomeng; Wu, Jiarui; Zhang, Bing; Zhou, Wei

    2016-04-01

    To evaluate systematically the efficacy and safety of Danshenchuanxiongqin Injection (DCI) in the treatment of unstable angina pectoris (UAP). Randomized controlled trials (RCTs) regarding DCI used for treating UAP were searched in English and Chinese electronic databases from inception to January 2014. Two reviewers independently retrieved RCTs and extracted relevant information. The Cochrane risk of bias method was used to assess the quality of included studies, and a Meta-analysis was conducted with Review Manager 5.2 software. Eleven RCTs involving 1034 participants were included. The methodological quality was relatively passable. The Meta-analysis indicated that the combined use of DCI and conventional treatment with Western Medicine (WM) was more efficacious in the outcomes of total effective rate [Relative Risk (RR) = 1.27, 95% CI (confidence interval; 1.18, 1.35), P < 0.000 01], the total effective rate of ECG [RR = 1.40, 95% CI (1.18, 1.66), P < 0.000 01], total cholesterol [Mean difference (MD) = -0.58, 95% CI (- 0.83, - 0.33), P < 0.000 01], total triglycerides [MD = - 0.36, 95% CI (- 0.54, - 0.17), P = 0.0001], and the number of ST-segment depression [MD = -0.36, 95% CI (- 0.54, - 0.17), P = 0.0001]. There were two adverse drug reactions reported in one study. Based on the systematic review, DCI combined with WM appeared to be efficacious in the treatment UAP. However, the evidence of DCI for treating UAP requires large-scale and double-blind RCTs to substantiate these findings.

  18. Changes of serum angiogenic factors concentrations in patients with diabetes and unstable angina pectoris.

    Science.gov (United States)

    Gui, Chun; Li, Shi-kang; Nong, Qin-ling; Du, Fang; Zhu, Li-guang; Zeng, Zhi-yu

    2013-02-19

    Diabetic microvascular changes are considered to be influenced by angiogenic factors. As a compensatory mechanism, the expression of some angiogenic factors are elevated in ischemic myocardium. The aim of this study was to investigate the changes of serum angiogenic factors, and the association among these angiogenic factors, the severity of coronary artery stenosis and collateral vessels form in patients with diabetes and unstable angina pectoris (UAP). 42 patients with diabetes (diabetes group), 57 patients with UAP (UAP group), and 36 age-matched healthy people (control group) were selected. Serum concentrations of angiogenic factors were measured using cytokine array technology. The severity of coronary artery stenosis was scored using the angiographic Gensini score. Coronary collateral vessels were scored according to Rentrop's classification. No significant differences in the serum concentrations of vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), angiogenin, angiostatin, basic fibroblast growth factor (bFGF) and platelet-derived growth factor-BB (PDGF-BB) were detected between control group and diabetes group. But in patients with diabetes complicated with UAP and in patients with UAP without diabetes, serum concentrations of VEGF and Ang-2 were elevated (p < 0.01, p < 0.01). Only serum Ang-2 concentrations were significantly correlated with Gensini score (r=0.585, p < 0.001), left ventricular end diastolic diameter (r=0.501, p < 0.001), left ventricular end systolic diameter (r=0.563, p < 0.001) and left ventricular ejection fraction (r=-0.523, p < 0.001). Serum concentrations of VEGF and Ang-2 were increased, and diabetes didn't affect this increases in patients with UAP. Serum Ang-2 concentrations were correlated with the severity of coronary artery stenosis.

  19. Myocardial rest iodine-123-{beta}-methyl-iodophenyl-pentadecanoic acid scintigraphy compared with dipyridamole stress thallium-201 scintigraphy in unstable angina

    Energy Technology Data Exchange (ETDEWEB)

    Misumi, Ikuo; Kimura, Yoshihiro; Hokamura, Youichi; Yamabe, Hiroshige; Ueno, Kazuhiro [Kumamoto City Hospital (Japan)

    1998-01-01

    Twelve patients with stable angina and 12 patients with unstable angina underwent rest iodine-123-{beta}-methyl-iodophenyl-pentadecanoic acid (BMIPP), dipyridamole stress thallium scintigraphy and delayed thallium scintigraphy. In stable angina, sensitivity for detecting ischemic segments was higher in dipyridamole thallium (74%) than rest BMIPP (48%) images (p<0.05), but there was no significant difference between the 2 images in unstable angina. In unstable angina, the incidence of segments with higher defect scores on BMIPP images than on delayed thallium images and the opposite pattern was 27 and 5 (p<0.01). In stable angina, there was no difference. The mean defect score on BMIPP (6.3{+-}5.6) was higher than that on delayed thallium scintigraphy (2.9{+-}2.7) and it was almost the same as on the initial dipyridamole stress test (6.5{+-}5.2). In conclusion, BMIPP scintigraphy is safer and may be as useful in detecting myocardial ischemia in patients with unstable angina as thallium scintigraphy. (author)

  20. [Application of ″Fu Yang and activating blood circulation″ in treatment of unstable angina pectoris patients].

    Science.gov (United States)

    Gao, Jia-Liang; Li, Jun; Wang, Jie

    2016-02-01

    Coronary heart disease(CHD) has become a major public health problem in the world, while the unstable angina (UA) is one of an important type. Hypofunction of yang qi in chest and cardiac blood stasis has been considered as the basic pathogenesis of UA.According to the deficiency of yang and blood stasis run through the process of CHD, fu yang and activating blood circulation could be main treatment. Wenxin decoction which has the function of fu yang and activating blood circulation, not only can effectively improve the symptoms of angina pectoris, the ischemic ECG, but also can significantly improve blood rheology, blood lipids and so on. So deepening the theory of ″fu yang and activating blood circulation″ and the application of ″Wenxin decoction″ in the treatment of UA would have an important clinical value for improving the therapeutic efficacy of CHD. Copyright© by the Chinese Pharmaceutical Association.

  1. Diagnostic Potential of Plasmatic MicroRNA Signatures in Stable and Unstable Angina

    Science.gov (United States)

    D'Alessandra, Yuri; Carena, Maria Cristina; Spazzafumo, Liana; Martinelli, Federico; Bassetti, Beatrice; Devanna, Paolo; Rubino, Mara; Marenzi, Giancarlo; Colombo, Gualtiero I.; Achilli, Felice; Maggiolini, Stefano; Capogrossi, Maurizio C.; Pompilio, Giulio

    2013-01-01

    Purpose We examined circulating miRNA expression profiles in plasma of patients with coronary artery disease (CAD) vs. matched controls, with the aim of identifying novel discriminating biomarkers of Stable (SA) and Unstable (UA) angina. Methods An exploratory analysis of plasmatic expression profile of 367 miRNAs was conducted in a group of SA and UA patients and control donors, using TaqMan microRNA Arrays. Screening confirmation and expression analysis were performed by qRT-PCR: all miRNAs found dysregulated were examined in the plasma of troponin-negative UA (n=19) and SA (n=34) patients and control subjects (n=20), matched for sex, age, and cardiovascular risk factors. In addition, the expression of 14 known CAD-associated miRNAs was also investigated. Results Out of 178 miRNAs consistently detected in plasma samples, 3 showed positive modulation by CAD when compared to controls: miR-337-5p, miR-433, and miR-485-3p. Further, miR-1, -122, -126, -133a, -133b, and miR-199a were positively modulated in both UA and SA patients, while miR-337-5p and miR-145 showed a positive modulation only in SA or UA patients, respectively. ROC curve analyses showed a good diagnostic potential (AUC ≥ 0.85) for miR-1, -126, and -483-5p in SA and for miR-1, -126, and -133a in UA patients vs. controls, respectively. No discriminating AUC values were observed comparing SA vs. UA patients. Hierarchical cluster analysis showed that the combination of miR-1, -133a, and -126 in UA and of miR-1, -126, and -485-3p in SA correctly classified patients vs. controls with an efficiency ≥ 87%. No combination of miRNAs was able to reliably discriminate patients with UA from patients with SA. Conclusions This work showed that specific plasmatic miRNA signatures have the potential to accurately discriminate patients with angiographically documented CAD from matched controls. We failed to identify a plasmatic miRNA expression pattern capable to differentiate SA from UA patients. PMID:24260372

  2. [Circadian blood pressure characteristics in hospitalized unstable angina pectoris patients with hypertension].

    Science.gov (United States)

    Zhang, W; Zhu, H; Yao, S Y; Li, Y; Liu, J; Xue, H

    2017-07-24

    Objective: To define the characteristic of circadian rhythm of blood pressure in unstable angina pectoris (UAP)patients with hypertension and its effects on the cardiovascular events. Methods: It was a prospective study.Based on coronary angiographic results, 742 consecutive hospitalized UAP patients with hypertension and 89 consecutive hospitalized hypertensive patients were recruited between September 2014 and December 2015 in this study. Clinical data and the results of 24-hour ambulatory blood pressure monitoring (ABPM) were analyzed. Results: The total prevalence of hypertension in UAP is about 77.1%(742/962) in our cohort. The decrease of night-time systolic and diastolic blood pressure in UAP patients complicated with hypertension was lower than that in hypertensive patients ( P <0.05). The prevalence of dipper, non-dipper and reverse dipper pattern was 12.4%(92/742), 34.9%(259/742) and 52.7%(391/742) in UAP patients complicated with hypertension, 18.0%(16/89), 48.3%(43/89) and 33.7%(30/89) in hypertensive patients. Obviously, the abnormal circadian rhythm of blood pressure was more significant in UAP patients with hypertension than in hypertensive patients, characterized by higher reverse dipper pattern in UAP patients with hypertension compared to patients with hypertension( P =0.00), similar results were evidenced among the male and female patients and patients with various ages. Subgroup analysis showed that except similar results on the incidence of reverse dipper pattern in controlled blood pressure aged less than 45 years old, the incidence of reverse dipper pattern was all significantly higher in UAP patients complicating with hypertension than in hypertensive patients independent no matter blood pressure controlled or not (all P <0.05). After adjustment for sex, age, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and other risk factors, binary logistic regression analysis showed that reverse dipper pattern

  3. Influence of nifedipine on left ventricular perfusion and function in patients with unstable angina: Evaluation with radionuclide techniques

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    Wall, E.E. van der; Kerkkamp, H.J.; Simoons, M.L.; Rijk, P.P. van; Reiber, J.H.C.; Bom, N.; Lubsen, J.C.; Lie, K.I.

    1986-04-01

    In 1981, a large, double-blind, randomized trial was started in The Netherlands to evaluate the therapeutic effects of nifedipine and/or metoprolol in patients with unstable angina. This study has been called the Holland Interuniversity Nifedipine/metoprolol Trial (HINT) and required several hundred patients to establish potential therapeutic effects. From December 1982 to January 1984 the effects of nifedipine on left ventricular (LV) performance in a subgroup of 52 HINT patients were studied using radionuclide techniques. All patients (23 on nifedipine, 29 controls) underwent thallium-201 scintigraphy or radionuclide angiography just before and 48 h after the start of experimental medication. The radionuclide angiographic studies were also performed at 1 and 4 h after treatment. Nifedipine did not influence the incidence of disapperance of perfusion defects on the 48-h thallium images. No significant differences in overall LV ejections fraction (EF) were seen at any time between nifedipine-treated patients and controls. However, paired observations in 37 patients showed improvement of LVEF after 48 h in 8 patients on nifedipine and in only 1 control patient. Scintigraphic measurements on admission were not related to clinical outcome after 48 h. Concomitant administration of metoprolol did not influence LVEF in either group. It is concluded that nifedipine improves LVEF after 48 h in a subset of patients with unstable angina without affecting myocardial perfusion. This finding indicates that nifedipine has a predominant effect on afterload reduction in patients with unstable angina. Also, early scintigraphic measurements had no significant predictive value for subsequent cardiac events.

  4. Ischemia-modified albumin in differential diagnosis of acute coronary syndrome without ST elevation and unstable angina pectoris.

    Science.gov (United States)

    Wudkowska, Anna; Goch, Jan; Goch, Aleksander

    2010-04-01

    Ischemia modified albumin (IMA) was registered by the United States Food and Drug Administration as a marker of myocardial ischemia. To assess the usefulness of IMA measurement for differentiating patients with acute coronary syndrome (ACS) with no ST elevation and patients with unstable angina pectoris. The study group consisted of 121 patients (mean age 63 +/- 12 years, 84 males), who were admitted to our department with retrosternal chest pain occurring at rest and lasting more than 20 minutes. The patients had laboratory tests performed including aspartate aminotransferase, izoenzyme of creatine kinase activity, troponin T, N-terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, IMA concentration and creatinine clearance. Coronary angiography was also performed. All study patients were divided into 2 groups: group I with elevated troponin concentration (58 patients) and group II with troponin concentration below reference value (63 patients). The IMA concentration in the serum did not differ significantly between group I (troponin positive) and group II (troponin negative) (95.2 +/- 12.8 U/mL vs 94.0 +/- 17.9 U/mL, NS). The percentage of patients with elevated IMA values (cut off point of 85 U/mL) did not differ significantly between group I and group II patients (76.6% vs 76.2%, NS). In patients from group I an upward trend was noted, whereas in patients from group II a downward trend was associated with the duration of ischemic chest pain. In group I the correlation between the IMA concentration and the NT-proBNP concentration was positive (R = 0.2957; p unstable angina. 2. The upward trend of IMA concentration was associated with the duration of chest pain in patients with ACS, whereas the opposite trend was found in patients with unstable angina pectoris.

  5. Prognosis in medically stabilized unstable angina: Early Holter ST-segment monitoring compared with predischarge exercise thallium tomography

    International Nuclear Information System (INIS)

    Marmur, J.D.; Freeman, M.R.; Langer, A.; Armstrong, P.W.

    1990-01-01

    The objective of this study was to assess the relative value of invasive and noninvasive predictors of outcome in patients after unstable angina. Fifty-four patients with unstable angina who had 6-month follow-up after stabilization on medical therapy were evaluated. We prospectively compared 24-hour Holter ST-segment monitoring at admission, quantitative exercise thallium tomography, and cardiac catheterization 5 +/- 2 days after admission and analyzed their value for predicting a cardiac event in patients with unstable angina within 6 months. When patients with a favorable outcome (n = 40) were compared with patients with an unfavorable outcome (n = 11) no statistical difference was found in duration of ST shift of 1 mm or more on Holter monitoring (51 +/- 119 min compared with 37 +/- 43 min), exercise duration by the standard Bruce protocol (8.0 +/- 3.6 min compared with 7.9 +/- 3.1 min), exercise-induced ST depression (0.6 +/- 0.9 mm compared with 1.0 +/- 1.0 mm), and contrast left ventricular ejection fraction (70% +/- 10% compared with 69% +/- 15%). Patients with a favorable outcome were distinguished from those with an unfavorable outcome by a higher maximum rate-pressure product (24 x 10(3) +/- 6 x 10(3) compared with 18 x 10(3) +/- 7 x 10(3), P = 0.0025), smaller size of the reversible scintigraphic perfusion defect expressed as a percentage of total myocardium imaged (6% +/- 11% compared with 17% +/- 18%, P = 0.05) and a smaller number of vessels with stenosis of 50% or more (1.1 +/- 1.2 compared with 2.1 +/- 1.0, P = 0.01). On multiple logistic regression analysis, a history of previous myocardial infarction was the most powerful predictor of outcome. In patients without myocardial infarction, reversible exercise thallium perfusion defect size was the only predictor

  6. A Novel Medical Treatment for Lipid Control in Patients with Unstable Angina Pectoris and Statin-Induced Liver Dysfunction.

    Science.gov (United States)

    Cui, Fang; Zhang, Youliang; Wei, Qingmin; Liu, Cuihua; Wang, Junhui; Zhang, Meng

    2015-01-01

    This study aims to evaluate the safety and efficacy of Xuezhikang in the treatment of unstable angina pectoris (UAP) in patients with elevated liver enzymes caused by statins. Ninety UAP patients with elevated liver enzymes (higher than 3-fold the upper limits of normal caused by statins) were randomly divided into 3 groups: withdrawal of simvastatin (group A), continued taking of simvastatin (group B) and switching to Xuezhikang capsules (group C). Blood lipids and high-sensitivity C-reactive protein (hs-CRP) were measured before and after treatment, and liver enzymes were measured every two weeks. As the liver enzymes of the patients in group A returned to normal, they could again undertake administration of simvastatin. If the liver enzyme levels remained abnormal at four weeks, polyene phosphatidylcholine would be added. The endpoint events of each group were followed-up. After treatment for 4 weeks, the liver enzymes decreased in all of the three groups and there was a significant difference (p 0.05). The blood lipids and hs-CRP were both reduced in group B and C. The decreased triglyceride and hs-CRP levels and increased high-density lipoprotein cholesterol level in group C were more remarkable than those in group B (p Unstable angina pectoris; Xuezhikang capsules.

  7. Evaluation of Role of C-Reactive Protein Level on Cardiovascular Events During 14 Days after Admission of Patients with Unstable Angina in the Ekbatan Hospital, Hamadan, 2002

    Directory of Open Access Journals (Sweden)

    B. Naghsh Tabrizi

    2007-01-01

    Full Text Available Introduction & Objective: Unstable angina is in the center of spectrum from chronic stable angina to acute myocardial infarction. Due to high prevalence of unstable angina, it is important to find a factor that predicts prognosis and management modality. We decided to measure CRP level for the items that mentioned above.Materials & Methods: This study was a cross-sectional study that 138 patients who were admitted with unstable angina in the CCU and cardiac ward of Ekbatan Hospital in Hamedan were considered for measuring CRP level. Age, sex, period of disease, and left ventricular ejection fraction percentile were worked out. After quantitative CRP measuring and 14 days follow up, the questionnaire was completed.Results: CRP levels were 116.3 and 124.3 ng/ml in the patients with and without cardiovascular events (whole events respectively during 14 days follow up. Recurrent unstable angina, myocardial infarction and mortality rate were higher in the patients with elevated level of CRP but need to perform coronary angiography was lower.Conclusion: CRP level had no correlation with occurrence of cardiovascular events (whole events during 14 days follow up.

  8. Panax notoginseng Preparations for Unstable Angina Pectoris: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Song, Haiying; Wang, Peili; Liu, Jiangang; Wang, Chenglong

    2017-08-01

    This paper assessed the evidence of Panax notoginseng preparations in patients suffering from UAP using meta-analysis and systematic review methods. Methods were according to the Cochrane Handbook and analysed using Revman 5.3. A search of PubMed, Cochrane Library, Embase, MEDLINE, Chinese national knowledge infrastructure (CNKI), Vip information database, Wanfang data and Chinese Biomedical Literature Database (SinoMed) was conducted to identify randomized controlled trials (RCTs) of P. notoginseng preparations on UAP regardless of blinding, sex and language. The outcomes include all-cause mortality, cardiac mortality, cardiovascular events, UAP symptoms, improvement of electrocardiogram and adverse events. Eighteen RCTs including 1828 patients were identified. The level of reporting is generally poor. Among 18 studies, 16 studies were prescribed P. notoginseng injections, and two studies were oral P. notoginseng preparations. Reduction of cardiovascular events (RR:0.35;95% CI:0.13 to 0.94), alleviation of angina pectoris symptoms (RR:1.23;95% CI 1.18 to 1.29), improvement of ECG (RR:1.22;95% CI 1.15 to 1.28) and reduced frequency of angina pectoris (MD:-1.48; 95% CI -2.49 to -0.48) were observed. Cardiac mortality and duration of angina pectoris were not statistically significant. Panax notoginseng is beneficial to UAP patients; the results of these reviews may have important implications to clinical work. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  9. Correlation between Serum High Sensitivity CRP Level and Inhospital Cardiac Events in the Patients with Unstable Angina

    Directory of Open Access Journals (Sweden)

    H. Kazerani

    2007-10-01

    Full Text Available Introduction & Objective: Several studies have been performed to evaluate correlation of serum high sensitivity CRP (hs-CRP level with the prognosis of the patients with diagnosis of unstable angina, and by now different results were reported. The aim of this study was to assess correlation between serum hs-CRP level and inhospital prognosis and cardiac events in the patients with unstable angina. Materials & Methods: This descriptive analytic study was performed from Sep 2004 till Feb 2006 in Shahid Beheshti hospital. Kermanshah, Iran. Sera were collected from 250 patients for hs-CRP measurement. Exclusion criteria were: acute ST elevation MI, non ST elevation MI, patients with history of recent infection, patients with recent trauma and patients with serum high sensitive CRP level more than 10 mg/lit. Patients were divided into two groups, first group whose serum hs-CRP level was less than 3 mg/lit and second group whose serum hs-CRP level was between 3 and 10 mg/lit. They were followed for recurrent chest pain, arrhythmias, pulmonary edema, acute myocardial infarction and in hospital death. Results were analyzed using x² and t-test. Results: Mean age were 57±7.8 and 58±11.5 years in first group and second group respectively. There was statistically significant difference in some cardiac complications such as dyspnea, duration of hospitalization, recurrent chest pain, CCU admission (p<0.001 and in hospital myocardial infarction (p=0.03, between two groups. Some complications did not have significant difference such as pulmonary edema, cardiogenic shock, arrhythmia, S3, S4 and pulmonary rates .There was no mortality in both groups. Conclusion: According to the results, we can use serum hs-CRP level for risk stratification in the patients with diagnosis of unstable angina. Obviously the patients with high serum hs-CRP level need more attention whether early invasive management help these patients, may be the matter of later studies.

  10. Correlation between C-Reactive Protein in Peripheral Vein and Coronary Sinus in Stable and Unstable Angina

    Energy Technology Data Exchange (ETDEWEB)

    Leite, Weverton Ferreira, E-mail: wfleite@cardiol.br [Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP (Brazil); Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP (Brazil); Ramires, José Antonio Franchini; Moreira, Luiz Felipe Pinho; Strunz, Célia Maria Cassaro [Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP (Brazil); Mangione, José Armando [Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP (Brazil)

    2015-03-15

    High sensitivity C-reactive protein (hs-CRP) is commonly used in clinical practice to assess cardiovascular risk. However, a correlation has not yet been established between the absolute levels of peripheral and central hs-CRP. To assess the correlation between serum hs-CRP levels (mg/L) in a peripheral vein in the left forearm (LFPV) with those in the coronary sinus (CS) of patients with coronary artery disease (CAD) and a diagnosis of stable angina (SA) or unstable angina (UA). This observational, descriptive, and cross-sectional study was conducted at the Instituto do Coração, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, and at the Hospital Beneficência Portuguesa de Sao Paulo, where CAD patients referred to the hospital for coronary angiography were evaluated. Forty patients with CAD (20 with SA and 20 with UA) were included in the study. Blood samples from LFPV and CS were collected before coronary angiography. Furthermore, analysis of the correlation between serum levels of hs-CRP in LFPV versus CS showed a strong linear correlation for both SA (r = 0.993, p < 0.001) and UA (r = 0.976, p < 0.001) and for the entire sample (r = 0.985, p < 0.001). Our data suggest a strong linear correlation between hs-CRP levels in LFPV versus CS in patients with SA and UA.

  11. Chinese patent medicine Xuefu Zhuyu capsule for the treatment of unstable angina pectoris: A systematic review of randomized controlled trials.

    Science.gov (United States)

    Yang, Xiaochen; Xiong, Xingjiang; Yang, Guoyan; Wang, Jie

    2014-04-01

    Xuefu Zhuyu Capsule (XFZY) has been commonly used for relieving chest pain in patients with coronary heart disease (CHD). Randomized controlled trials (RCTs) on XFZY in treating unstable angina (UA) have not been systematically reviewed. This study aims to provide a PRISMA-compliant systematic review to evaluate the efficacy of XFZY in treating UA. An extensive search of 7 medical databases was performed up to June 2013. RCTs involving XFZY or combined with conventional drugs versus conventional drugs were identified. Meta-analysis was performed to evaluate the cardiovascular effects of XFZY. Rev Man 5.0 was used for data analysis. 8 RCTs were included in this review. Statistical analysis of the results showed that XFZY combined with conventional drugs had significant effect on relieving angina symptoms (RR: 1.26 [1.16, 1.38]; P<0.00001) and improving ECG (RR: 1.20 [1.04, 1.38]; P=0.01) compared with conventional drugs alone. No severe adverse events were reported. XFZY combined with conventional drugs appears to have potential cardiovascular effects in treatment of UA with few adverse events. However, further rigorous designed trials are still needed. Copyright © 2014. Published by Elsevier Ltd.

  12. Assessment of coronary plaque characteristics by optical coherence tomography in patients with diabetes mellitus complicated with unstable angina pectoris.

    Science.gov (United States)

    Feng, Tian; Yundai, Chen; Lian, Chen; Zhijun, Sun; Changfu, Liu; Jun, Guo; Hongbin, Liu

    2010-12-01

    Diabetic patients are characterised by poorer prognosis and more cardiovascular complications compared with non-diabetic patients, which may be due to metabolic abnormalities and atherosclerotic plaque characteristics. Patients with unstable angina pectoris were enrolled in the study and divided into diabetes mellitus (DM) (patients, n=25; plaques, n=42) and non-DM (patients, n=53; plaques, n=65) groups according to their DM history. Optical coherence tomography (OCT) examinations were performed on all patients, and images were analysed by two independent investigators. Fibrous cap thickness was measured at the thinnest point of each plaque. The presence of plaque disruption, dissection, erosion, thrombosis and calcification were also noted. Calcified plaques in the DM group were significantly greater than those in the non-DM group (42.9% vs. 23.1%; p=0.03). Thin-cap fibroatheroma (TCFA) were detected, and no significant difference was found in the frequencies (42.9% vs. 52.3%; p=0.34) and fibrous cap thickness (57.08 ± 6.20 μm vs. 56.11 ± 9.23 μm, p=0.74) between the DM and non-DM groups. Thrombus and plaque erosion were similar in the two groups, but the frequency of dissection in the DM group was greater than that in the non-DM group (21.4% vs. 7.7%, p=0.04). The high sensitivity C-reactive protein between the two groups was similar (0.44 ± 0.20mg/dl vs. 0.46 ± 0.15 mg/dl, p=0.83). Higher calcification and dissection were detected in diabetic patients with unstable angina pectoris, and the difference in coronary plaque characteristics can explain the difference in clinical prognoses between DM and non-DM patients. Crown Copyright © 2010. Published by Elsevier Ireland Ltd. All rights reserved.

  13. Circulating CD36 and fractalkine levels are associated with vulnerable plaque progression in patients with unstable angina pectoris.

    Science.gov (United States)

    Li, Rui Jian; Yang, Ming; Li, Ji Fu; Xue, Li; Chen, Yu Guo; Chen, Wen Qiang

    2014-11-01

    The chemokine, fractalkine, independently enhances the vulnerability of coronary atherosclerotic plaques. The present study investigated the combined effects of CD36 and fractalkine on coronary plaque progression in patients with unstable angina pectoris. In the present study, 120 unstable angina pectoris patients undergoing coronary angiography and intravascular ultrasound were divided into two groups: an intermediate lesion group (lumen diameter stenosis 50-70%, 80 patients) and a severe lesion group (at least one lesion with lumen diameter stenosis > 70%, 40 patients). The control group consisted of 40 healthy age- and sex-matched subjects. Concentrations of CD36 and fractalkine were measured by enzyme-linked immunosorbent assay. Major adverse cardiovascular events were monitored over a 2-year follow up. Intravascular ultrasound showed that patients with severe lesions had more calcified and mixed plaques, and a larger plaque area and plaque burden than patients with intermediate lesions (P < 0.05-0.01). More patients with severe lesions underwent stent deployment (P < 0.05) than those with intermediate lesions. CD36 and fractalkine concentrations were significantly higher in the severe lesion patients (P < 0.05), and both had significant positive correlations (P < 0.05) with the plaque burden of atherosclerotic lesions. Using the matched nested case-control study, we found that CD36 and fractalkine levels were higher in patients with recurrent major adverse cardiovascular events than controls (P < 0.05). In conclusion, CD36 and fractalkine both promote, and might synergistically enhance, the progression of coronary atherosclerotic plaques. © 2014 Wiley Publishing Asia Pty Ltd.

  14. Role of multi-slice CT coronary angiography in evaluating the different patterns of coronary artery disease in patients with unstable angina

    Directory of Open Access Journals (Sweden)

    Gamal Eldine M. Niazi

    2015-09-01

    Conclusion: Non-invasive multi-slice CT coronary angiography is a reliable technique of high ability to detect coronary artery disease and estimate the degree of obstruction, number of affected arteries and the pattern of their affection and can be used in workup in patients with unstable angina.

  15. Elevated plasma levels of oxidized low-density lipoprotein relate to the presence of angiographically detected complex and thrombotic coronary artery lesion morphology in patients with unstable angina

    NARCIS (Netherlands)

    Yamashita, Hajime; Ehara, Shoichi; Yoshiyama, Minoru; Naruko, Takahiko; Haze, Kazuo; Shirai, Nobuyuki; Sugama, Yoshimi; Ikura, Yoshihiro; Ohsawa, Masahiko; Itabe, Hiroyuki; Kataoka, Toru; Kobayashi, Yoshiki; Becker, Anton E.; Yoshikawa, Junichi; Ueda, Makiko

    2007-01-01

    Increased levels of oxidized low-density lipoprotein (ox-LDL) are related to plaque instability, so the aim of the present study was to investigate whether there is a relationship between angiographic coronary plaque morphology in patients with unstable angina pectoris (UAP) and the level of ox-LDL.

  16. Manual Thrombus Aspiration and the Improved Survival of Patients With Unstable Angina Pectoris Treated With Percutaneous Coronary Intervention (30 Months Follow-Up).

    Science.gov (United States)

    Yildiz, Bekir S; Bilgin, Murat; Zungur, Mustafa; Alihanoglu, Yusuf I; Kilic, Ismail D; Buber, Ipek; Ergin, Ahmet; Kaftan, Havane A; Evrengul, Harun

    2016-02-01

    The clinical effect of intracoronary thrombus aspiration during percutaneous coronary intervention in patients with unstable angina pectoris is unknown. In this study, we aimed to assess how thrombus aspiration during percutaneous coronary intervention affects in-hospital and 30-month mortality and complications in patients with unstable angina pectoris.We undertook an observational cohort study of 645 consecutive unstable angina pectoris patients who had performed percutaneous coronary intervention from February 2011 to March 2013. Before intervention, 159 patients who had culprit lesion with thrombus were randomly assigned to group 1 (thrombus aspiration group) and group 2 (stand-alone percutaneous coronary intervention group). All patients were followed-up 30 months until August 2015.Thrombus aspiration was performed in 64 patients (46%) whose cardiac markers (ie, creatinine kinase [CK-MB] mass and troponin T) were significantly lower after percutaneous coronary intervention than in those of group 2 (CK-MB mass: 3.80 ± 1.11 vs 4.23 ± 0.89, P = 0.012; troponin T: 0.012 ± 0.014 vs 0.018 ± 0.008, P = 0.002). Left ventricular ejection fraction at 6, 12, and 24 months postintervention was significantly higher in the group 1. During a mean follow-up period of 28.87 ± 6.28 months, mortality rates were 6.3% in the group 1 versus 12.9% in the group 2. Thrombus aspiration was also associated with significantly less long-term mortality in unstable angina pectoris patients (adjusted HR: 4.61, 95% CI: 1.16-18.21, P = 0.029).Thrombus aspiration in the context of unstable angina pectoris is associated with a limited elevation in cardiac enzymes during intervention that minimises microembolization and significantly improves both of epicardial flow and myocardial perfusion, as shown by angiographic TIMI flow grade and frame count. Thrombus aspiration during percutaneous coronary intervention in unstable angina pectoris patients has better

  17. Estratificando o risco na angina instável com a ecocardiografia sob estresse com dobutamina Stratifying the risk in unstable angina with dobutamine stress echocardiography

    Directory of Open Access Journals (Sweden)

    Brivaldo Markman Filho

    2006-09-01

    Full Text Available OBJETIVO: Avaliar a importância da ecocardiografia sob estresse pela dobutamina (EED na estratificação de risco de pacientes com angina instável (AI de baixo a moderado risco, quanto à capacidade de predizer os eventos clínicos combinados (morte de causa cardiovascular, infarto agudo do miocárdio (IAM, AI recorrente, necessidade de revascularização miocárdica no seguimento de 6 meses. MÉTODOS: Estudo prospectivo, multicêntrico. Os pacientes incluídos estavam internados, assintomáticos havia 24 horas e a medicação em uso não era suspensa para a realização do exame. O EED era realizado preferencialmente até 72 horas da chegada ao hospital. RESULTADOS: Foram avaliados 95 pacientes consecutivos. O EED foi positivo para isquemia em 40 pacientes (42,1% e em 55 (57,9%, foi negativo. Eventos ocorreram em 28 pacientes, 26 dos quais tinham o EED positivo para isquemia miocárdica. Os outros 67 pacientes não tiveram eventos; desses, 53 tinham o EED negativo. A sensibilidade, especificidade, acurácia, valor preditivo positivo e negativo do teste frente aos desfechos foram: 92,9%, 79,1%, 83,2%, 65% e 96,4%, respectivamente. Sobrevida livre de eventos após 6 meses para os pacientes com EED negativo foi de 96%, comparada com 35% nos que tiveram o EED positivo (pOBJECTIVE: To evaluate the role of dobutamine stress echocardiography (DSE in the risk stratification of low to moderate risk unstable angina (UA patients, to predict the combined clinical outcome of cardiovascular death, myocardial infarction (MI, recurrent UA and the need of revascularization procedures in a 6 month period. METHODS: Multicenter prospective study. Patients should be admitted to the hospital and asymptomatic in the last 24 hours. The exam was performed up to 72 hours from the hospital admission and no medication was stopped prior to the test. RESULTS: Ninety-five consecutive patients were evaluated by DSE. Forty patients (42,1% had a positive ischemic test and

  18. A new method to quantify coronary calcification by intravascular ultrasound - the different patterns of calcification of acute myocardial infarction, unstable angina pectoris and stable angina pectoris.

    Science.gov (United States)

    Wang, Xiaofei; Lu, Chengzhi; Chen, Xin; Zhao, Xiangdong; Xia, Dasheng

    2008-11-01

    Intravascular ultrasound (IVUS) enables the identification of calcification with more details and quantification of calcification, but there is not a proper method to quantify the calcification with IVUS. Previous IVUS studies used arc or length of calcium, respectively, to quantify calcification, but calcium is determined by a combination of arc and length. We devised a new method to quantify calcium as arc area (AA) in the present study, and AA is two-dimensional and irrelevant to vessel size. We selected 201 patients with stable angina pectoris (SAP), unstable angina pectoris (UAP), or acute myocardial infarction (AMI) who underwent IVUS imaging of a de novo native atherosclerotic lesion considered to be the culprit lesion before percutaneous coronary intervention between December 2001 and December 2007. The culprit lesion site for analysis was the 10 mm-long segment including the smallest lumen cross-sectional area. The arc of each calcium deposit in each image was measured with a protractor centered on the lumen and the length of each calcium deposit was calculated with the number of images containing the calcium deposit minus 1, then multiplying 0.5 mm (the images were 0.5 mm apart). Finally, the AA was calculated by arc (degree) multiplying length (mm). The average number of calcium deposits in the culprit lesions of patients with acute myocardial infarction (AMI) was significantly larger than patients with SAP or UAP, and the number of calcium deposits of patients with SAP or UAP was almost the same (mean +/- SD, AMI 2.21 +/- 1.98, SAP 1.15 +/- 1.01, UAP 1.20 +/- 1.15, AMI versus SAP or UAP; p < 0.0005). The average AA per calcium deposit was significantly different in culprit lesions of patients with SAP and UAP or AMI, the calcium deposits were bigger in SAP than in UAP or AMI, and there were no differences between UAP and AMI (mean +/- SD, SAP 788.6 +/- 767.0 degree x mm, UAP 136.6 +/- 189.3 degree x mm, AMI 148.4 +/- 217.1 degree x mm, SAP versus UAP or

  19. Application of current guidelines to the management of unstable angina and non-ST-elevation myocardial infarction.

    Science.gov (United States)

    Braunwald, Eugene

    2003-10-21

    Unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) is a common but heterogeneous disorder with patients exhibiting widely varying risks. Early risk stratification is at the center of the management program and can be achieved using clinical criteria and biomarkers, or a combination. In addition to anti-ischemic therapy and aspirin, the thienopyridine clopidogrel is indicated except in patients who are potential candidates for urgent coronary artery bypass grafting (CABG). Platelet glycoprotein (GP) IIb/IIIa antagonists are indicated in high-risk patients likely to undergo percutaneous coronary intervention (PCI) but are not indicated in the management of lower-risk patients who do not undergo PCI. There is a growing body of evidence to support the substitution of the low-molecular-weight heparin (LMWH) enoxaparin for unfractionated heparin (UFH). Three recent trials have demonstrated the benefit of an early invasive strategy with catheterization followed by revascularization in patients at high and intermediate risk. Lower-risk patients should undergo early noninvasive stress testing. An intensive program of secondary prevention is mandatory and should be begun before hospital discharge.

  20. Identification and characterization of novel serum microRNAs in unstable angina pectoris and subclinical atherosclerotic patients.

    Science.gov (United States)

    Sun, Qiyu; Jia, Xingwang; Gao, Jing; Zhang, Pengjun; Mou, Wenjun; Yang, Caie; Tong, Hongli; Wen, Xinyu; Tian, Yaping

    2015-05-01

    MicroRNAs (miRNAs) are involved in cardiac developmental and pathological processes, and serum profile is useful for identifying novel miRNAs. Serum samples were collected from unstable angina pectoris (UAP) and subclinical atherosclerotic (AS) patients. Solexa sequencing was used to predict novel miRNAs in 15 control individuals, 15 AS patients and 15 UAP patients. After bioinformatics analysis and filtering out in the newest version of miRbase (version 20.0), three novel miRNAs were validated in 80 control individuals, 80 AS patients and 80 UAP patients by quantitative reverse transcriptase polymerase chain reaction. Two of the three novel microRNAs (N1 and N3) were expressed at the highest levels in the AS group. N1 had an area under curve (AUC) of 0.811 (95% confidence interval 0.743-0.880) for AS. N3 showed a moderate separation with an area under curve (AUC) of 0.748 (95% confidence interval 0.664-0.833) for AS. Combined the two novel microRNAs can significantly distinguish AS from control. Three novel miRNAs were identified by Solexa sequencing and two of them may be new potential predictors for arthrosclerosis. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs. major adverse cardiac events.

    Science.gov (United States)

    Schlett, Christopher L; Nance, John W; Schoepf, U Joseph; O'Brien, Terrence X; Ebersberger, Ullrich; Headden, Gary F; Hoffmann, Udo; Bamberg, Fabian

    2014-07-01

    CT angiography (CTA) has prognostic value in patients. But it is unknown whether differences in atherosclerosis by CTA predict the development of unstable angina pectoris (UAP) vs. major adverse cardiac events (MACE). We followed patients undergoing CTA as part of their acute chest pain work-up. Primary outcome was the development of UAP or MACE (cardiac death, myocardial infarction, revascularization) during a minimum follow-up of 12-months. CTAs were assessed for extent and composition of coronary plaque and stenosis. Ordinal regression with a 3-level outcome (no events, UAP, MACE) was applied. Among 315 patients, 22 developed UAP and 31 MACE. While UAP patients had higher atherosclerosis burden with respect to all assessed features compared to patients with no events (p ≤ 0.02), only mixed plaque extent was significantly different between UAP and MACE patients (p=0.02). The odds ratio was 4.55 for being in a higher disease-level comparing patients with low extent to those with no mixed plaque, and 3.02 comparing patients with high to those with low. These findings remained after adjustments for potential confounders. The extent of mixed coronary plaque is different between patients who develop UAP vs. MACE, supporting the hypothesis that it is a more culprit morphology. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. [Association study between Chinese medicine blood stasis syndrome and TIMI risk stratification of patients with unstable angina pectoris].

    Science.gov (United States)

    Qian, Wei; Zhao, Fu-hai; Shi, Da-zhuo; Wu, Wei; You, Shi-Jie

    2013-08-01

    To study the correlation between thrombolysis in myocardial infarction (TIMI) risk stratification and blood stasis syndrome (BSS) score in patients with unstable angina pectoris (UAP), and to analyze the relation of BBS degree and UAP clinical outcomes. Collected were general data, demographic data, risk factors, Chinese medical symptoms and syndromes, coronary artery angiography results, relevant physical and chemical examinations from 114 UAP inpatients. Gensini score, TIMI risk score, and BSS score of these patients were calculated. The BBS score and Gensini score were significantly positively correlated (r = 0.78, P < 0.01). The BBS score was significantly higher in those with lesion in three branches than those with lesion in one branch or in two branches (P < 0.05). The BBS score was significantly higher in the high risk group than in the lower risk group and the medium risk group (P < 0.01). The TIMI risk score was obviously higher in the severe blood stasis group than in the moderate blood stasis group and the mild blood stasis group (P < 0. 05, P < 0.01). The BBS score and TIMI risk score was positively correlated (r = 0.23, P < 0.05). The BBS score was positively correlated with more coronary arteries involved. The more severe BBS degree, the TIMI risk score more higher, and the BBS degree more syndrome.

  3. Effect of PCI on inflammatory factors, cTnI, MMP-9 and NT-pro BNP in patients with unstable angina pectoris

    Directory of Open Access Journals (Sweden)

    Ke-Tong Liu

    2016-05-01

    Full Text Available Objective: To investigate the effect of PCI on inflammatory factors, cTnI, MMP-9and NTpro BNP in patients with unstable angina pectoris. Methods: A total of 80 unstable angina pectoris patients were divided into observation group (40 cases and control group (40 cases. The observation group was given the therapy of PCI, and the control group was given coronary angiography. To observe the of inflammatory factors, cTnI, MMP-9 and NT-pro BNP were tested and compared before and after operation. Results: At 24 h after operation, CRP and IL-18 levels were increased significantly after treatment inoperation groups, there was no difference on inflammatory factors in control group, and had significant difference on inflammatory factors in two groups; At 24 h after operation, cTnI, MMP-9 and NT-pro BNP levels were increased significantly after treatment inoperation groups, there was no difference on inflammatory factors in control group, and had significant difference on inflammatory factors in two groups. Conclusion: PCI therapy can induce inflammation and myocardial injury in patients with unstable angina pectoris.

  4. Trends in time to invasive examination and treatment from 2001 to 2009 in patients admitted first time with non-ST elevation myocardial infarction or unstable angina in Denmark

    DEFF Research Database (Denmark)

    Mårtensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva

    2014-01-01

    OBJECTIVE: To investigate trends in time to invasive examination and treatment for patient with first time diagnosis of non-ST elevation myocardial infarction (NSTEMI) and unstable angina during the period from 2001 to 2009 in Denmark. DESIGN: From 1 January 2001 to 31 December 2009 all first time...... hospitalisations with NSTEMI and unstable angina were identified in the National Patient Registry (n=65 909). Time from admission to initiation of coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was calculated. We described the development in invasive...... increased substantially over time while the proportion receiving a CABG decreased for both NSTEMI and unstable angina. For both NSTEMI and unstable angina, a significant increase in invasive examination and treatment probability at 3 days for CAG and PCI were seen especially from 2007 through to 2009...

  5. [Management of unstable angina: advanced age is still an independent predictive factor of more conservative management after prognostic stratification with stress test].

    Science.gov (United States)

    Moreno, R; García, E; Cantalapiedra, J L; Ortega, A; López de Sá, E; López-Sendón, J L; Delcán, J L

    2000-07-01

    In the management of ischemic heart disease, elderly patients constitute a subgroup that, despite having a worse prognosis, are usually managed more conservatively. The objective of this study was to evaluate if, in the management of unstable angina, a more conservative attitude in elderly patients is maintained after stratification by exercise test. The study population is constitude by 859 patients admitted to hospital due to suspected unstable angina that were referred to exercise test after medical stabilization. The management (invasive versus conservative, according to submission to cardiac catheterization or not) of patients was retrospectively studied, comparing patients 70 years-of age. Out of the 859 patients, 156 (18%) were > 70 years old, and the exercise test was positive in 281 (33%). Cardiac catheterization was performed in 494 (57%): 62% in older and 38% in younger patients (p management were: a negative exercise test, > 85% of the maximum heart rate, duration of exercise test more than 6 minutes, female gender, smoking and absence of episodes of rest angina. In the multivariate analysis, the statistically significant characteristics associated with an invasive management were the result of the exercise test (OR for positive result: 4.50; IC 95% = 2.73-7.63; p or = 6 minutes: 0.51; IC 95% = 0.29-0.88; p = 0.0177), the percentage of the maximum heart rate (OR for > or = 85%: 0.65; IC 95% = 0.42-0.98; p = 0.0391) and age (OR for > 70 years 0.36; IC 95% = 0.20-0.62; p = 0.0004). In the management of unstable angina, elderly patients constitute a more conservatively managed subgroup even after risk stratification with exercise test.

  6. Differences in coronary artery disease by CT angiography between patients developing unstable angina pectoris vs. major adverse cardiac events

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, Christopher L. [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg (Germany); Nance, John W. Jr. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD (United States); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); O’Brien, Terrence X. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (United States); Ebersberger, Ullrich [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Department of Cardiology and Intensive Care Medicine, Heart Centre Munich-Bogenhausen, Munich (Germany); Headden, Gary F. [Heart and Vascular Center, Medical University of South Carolina, Charleston, SC (United States); Hoffmann, Udo [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Bamberg, Fabian [Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (United States); Department of Radiology, University of Munich, Grosshadern Campus, and Munich Heart Alliance, Munich (Germany); Department of Radiology, University of Tuebingen (Germany)

    2014-07-15

    Highlights: • Patients developing UAP had overall more atherosclerosis as patients without any events. • Patients developing MACE had only more mixed plaque as those developing UAP. • Different atherosclerotic plaque components by CTA carry different prognostic value. - Abstract: Objective: CT angiography (CTA) has prognostic value in patients. But it is unknown whether differences in atherosclerosis by CTA predict the development of unstable angina pectoris (UAP) vs. major adverse cardiac events (MACE). Methods: We followed patients undergoing CTA as part of their acute chest pain work-up. Primary outcome was the development of UAP or MACE (cardiac death, myocardial infarction, revascularization) during a minimum follow-up of 12-months. CTAs were assessed for extent and composition of coronary plaque and stenosis. Ordinal regression with a 3-level outcome (no events, UAP, MACE) was applied. Results: Among 315 patients, 22 developed UAP and 31 MACE. While UAP patients had higher atherosclerosis burden with respect to all assessed features compared to patients with no events (p ≤ 0.02), only mixed plaque extent was significantly different between UAP and MACE patients (p = 0.02). The odds ratio was 4.55 for being in a higher disease-level comparing patients with low extent to those with no mixed plaque, and 3.02 comparing patients with high to those with low. These findings remained after adjustments for potential confounders. Conclusion: The extent of mixed coronary plaque is different between patients who develop UAP vs. MACE, supporting the hypothesis that it is a more culprit morphology.

  7. Changes of dendritic cells and fractalkine in type 2 diabetic patients with unstable angina pectoris: a preliminary report.

    Science.gov (United States)

    Yao, Kang; Lu, Hao; Huang, Rongchong; Zhang, Shuning; Hong, Xiaowu; Shi, Hongyu; Sun, Aijun; Qian, Juying; Zou, Yunzeng; Ge, Junbo

    2011-06-10

    It has been shown that dendritic cells (DCs) and fractalkine play a role in accelerating progression of the inflamed atherosclerotic lesions and plaque rupture. We evaluated the numbers and functional changes of DCs and its subsets in human type 2 diabetes with or without unstable angina pectoris (UAP). The study population consisted of 39 diabetic patients (DM:18 without CAD; DM + UAP: 21 with UAP), 18 non-diabetic UAP patients (UAP), and 15 healthy control (Normal). Peripheral blood DCs and its subsets were measured by three color flow cytometry. Serum levels of fractalkine, IL-12, and IFN-α were also measured. The functional status of the monocyte-derived DCs was analyzed by flow cytometry and allogeneic mixed T lymphocytes reaction. The percent and absolute numbers of DCs and mDC within the total leukocyte population was similar for Normal and DM, while significantly lower in DM + UAP. pDC numbers were not significantly altered. Serum fractalkine in DM + UAP was highest among the four groups (p = 0.04 vs. UAP, p = 0.0003 vs. DM, p < 0.0001 vs. Normal). Circulating mDC inversely correlated with serum fractalkine (r = -0.268, p = 0.01) level. Compared with DM and UAP, the costimulatory molecules CD86 and proliferation of T cells stimulated by DCs were significantly increased in DM + UAP group. Our study suggested that increases in the fractalkine level and the number and functional changes of blood DCs might contribute to diabetic coronary atherosclerosis and plaque destabilization.

  8. Serum Uric Acid Could Differentiate Acute Myocardial Infarction and Unstable Angina Pectoris in Hyperuricemic Acute Coronary Syndrome Patients.

    Science.gov (United States)

    Hasic, Sabaheta; Kadic, Damira; Kiseljakovic, Emina; Jadric, Radivoj; Spahic, Emina

    2017-04-01

    Serum uric acid (SUA) is the final product of purine metabolism in humans. The present study aimed to identify a potential association between serum UA and cardiac troponin I (cTnI) levels and to find out whether uric acid could differentiate patients presenting with the acute myocardial infarction (AMI) and unstable angina pectoris (UAP) in hyperuricemic and normouricemic acute coronary syndrome (ACS) patients. Eighty ACS patients, aged 50-83 years, were enrolled in the study, 40 of them presenting with AMI and 40 with UAP. Frequency of patients with serum uric level over threshold for hyperuricemia was investigated and two groups of patients were formed such as hyperuricemic and normouricemic groups (A and B groups, respectively) independently of type of ACS. Those groups of patients were also subjected to cTnI measurement. Levels of SUA are associated with the type of ACS in the hyperuricemic ACS patients (AMI versus UAP, 499(458-590), 425(400-447) mmol/L, p=0.007, respectively). Uric acid correlated significantly with cTnI, moderate positively in the group A (rho=0.358, p=0.038) and moderate negatively in the group B (r=-0.309, p=0.037) of ACS patients. Multiple logistic regression analysis revealed that cTnI and age were independently associated with the SUA levels in the group A of ACS patients. Serum uric acid differentiates AIM and UAP patients in hyperuricemic group of acute coronary syndrome. Therefore it can be used as nonspecific parameter for evaluation of the myocardial lesion extent only in hyperuricemic ACS patients. This is supported by finding that cTnI along with age predicts SUA level in hyperuricemic ACS patients.

  9. Effect of Yixinkangtai Capsule combined with diltiazem on endothelial function, blood viscosity and lipid metabolism in patients with unstable angina pectoris

    Directory of Open Access Journals (Sweden)

    Yu-Feng Yuan

    2017-10-01

    Full Text Available Objective: To discuss the effect of Yixinkangtai Capsule combined with diltiazem on endothelial function, blood viscosity and lipid metabolism in patients with unstable angina pectoris. Methods: A total of 150 patients with unstable angina pectoris who were treated in the hospital between February 2014 and February 2017 were divided into the control group (n=75 and the research group (n=75 according to the random number table method. Control group received clinical conventional therapy, research group received Yixinkangtai Capsule combined with diltiazem therapy on the basis of conventional therapy, and both groups received 3 months of treatment. Differences in endothelial function, blood viscosity and lipid metabolism were compared between the two groups of patients before and after treatment. Results: Before treatment, the differences in serum levels of endothelial function indexes, blood viscosity indexes and lipid metabolism indexes were not statistically significant between the two groups. After 3 months of treatment, serum NO level of research group was higher than that of control group while ET-1 level was lower than that of control group; serum blood viscosity index TXB2 content of research group was lower than that of control group while PGI2 content was higher than that of control group; serum lipid metabolism indexes TG, TC and LDL-C contents of research group were lower than those of control group while HDL-C content was higher than that of control group. Conclusion: Yixinkangtai Capsule combined with diltiazem therapy can effectively optimize the endothelial function, reduce the blood viscosity and balance the lipid metabolism in patients with unstable angina pectoris.

  10. Comparison of long-term mortality after percutaneous coronary intervention in patients treated for acute ST-elevation myocardial infarction versus those with unstable and stable angina pectoris.

    Science.gov (United States)

    Hirsch, Alexander; Verouden, Niels J W; Koch, Karel T; Baan, Jan; Henriques, José P S; Piek, Jan J; Rohling, Wim J; van der Schaaf, Rene J; Tijssen, Jan G P; Vis, Marije M; de Winter, Robbert J

    2009-08-01

    Data remain limited regarding the comparative long-term mortality across the spectrum of patients with different indications for percutaneous coronary intervention (PCI). We evaluated early and late mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI compared with early and late mortality in patients undergoing PCI for unstable angina (UA) or non-STEMI (NSTEMI) and stable angina. A total of 10,549 consecutive patients undergoing PCI from 1997 to 2005 at a single institution were followed up prospectively (median 3.2 years, interquartile range 1.5 to 5.6) to assess all-cause mortality. The indication for PCI was STEMI in 28%, UA/NSTEMI in 32%, and stable angina in 40%. The mortality rate at 6 years was 18.9% in patients with STEMI, 16.2% in patients with UA/NSTEMI, and 11.7% in those with stable angina. During the initial 6 months, patients with STEMI had an increased risk of death compared with patients with UA/NSTEMI (relative risk [RR] 3.09, 95% confidence interval [CI] 2.46 to 3.89) and stable angina (RR 5.82, 95% CI 4.45 to 7.62). However, between 6 months and 6 years, mortality accrued at an almost similar rate among patients with STEMI and those with stable angina (RR 1.06, 95% CI 0.86 to 1.32) and mortality was greatest in patients with UA/NSTEMI (UA/NSTEMI vs stable angina: RR 1.33, 95% CI 1.11 to 1.58; STEMI vs UA/NSTEMI: RR 0.80, 95% CI 0.65 to 0.99). In conclusion, we have demonstrated that the inferior survival rates in patients with STEMI after primary PCI are mainly attributed to greater mortality in the first months after the event. These observations highlight that new adjunctive therapeutic strategies should aim at mortality reduction in the first months after primary PCI.

  11. Statin Treatment by Low-Density Lipoprotein Cholesterol Levels in Patients With Non-ST-Segment Elevation Myocardial Infarction/Unstable Angina Pectoris (from the CRUSADE Registry).

    Science.gov (United States)

    O'Brien, Emily C; Simon, DaJuanicia N; Roe, Matthew T; Wang, Tracy Y; Peterson, Eric D; Alexander, Karen P

    2015-06-15

    Elevated low-density lipoprotein cholesterol (LDL-C) is associated with increased risk of myocardial infarction and is a target for disease prevention. The association between initial LDL-C and statin treatment in patients with non-ST-segment elevation myocardial infarction (NSTEMI)/unstable angina pectoris (UAP) has not been well characterized. We explored detailed LDL-C levels and statin treatment in 22,938 patients with NSTEMI/UAP enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines Registry (2003 to 2006). Patients reporting home statin use or previous cardiovascular disease were excluded. We examined statin receipt at discharge across 4 categories of baseline LDL-C: very low (130 mg/dl). In conclusion, >1/3 of patients with NSTEMI/UAP had an LDL-C level <100. Those with low LDL-C were older, had more co-morbidities, and were less likely to be prescribed a statin at discharge than those with higher LDL-C. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Comparison of resting {beta}-methyl-iodophenyl pentadecanoic acid (BMIPP) and thallium-201 tomography using quantitative polar maps in patients with unstable angina

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Akio; Takada, Yasuo; Nagasaka, Makoto; Kato, Rinya; Watanabe, Toshiya; Shimokata, Keiko; Yasui, Shoji [Nagoya National Hospital, Aichi (Japan)

    1997-02-01

    We compared resting {beta}-methyl-iodophenyl pentadecanoic acid (BMIPP) tomography with resting thallium-201 tomography in 28 patients with unstable angina. Tracer distribution was displayed on a polar map and compared with a normal standard deviation map obtained from a group of 12 normal subjects. The extent scores and severity scores obtained by BMIPP were significantly greater than those obtained by thallium-201. Confirmation by coronary angiography revealed the sensitivity of the methods in identifying patients to be 89% for BMIPP and 54% for thallium-201. There were significant differences between BMIPP and thallium-201 in the sensitivities of detecting postischemic jeopardized myocardium in the area supplied by the right coronary artery (RCA; 53% vs 18%, p<0.05), left circumflex artery (LCX; 78% vs 39%, p<0.025) and all 3 vessels combined (71% vs 35%, p<0.001) but no significant differences in specificity (RCA: 82% vs 64%; LCX: 70% vs 90%; and total 3 vessels combined: 75% vs 79%). In conclusion, resting BMIPP tomography is more sensitive than resting thallium-201 tomography in detecting postischemic myocardial damage in patients with unstable angina. (author)

  13. The role of leukocyte counts in patients with unstable angina pectoris or myocardial infarction; prognostic significance and correlation with plasma brain natriuretic peptide (BNP) levels.

    Science.gov (United States)

    Akhtar, Naveed; Adil, Malik Muhammad; Ahmed, Waqas; Habib-ur-Rehman; Shahs, Mumtaz Ali

    2011-01-01

    To study the role of leukocyte count in patients with unstable angina pectoris or myocardial infarction (Acute Coronary Syndrome) its prognostic significance and correlation with plasma brain natriuretic peptide (BNP) levels. A total of 143 Patients with unstable angina pectoris, non-ST segment elevation MI and ST segment elevation MI were considered for entry into the study. Plasma BNP levels were measured using a commercial BNP kit (AxSym System BNP Reagent Pack, Abbott Laboratories, Abbott Park, IL, USA). Leukocyte count was measured on CELL DYNE counter of Abbott Laboratories. Mean age of the patients were 58.67 +/- 12.48 years. Mean leukocyte count was 9772 +/- 3006 /cumm. In all 43 (30%) patients had high leukocyte count, and 82 (57%) patients had elevated BNP level. Out of 61 patients with normal BNP level, 49 (80%) had normal leukocyte count and 12 (20%) had elevated leukocyte count. Out of 82 patients with elevated BNP level, 51 (62%) had normal leukocyte count and 31 (38%) had elevated leukocyte count (P = 0.01). No statistically significant association was found between Leukocyte count and ACS. Although there is a trend of increased Leukocyte count noted in patients with increase BNP level. This finding necessitates further studies to elucidate its accurate significance.

  14. [The prehospital diagnosis of unstable angina pectoris in case of a mid-urbanized town of West Siberia: results of a population-based study].

    Science.gov (United States)

    Ziablov, Iu I; Okrugin, S A; Garganeeva, A A

    2013-01-01

    To assess the prehospital diagnosis of unstable angina pectoris (UAP) in the population of a mid-urbanized town in West Siberia. The study was conducted using the WHO epidemiological program "The acute myocardial infarction registry" that had been implemented in Tomsk since 1984. All the registered patients aged 20 to 70 years who had been diagnosed as having unstable (progressive) angina pectoris before admission to hospital and after its discharge were examined. A total of 2760 cases of suspected UAP were registered over the 2-year study period. 2139 (77.5%) patients were examined, which allows the findings to be considered to be significant. UAP was verified in 1477 (69.1%) patients. During the follow-up period, 1175 (79.5%) of the examined patients sought medical advice for acute UAP, most did at an emergency care station and regional polyclinics. The detection rate of the disease was 82.4% during the primary examination. In accordance with the diagnosis made, 65.48% of the patients were sent to hospital, including 81.42% who were to the therapy hospitals operating around the clock. 406 subjects were non-hospitalized; of them 313 (77.09%) refused hospitalization; in this connection, they were referred for a cardiology dispensary to receive outpatient treatment. The prehospital diagnosis of UAP was found to have a rather high level while only every five patients with verified UAP were admitted to a specialized hospital.

  15. Does access to invasive examination and treatment influence socioeconomic differences in case fatality for patients admitted for the first time with non-ST-elevation myocardial infarction or unstable angina?

    DEFF Research Database (Denmark)

    Mårtensson, Solvej; Gyrd-Hansen, Dorte; Prescott, Eva

    2016-01-01

    Aims: Our aim was to investigate whether there is social inequality in access to invasive examination and treatment, and whether access explains social inequality in case fatality in a nationwide sample of patients admitted for the first time with unstable angina or non-ST-elevation myocardial...... infarction (NSTEMI) in Denmark. Methods and results: All patients admitted for the first time with NSTEMI (n=16,625) or unstable angina (n=8,800) from 2001 to 2009 in Denmark were included. We measured time from admission to coronary angiography (CAG), percutaneous coronary intervention (PCI) or coronary...... artery bypass graft (CABG). The outcomes were 30-day and one-year case fatality. We found social inequality in access to CAG and one-year case fatality for both NSTEMI and unstable angina patients, but the time waited for CAG did not explain the social inequality in case fatality. Conclusions: Despite...

  16. [Effects of different statins, ezetimibe/simvastatin combination on hsCRP levels in unstable angina pectoris and non-ST elevation myocardial infarction patients: a randomized trial].

    Science.gov (United States)

    Namal, Esat; Sener, Nur; Ulaş, Turgay; Akçalı, Zafer; Oztekin, Erkan; Borlu, Fatih

    2011-12-01

    The aim of our study was to evaluate the effects of two different statins and a statin/ezetimibe combination on high sensitive C-reactive protein (hsCRP) values, which were given at high doses in the early period of acute coronary syndromes. A total of 150 patients with non-ST elevation myocardial infarction and unstable angina pectoris were enrolled to our prospective, randomized, single-blind study. Patients were divided into three groups by block randomization method. One group received 20 mg/day atorvastatin, one group received 10 mg/day rosuvastatin and the other group received 10 mg/day ezetimibe/simvastatin combination therapy, which was initiated within the first 24 hours of admission. Follow-up duration was 2 months . Biochemical investigations and hsCRP levels (by nephelometric method) were performed with 138 patients evaluated at baseline, 10th and 60th days of therapy. Decreases of hsCRP levels were analyzed with one-way MANOVA and repeated measures of ANOVA methods. Post-hoc Tukey HSD test was performed for finding the different group, when the difference was detected between the groups. Tenth day hsCRP levels in ezetimibe/simvastatin group was significantly lower than the other groups (punstable angina and non ST elevation myocardial infarction.

  17. Predictive value of neutrophil to lymphocyte ratio in clinical outcomes of non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up.

    Science.gov (United States)

    Gul, Mehmet; Uyarel, Huseyin; Ergelen, Mehmet; Ugur, Murat; Isık, Turgay; Ayhan, Erkan; Turkkan, Ceyhan; Aksu, Hale Unal; Akgul, Ozgur; Uslu, Nevzat

    2014-05-01

    We sought to determine the prognostic value of neutrophil to lymphocyte ratio (NLR) in non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). A total of 308 (mean age 59.22 ± 11.93) patients with NSTEMI and UAP were prospectively evaluated. The study population was divided into tertiles based on admission NLR values. The patients were followed for clinical outcomes for up to 3 years after discharge. In the Kaplan-Meier survival analysis, 3-year mortality was 21.6% in patients with high NLR versus 3% in the low-NLR group (P 3.04 yielded a sensitivity of 79% and specificity of 71%. Admission NLR is the strong and independent predictor of a 3-year cardiovascular mortality in patients with NSTEMI and UAP.

  18. Usefulness of exercise electrocardiography and thallium scintigraphy in unstable angina pectoris in predicting the extent and severity of coronary artery disease

    International Nuclear Information System (INIS)

    Freeman, M.R.; Chisholm, R.J.; Armstrong, P.W.

    1988-01-01

    The safety and efficacy of exercise electrocardiography and thallium scintigraphy early in the course of unstable angina pectoris were assessed 4.6 +/- 1.6 days after admission in 67 patients with unstable angina that stabilized after medical therapy. Coronary arteriography was performed in all patients 5.4 +/- 2.4 days after admission. There was no difference in clinical, exercise or scintigraphic variables between patients with stenoses less than 50% and patients with 1-vessel coronary artery disease (CAD) defined as a diameter stenosis greater than or equal to 50%. Patients with 3-vessel CAD had a significantly shorter exercise duration than patients with less than 50%-diameter narrowing (5.5 +/- 2.2 vs 8.3 +/- 3.3 minutes, respectively), lower exercise heart rate (119 +/- 20 vs 149 +/- 22 beats/min) and systolic blood pressure (156 +/- 29 vs 166 +/- 33 mm Hg), more frequent chest pain (76 vs 20%) and more pronounced ST depression (-1.48 +/- 1.37 vs -0.33 +/- 0.72 mm). In addition, thallium defect size on exercise was greater in the patients with 2-vessel CAD (159 +/- 132 degrees) and 3-vessel CAD (255 +/- 132 degrees) than in patients with no CAD (28 +/- 319 degrees) or 1-vessel CAD (73 +/- 78 degrees), p greater than or equal to 0.05. Multiple regression analysis demonstrated that thallium defect size was the best predictor of extent of CAD, with exercise heart rate and presence of chest pain during exercise also predictive of extent of CAD

  19. Effects of trimetazidine on periprocedural microRNA-21 expression by CD4+ T lymphocytes in patients with unstable angina pectoris.

    Science.gov (United States)

    Su, Qiang; Li, Lang; Zhao, Jinmin; Sun, Yuhan; Yang, Huafeng

    2017-12-01

    Post-percutaneous coronary intervention (PCI) myocardial injury is related to the CD4+ T lymphocyte-mediated inflammatory response. microRNA-21 expression is associated with CD4+ T lymphocyte activation. The pre-PCI use of trimetazidine prevents periprocedural myocardial injury and reduces inflammatory cytokine levels. This study aimed to assess the effects of trimetazidine on periprocedural microRNA-21 expression by CD4+ T lymphocytes in patients with unstable angina pectoris. A total of 252 patients with unstable angina pectoris were randomized to the trimetazidine (60 mg/d, administered 3 days before PCI, n=128) and control (no trimetazidine, n=124) groups. Serum CK-MB, cTnI, and hs-CRP levels were tested pre-PCI and 16-24 h post-PCI. Peripheral blood CD4+ T lymphocytes were isolated by magnetic activated cell sorting. Quantitative polymerase chain reaction was used to assess microRNA-21 and PDCD4 mRNA expression levels in CD4+ T lymphocytes, and western blot was used to evaluate PDCD4 protein expression. Enzyme-linked immunosorbent assay was used to assess serum TNF-α and IL-10 levels. Compared with the control group, the trimetazidine group had a lower frequency of patients with post-PCI serum CK-MB and cTnI levels higher than normal values; the trimetazidine group had also significantly lower serum hs-CRP and TNF-α levels, and higher IL-10 levels post-PCI. Finally, the trimetazidine group had significantly lower PDCD4 expression and higher microRNA-21 levels in CD4+ T lymphocytes post-PCI. Trimetazidine reduces the incidence of periprocedural myocardial injury, possibly by increasing microRNA-21 levels in CD4+ T lymphocytes and inhibiting PDCD4-mediated inflammatory response.

  20. C-reactive protein in unstable angina pectoris and its relation to coronary angiographic severity and diffusion scores of coronary lesions.

    Science.gov (United States)

    Soysal, Dilek; Karakuş, Volkan; Yavaş, Hakan Haldun; Biçeroğlu, Serdar; Köseoğlu, Mehmet; Yeşil, Murat

    2010-10-01

    We aimed to assess the relationship between C-reactive protein (CRP) and the severity and diffusion of coronary artery lesions in patients with unstable angina pectoris (UAP) and the independent association of CRP with this clinical situation. This cross-sectional, observational study included 50 patients. Classification by Braunwald was used for UAP. The severity and diffusion of angiographic coronary disease were graded according to Reardon's modified scoring system. Plasma CRP levels were quantified by immunoturbidimetry. Nonparametric tests were used for comparison of CRP and other risk factors, and logistic regression analysis for evaluation of independent association between CRP and unstable angina pectoris. The severity score was 46±18 points in class IIB1 UAP, 36±20 points in class IIB2 and 53±18 points in class IIIB2 (p=0.017, class IIIB2 vs IIB2). Respectively, CRP levels were 6.6 mg/L, 3.8 mg/L and 4.8 mg/L (p=0.371, class IIB1 vs IIB2 vs IIIB2). Lesions with diffusion score 4 revealed higher CRP values than lesions with diffusion score 1 (11.1 mg/L vs 3.1 mg/L, p=0.048). Adjusting age, sex and smoking, assessment of partial correlation analysis showed a positive, moderately powerful and significant association between CRP levels and the severity and diffusion scores of the coronary lesions (r=0.30; p=0.034 and r=0.31; p=0.030, respectively) in the whole study group. Multiple logistic regression analysis showed no appreciable independent association between CRP and UAP (OR: 1.63, 95%CI: 0.90-5.63, p=0.093). Although, CRP was correlated with the severity and diffusion of angiographic coronary disease in patients with UAP, there was no independent association between CRP and clinical severity of UAP.

  1. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners’ perceptions.

    NARCIS (Netherlands)

    Engel, J.; Heeren, M.J.; Wulp, I. van der; Bruijne, M.C. de; Wagner, C.

    2014-01-01

    Background Cardiac risk scores estimate a patient’s risk of future cardiac events or death. They are developed to inform treatment decisions of patients diagnosed with unstable angina or non-ST-elevation myocardial infarction. Despite recommending their use in guidelines and

  2. Impact of Clinical Presentation (Stable Angina Pectoris vs Unstable Angina Pectoris or Non-ST-Elevation Myocardial Infarction vs ST-Elevation Myocardial Infarction) on Long-Term Outcomes in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents.

    Science.gov (United States)

    Giustino, Gennaro; Baber, Usman; Stefanini, Giulio Giuseppe; Aquino, Melissa; Stone, Gregg W; Sartori, Samantha; Steg, Philippe Gabriel; Wijns, William; Smits, Pieter C; Jeger, Raban V; Leon, Martin B; Windecker, Stephan; Serruys, Patrick W; Morice, Marie-Claude; Camenzind, Edoardo; Weisz, Giora; Kandzari, David; Dangas, George D; Mastoris, Ioannis; Von Birgelen, Clemens; Galatius, Soren; Kimura, Takeshi; Mikhail, Ghada; Itchhaporia, Dipti; Mehta, Laxmi; Ortega, Rebecca; Kim, Hyo-Soo; Valgimigli, Marco; Kastrati, Adnan; Chieffo, Alaide; Mehran, Roxana

    2015-09-15

    The long-term risk associated with different coronary artery disease (CAD) presentations in women undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is poorly characterized. We pooled patient-level data for women enrolled in 26 randomized clinical trials. Of 11,577 women included in the pooled database, 10,133 with known clinical presentation received a DES. Of them, 5,760 (57%) had stable angina pectoris (SAP), 3,594 (35%) had unstable angina pectoris (UAP) or non-ST-segment-elevation myocardial infarction (NSTEMI), and 779 (8%) had ST-segment-elevation myocardial infarction (STEMI) as clinical presentation. A stepwise increase in 3-year crude cumulative mortality was observed in the transition from SAP to STEMI (4.9% vs 6.1% vs 9.4%; p <0.01). Conversely, no differences in crude mortality rates were observed between 1 and 3 years across clinical presentations. After multivariable adjustment, STEMI was independently associated with greater risk of 3-year mortality (hazard ratio [HR] 3.45; 95% confidence interval [CI] 1.99 to 5.98; p <0.01), whereas no differences were observed between UAP or NSTEMI and SAP (HR 0.99; 95% CI 0.73 to 1.34; p = 0.94). In women with ACS, use of new-generation DES was associated with reduced risk of major adverse cardiac events (HR 0.58; 95% CI 0.34 to 0.98). The magnitude and direction of the effect with new-generation DES was uniform between women with or without ACS (pinteraction = 0.66). In conclusion, in women across the clinical spectrum of CAD, STEMI was associated with a greater risk of long-term mortality. Conversely, the adjusted risk of mortality between UAP or NSTEMI and SAP was similar. New-generation DESs provide improved long-term clinical outcomes irrespective of the clinical presentation in women. Published by Elsevier Inc.

  3. Comparison of frequency of calcified versus non-calcified coronary lesions by computed tomographic angiography in patients with stable versus unstable angina pectoris.

    Science.gov (United States)

    Meijs, Matthijs F L; Meijboom, W Bob; Bots, Michiel L; Kyrzopoulos, Stamatis; Eu, Rick Neoh; Prokop, Mathias; Doevendans, Pieter A; de Feyter, Pim J; Cramer, Maarten J

    2009-08-01

    Computed tomographic coronary angiography (CTCA) can noninvasively identify calcified and noncalcified coronary plaques. The aim of this study was to compare the phenotypes of all plaques and of culprit plaques between patients with unstable angina pectoris (UAP) and those with stable angina pectoris (SAP), because plaque characteristics may differ between these patients. In 110 patients with UAP and 189 with SAP from a multicenter study comparing 64-slice CTCA with conventional coronary angiography, the number and phenotypes (noncalcified, mixed, and calcified) of coronary plaques were compared. In a subanalysis in 50 patients with UAP and 64 with SAP, culprit plaque characteristics, including culprit plaque cross-sectional area relative to total vessel cross-sectional area, culprit plaque length, remodeling index, and spotty calcification, were determined. Odds ratios for the presence of UAP, adjusted for clinical variables and the total number of plaques, were calculated for plaque characteristics on CTCA. Although the number of plaques was similar for patients with UAP and those with SAP, plaques in patients with UAP were more frequently noncalcified than in patients with SAP. The odds ratio for UAP was 1.3 (95% confidence interval [CI] 1.1 to 1.5) per noncalcified plaque. In the culprit plaque subanalysis, odds ratios for UAP were 0.99 (95% CI 0.96 to 1.01) per millimeter culprit plaque length, 2.7 (95% CI 1.2 to 6.4) for noncalcified culprit plaque, and 1.06 (95% CI 0.99 to 1.13) per percentage relative culprit plaque cross-sectional area. No significant relation was found between remodeling index or spotty calcification and UAP. In conclusion, noncalcified plaques and large noncalcified culprit plaques are more frequently found in patients with UAP than in those with SAP.

  4. Does slice thickness affect diagnostic performance of 64-slice CT coronary angiography in stable and unstable angina patients with a positive calcium score?

    Energy Technology Data Exchange (ETDEWEB)

    Meijs, Matthijs F.L.; Vos, Alexander M. de; Cramer, Maarten J.; Doevendans, Pieter A.; Vries, Jan J.J. de; Rutten, Annemarieke; Budde, Ricardo P.J.; Prokop, Mathias (Dept. of Radiology, Univ. Medical Center Utrecht, Utrecht (Netherlands)), e-mail: m.meijs@umcutrecht.nl; Meijboom, W. Bob; Feyter, Pim J. de (Dept. of Cardiology, Erasmus Medical Center, Rotterdam (Netherlands))

    2010-05-15

    Background: Coronary calcification can lead to over-estimation of the degree of coronary stenosis. Purpose: To evaluate whether thinner reconstruction thickness improves the diagnostic performance of 64-slice CT coronary angiography (CTCA) in angina patients with a positive calcium score. Material and Methods: We selected 20 scans from a clinical study comparing CTCA to conventional coronary angiography (CCA) in stable and unstable angina patients based on a low number of motion artifacts and a positive calcium score. All images were acquired at 64 x 0.625 mm and each CTCA scan was reconstructed at slice thickness/increment 0.67 mm/0.33 mm, 0.9 mm/0.45 mm, and 1.4 mm/0.7 mm. Two reviewers blinded for CCA results independently evaluated the scans for the presence of significant coronary artery disease (CAD) in three randomly composed series, with =2 weeks in between series. The diagnostic performance of CTCA was compared for the different slice thicknesses using a pooled analysis of both reviewers. Significant CAD was defined as >50% diameter narrowing on quantitative CCA. Image noise (standard deviation of CT numbers) was measured in all scans. Inter-observer variability was assessed with kappa. Results: Significant CAD was present in 8% of 304 available segments. Median total Agatston calcium score was 181.8 (interquartile range 34.9-815.6). Sensitivity at 0.67 mm, 0.9 mm, and 1.4 mm slice thickness was 70% (95% confidence interval 57-83%), 74% (62-86%), and 70% (57-83%), respectively. Specificity was 85% (82-88%), 84% (81-87%), and 84% (81-87%), respectively. The positive predictive value was 30 (21-38%), 29 (21-37%), and 28 (20-36%), respectively. The negative predictive value was 97% (95-98%), 97% (96-99%), and 97% (96-99%), respectively. Kappa for inter-observer agreement was 0.56, 0.58, and 0.59. Noise decreased from 32.9 HU at 0.67 mm, to 23.2 HU at 1.4 mm (P<0.001). Conclusion: Diagnostic performance of CTCA in angina patients with a positive calcium score

  5. Correlation between turbidimetric and nephelometric methods of measuring C-reactive protein in patients with unstable angina or non-ST elevation acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Luis C. L. Correia

    2003-08-01

    Full Text Available OBJECTIVE: To evaluate the performance of the turbidimetric method of C-reactive protein (CRP as a measure of low-grade inflammation in patients admitted with non-ST elevation acute coronary syndromes (ACS. METHODS: Serum samples obtained at hospital arrival from 68 patients (66±11 years, 40 men, admitted with unstable angina or non-ST elevation acute myocardial infarction were used to measure CRP by the methods of nephelometry and turbidimetry. RESULTS: The medians of C-reactive protein by the turbidimetric and nephelometric methods were 0.5 mg/dL and 0.47 mg/dL, respectively. A strong linear association existed between the 2 methods, according to the regression coefficient (b=0.75; 95% C.I.=0.70-0.80 and correlation coefficient (r=0.96; P<0.001. The mean difference between the nephelometric and turbidimetric CRP was 0.02 ± 0.91 mg/dL, and 100% agreement between the methods in the detection of high CRP was observed. CONCLUSION: In patients with non-ST elevation ACS, CRP values obtained by turbidimetry show a strong linear association with the method of nephelometry and perfect agreement in the detection of high CRP.

  6. Detection and assessment of unstable angina using myocardial perfusion imaging: Comparison between technetium-99m sestamibi SPECT and 12-lead electrocardiogram

    International Nuclear Information System (INIS)

    Gregoire, J.; Theroux, P.

    1990-01-01

    Forty-five studies using technetium-99m (Tc-99m) sestamibi single photon emission computed tomography (SPECT) were performed on patients hospitalized for spontaneous chest pain suggestive of myocardial ischemia. The studies were done after an injection during an episode of chest pain and a repeated injection when the patients were free of pain. All patients were hospitalized with a presumed diagnosis of unstable angina, and none had evidence of a previous myocardial infarction. The presence of a perfusion defect observed with Tc-99m sestamibi injected during chest pain had a 96% sensitivity and a 79% specificity for the detection of significant coronary artery disease (stenosis greater than or equal to 50%) on subsequent angiography. When the criterion of a larger perfusion defect during pain compared to absence of pain was used, the sensitivity was 81% and the specificity was 84%. In contrast, transient electrocardiographic ischemic changes during pain had a sensitivity of 35% and a specificity of 68%; electrocardiographic changes during or outside episodes of chest pain had a sensitivity of 65% and a specificity of 63% for the diagnosis. Tc-99m sestamibi SPECT represents a reliable noninvasive diagnostic tool that could aid in the diagnosis of myocardial ischemia in patients with spontaneous chest pain and provide additional information to that provided by the electrocardiogram

  7. The association between electrocardiographic R wave peak time and coronary artery disease severity in patients with non-ST segment elevation myocardial infarction and unstable angina pectoris.

    Science.gov (United States)

    Rencüzoğulları, İbrahim; Çağdaş, Metin; Karakoyun, Süleyman; Karabağ, Yavuz; Yesin, Mahmut; Artaç, İnanç; İliş, Doğan; Selçuk, Murat; Öterkuş, Mesut; Tanboğa, Halil İbrahim

    We aimed to evaluate possible association between QRS duration (QRSD), R wave peak time (RWPT), and coronary artery disease severity identified using the SYNTAX score (SS) in patients with unstable angina pectoris (USAP) or non-ST segment elevation myocardial infarction (NSTEMI). A total of 176 USAP/NSTEMI patients were enrolled in the study. The high SS group (>22, n:45) patients had a higher prevalence of diabetes mellitus (DM); presence of ST segment depression ≥0.5 mm and 1 mm; ST segment elevation in the AVR lead (AVRSTE); longer QRSD and RWPT; and lower left ventricular ejection fraction (LVEF) than the low SS group (≤22, n: 131). The LVEF, AVRSTE, and RWPT (OR: 1.035, 95% CI: 1.003-1.067; p = 0.030) were independent predictors of high SS. The present study demonstrated that RWPT and AVRSTE could be used as predictors of high SS. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Usefulness of high-frequency vascular ultrasound imaging and serum inflammatory markers to predict plaque rupture in patients with stable and unstable angina pectoris.

    Science.gov (United States)

    Chen, Wen Qiang; Zhang, Mei; Ji, Xiao Ping; Ding, Shi Fang; Zhao, Yu Xia; Chen, Yu Guo; Zhang, Cheng; Zhang, Yun

    2007-11-01

    It remains unclear what kind of morphologic and biochemical features best predict plaque rupture in patients with angina pectoris (AP). This study aimed to investigate whether combined high-frequency vascular ultrasound imaging and measurements of serum inflammatory biomarkers can predict coronary plaque ruptures in patients with AP. The study population consisted of 20 patients with stable AP and 40 patients with unstable AP. High-frequency vascular ultrasound imaging was performed in the 2 groups to measure intima-media thickness, the plaque acoustic density of the common carotid arteries, and the flow-mediated dilation of the brachial arteries. Serum lipid profile and inflammatory biomarkers were measured in all patients. Using intravascular ultrasound, a list of coronary imaging parameters was obtained. A multivariate logistic regression model was applied to calculate the odds ratio of each parameter to predict coronary plaque ruptures detected by intravascular ultrasound. Of 139 coronary artery plaques identified by intravascular ultrasound, 48 plaques (9 in stable AP and 39 in unstable AP) developed ruptures. Among measured parameters, the values of carotid intima-media thickness, coronary external elastic membrane area, plaque area, plaque burden, plaque eccentric index and remodeling index, serum high-sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, and soluble vascular cell adhesion molecule-1 were significantly higher in unstable AP than in stable AP (p <0.05 to 0.01). Of these parameters, carotid intima-media thickness, serum high-sensitivity C-reactive protein, and the coronary remodeling index were found to be significant predictors of coronary plaque rupture, with odds ratios of 9.51 (95% confidence interval 1.29 to 21.81), 3.02 (95% confidence interval 1.01 to 7.65), and 0.01 (95% confidence interval 0.00 to 0.34), respectively. In conclusion, combined high-frequency ultrasound imaging of coronary and carotid arteries and

  9. Comparison of outcomes after percutaneous coronary intervention among different coronary subsets (stable and unstable angina pectoris and ST-segment and non-ST-segment myocardial infarction).

    Science.gov (United States)

    Loh, Joshua P; Pendyala, Lakshmana K; Kitabata, Hironori; Torguson, Rebecca; Omar, Alfazir; Minha, Sa'ar; Chen, Fang; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2014-06-01

    Percutaneous coronary intervention in the setting of acute myocardial infarction is known to predict stent thrombosis (ST). This study aims to compare the ST rates across different coronary subsets. This was an observational cohort study from a large, single-center registry. Included were 12,198 consecutive patients who underwent percutaneous coronary intervention with stenting. Patients were categorized according to their clinical presentation: stable angina pectoris (SAP, n = 3,700), unstable angina pectoris (UAP, n = 2,845), non-ST-segment elevation myocardial infarction (NSTEMI, n = 4,083), and ST-segment elevation myocardial infarction (STEMI, n = 1,570). The study end points were ST rates at 1 year. Patients with STEMI were younger with a lower prevalence of cardiovascular risk factors, except for smoking. More type C lesions were treated in STEMI, whereas drug-eluting stents were used less frequently in patients with STEMI compared with the other groups. Definite ST at 1 year was highest in patients with STEMI (1.4%; vs SAP, 0.4%; UAP, 0.5%; NSTEMI, 0.5%; p <0.001). One-year definite/probable ST rates were SAP, 0.8%; UAP, 1.1%; NSTEMI, 1.4%; and STEMI, 3.2% (p <0.001). On multivariable analysis, STEMI independently predicts definite ST (hazards ratio [HR] 3.07, 95% confidence interval [CI] 1.32 to 7.10), whereas both STEMI (HR 3.36, 95% CI 1.84 to 6.12) and NSTEMI (HR 2.04, 95% CI 1.20 to 3.07) were independent predictors of definite/probable ST. Clopidogrel cessation was the strongest predictor of ST (definite ST, HR 17.00, 95% CI 7.54 to 38.31; definite/probable ST, HR 4.69, 95% CI 2.39 to 9.20). In conclusion, in patients who underwent percutaneous coronary intervention, the acuity of clinical presentation corresponds to an increase in ST incidence. Adherence to clopidogrel is critical to prevent ST in patients who underwent percutaneous coronary intervention, especially in STEMI. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris: a serial optical coherence tomography study.

    Science.gov (United States)

    Kubo, Takashi; Imanishi, Toshio; Kitabata, Hironori; Kuroi, Akio; Ueno, Satoshi; Yamano, Takashi; Tanimoto, Takashi; Matsuo, Yoshiki; Masho, Takashi; Takarada, Shigeho; Tanaka, Atsushi; Nakamura, Nobuo; Mizukoshi, Masato; Tomobuchi, Yoshiaki; Akasaka, Takashi

    2008-07-01

    The aim of the present study was to compare lesion morphologies after sirolimus-eluting stent (SES) implantation between patients with unstable angina pectoris (UAP) and stable angina pectoris (SAP) with the use of optical coherence tomography (OCT). The lesion morphologies before and after coronary stenting have been proposed as important predictors of clinical outcome. The high resolution of OCT provides detailed information of coronary vessel wall. We enrolled 55 patients (UAP: n = 24, SAP: n = 31), and examined lesion morphologies by using OCT at pre- and post-SES implantation and 9 months' follow-up. The incidence of plaque rupture (42% vs. 3%, p < 0.001), intracoronary thrombus (67% vs. 3%, p < or = 0.001) and thin-capped fibroatheroma (cap thickness <65 microm; 46% vs. 3%, p < 0.001) at pre-intervention was significantly greater in UAP than that in SAP. Although stent profiles and procedural characteristics were not different between the 2 groups, inadequate stent apposition (67% vs. 32%, p = 0.038) and tissue protrusion (79% vs. 42%, p = 0.005) after percutaneous coronary intervention were observed more frequently in patients with UAP. Plaque rupture was significantly increased after percutaneous coronary intervention in patients with UAP (42% to 75%, p = 0.018), and the persistence of core cavity after plaque rupture (28% vs. 4%, p = 0.031) at 9 months' follow-up was observed more frequently in UAP patients compared with SAP patients. At 9 months' follow-up, the incidence of inadequately apposed stent (33% vs. 4%, p = 0.012) and partially uncovered stent by neointima (72% vs. 37%, p = 0.019) was significantly greater in UAP patients than that in SAP patients. All patients took aspirin and ticlopidine during follow-up period, and no patients had stent thrombosis or adverse coronary events. Serial OCT examinations demonstrated markedly different vascular response up to 9 months after SES implantation between UAP and SAP patients. Although the inadequate

  11. Effects of liposomal prostaglandin E1 on periprocedural myocardial injury in patients with unstable angina undergoing an elective percutaneous coronary intervention.

    Science.gov (United States)

    Fan, Yanming; Jiang, Yunfa; Fu, Xianghua; Cai, Junna; Wang, Yanbo; Li, Wei; Gu, Xinshun; Xing, Kun; Bai, Shiru; Bi, Xile

    2015-12-01

    The aim of this study was to explore whether intravenous administration of liposomal prostaglandin E1 (lipo-PGE1) can reduce the incidence of periprocedural myocardial injury (PMI) in patients with unstable angina undergoing an elective percutaneous coronary intervention (PCI). In this randomized-controlled study, a total of 219 patients were randomly assigned to a lipo-PGE1 group (n=110) and a control group (n=109). Patients in the lipo-PGE1 group received 20 μg/day of lipo-PGE1 diluted in 10 ml of normal saline through an intravenous injection over 5 min starting at 3 days before PCI and continuing for 4 days after PCI. In the control group, 10 ml of normal saline was administered using the same method. The primary end point was the occurrence of PMI defined as an elevation of cardiac troponin I above the upper limit of normal within 24 h after the procedure. The secondary end points were (i) changes in inflammatory factors including plasma high-sensitivity C-reactive protein, tumor necrosis factor α, and interleukin 6 before and at 24 h after PCI; (ii) the incidence of major adverse cardiac events in the patients during hospitalization and 30 days of follow-up after discharge, including cardiac deaths, severe heart failure, malignant arrhythmias, and target vessel revascularization. Within 24 h after PCI, the incidence of PMI was significantly lower in the lipo-PGE1 group compared with that in the control group (20 vs. 36.69%, P=0.009). Although the procedure induced a significant increase in high-sensitivity C-reactive protein, tumor necrosis factor α, and interleukin 6 levels, the values were significantly lower in the lipo-PGE1 group than those in the control group at 24 h after PCI (P<0.05). The proportion of thrombolysis in myocardial infarction grade 3 in the lipo-PGE1 group was higher than that in the control group (92.72 vs. 82.56%, P=0.037). There were no significant differences between the lipo-PGE1 group and the control group in the

  12. Plasma N-terminal pro-brain natriuretic peptide levels in patients with acute myocardial infarction, unstable angina pectoris and non-insulin-dependent diabetes

    International Nuclear Information System (INIS)

    Zhang Yonggang; Li Yuguang

    2004-01-01

    Objective: Determination of plasma N-terminal pro-brain natriuretic peptide [NT-proBNP (1-76)] levels is useful for the diagnosis of heart failure. Present study was to investigate the significance of changes of plasma NT-proBNP (1-76) levels in patients with acute myocardial infarction (AMI), unstable angina pectoris (UAP) and non-insulin-dependent diabetes (NIDD). Methods: Plasma NT-proBNP (1-76) levels were determined with RIA in 32 patients with AMI, 27 patients with UAP, 12 patients with NIDD and 20 controls. Moreover, 16 of the 32 AMI patients underwent percutaneous transluminal coronary angioplasty (PTCA) and plasma (1-76) levels were again determined 12hr before and 12hr after the procedure. Results: The plasma NT-proBNP (1-76) levels in controls were 360.8 ± 57.3 pg/ ml with no significant difference between the sexes. In patients with AMI, UAP and NIDD, NT-proBNP (1-76) levels were 554.1 ± 195.9 pg/ml, 525.7 ± 199.1 pg/ml and 552.6 ± 141.9 pg/ml respectively; all of them were significantly higher than those in controls (P 0.05). Conclusion: The plasma NT-proBNP (1-76) levels in patients with AMI, UAP and NIDD were increased significantly and the result suggested that NT-proBNP (1-76) might be a useful risk marker for these diseases. (authors)

  13. Sodium Tanshinone II A Sulfonate Injection as Adjuvant Treatment for Unstable Angina Pectoris: A Meta-Analysis of 17 Randomized Controlled Trials.

    Science.gov (United States)

    Tan, Di; Wu, Jia-Rui; Zhang, Xiao-Meng; Liu, Shi; Zhang, Bing

    2018-02-01

    To systematically evaluate the effectiveness and safety of Sodium Tanshinone II A Sulfonate Injection (STS) as one adjuvant therapy for treating unstable angina pectoris (UAP). Randomized controlled trials (RCTs) of UAP treated by STS were searched in the China National Knowledge Infrastructure Database (CNKI), VIP Database for Chinese Technical Periodicals (VIP), Wanfang Database, the Chinese Biomedical Literature Database (CBM), Web of Science, the Cochrane Library, Embase, and PubMed, which from inception to January, 2016. The Cochrane Risk Assessment Tool was used to evaluate the methodological quality of the RCTs. The Review Manager 5.3 software was used to conduct the metaanalysis. The results showed that 17 RCTs involving 1,372 patients were included. The meta-analysis indicated that the combined use of STS and Western medicine (WM) in the treatment of UAP can obviously improve the total effective rate [risk ratio (RR)=1.31, 95% confidence interval (CI) (1.24,1.39), P<0.0001], and the total effective rate of electrocardiogram [RR=1.43, 95% CI (1.30,1.56), P<0.0001], decrease the level of CRP [mean difference (MD)=-3.06, 95%CI (-3.85,-2.27), P<0.00001], fibrinogen [MD=-1.03, 95% CI (-1.16,-0.89), P<0.00001], and whole blood high shear viscosity [MD=-0.70, 95% CI (-0.92,-0.49), P<0.00001]. Additionally, the occurrence of adverse drug reaction of the experimental group was significantly higher than that of the control group [RR=3.57, 95% CI (1.28, 9.94), P<0.05]. Compared with WM, the combined use of STS was more effective.

  14. Prasugrel as opposed to clopidogrel improves endothelial nitric oxide bioavailability and reduces platelet-leukocyte interaction in patients with unstable angina pectoris: A randomized controlled trial.

    Science.gov (United States)

    Rudolph, Tanja K; Fuchs, Alexander; Klinke, Anna; Schlichting, Andrea; Friedrichs, Kai; Hellmich, Martin; Mollenhauer, Martin; Schwedhelm, Edzard; Baldus, Stephan; Rudolph, Volker

    2017-12-01

    Platelet inhibition has been linked to improved endothelial function, a prognostic factor in coronary artery disease. Whether prasugrel, a potent platelet inhibitor, affects endothelial function remains unknown. This was a double-blind, randomized, active-controlled, parallel trial. Patients with unstable angina pectoris undergoing percutaneous coronary intervention (PCI) received either a daily dose of clopidogrel 75mg (n=23) or prasugrel 10mg (n=22). Flow-mediated dilation (FMD), circulating nitrate and nitrite, inflammatory markers and platelet-leukocyte aggregates (PLAs) were assessed the day after PCI and after 3months. Baseline patient demographics were well matched between treatment groups. Prasugrel led to a significant improvement of FMD after 3months (9.01±3.64% vs. 6.65±3.24%, p=0.001). In contrast, no significant change was observed in the clopidogrel group (7.21±2.84% vs. 6.30±2.97%, p=0.187). Adjusted for baseline FMD, hyperlipidemia and statin use, the treatment effect on change in FMD favoured prasugrel by an absolute 1.97% (95% CI 0.29% to 3.66%, p=0.023). A significant reduction of plasma hsCRP, myeloperoxidase and neutrophil elastase and an increase of nitrate levels were noted in both treatment arms. Interestingly, only prasugrel significantly reduced sCD40 ligand and RANTES and increased nitrite levels. Prasugrel reduced the ADP-stimulated increase in PLAs by 40% (IR: 82 to 13), whereas clopidogrel revealed no such effect (1% increase (IR: 13 to 50) (p=0.01). Prasugrel exhibits beneficial mid-term effects on endothelial nitric oxide bioavailability and inflammatory markers. (EudraCT number: 2009-015406-19). Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Unstable angina pectoris prior to ST elevation myocardial infarction in patients treated with primary percutaneous coronary intervention has no influence on prognosis.

    Science.gov (United States)

    Kluz, Krystyna; Parenica, Jiri; Kubkova, Lenka; Littnerova, Simona; Tomandl, Josef; Poloczek, Martin; Toman, Ondrej; Tesak, Martin; Cermakova, Zdenka; Gottwaldova, Jana; Manousek, Jan; Pavkova Goldbergova, Monika; Spinar, Jindrich; Jarkovsky, Jiri

    2015-06-01

    Pre-infarction unstable angina pectoris (UAP) can be considered ischemic preconditioning. The aim of this study was to compare short and long term outcomes in patients with or without pre-infarction UAP and ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). 593 patients with STEMI (388 without and 205 with UAP) were evaluated. Levels of biomarkers (troponin I, BNP, NT-ProBNP, neopterin, endoglin and pentraxin-3) at hospital admission and 24 h after STEMI onset were assessed. Echocardiography was undertaken on the fourth day after MI and after 12 months. The median follow-up was 37 months. We found no significant differences in sex, age or risk factors for atherosclerosis between the UAP and non-UAP group. As the median time from the onset of chest pain to admission was significantly longer in the UAP group (228 min vs 258 min; P=0.009), we used a propensity score to obtain comparable matched groups for use in further analyses. The levels of NT-proBNP were significantly higher on admission and after 24 hours in the UAP group. Left ventricular functions according to invasive and echocardiographic parameters were entirely comparable at hospitalization and after 12 months. No differences were found in severity index of acute heart failure during hospitalization. The incidence of major acute coronary events during follow-up was comparable for the groups. In patients with STEMI treated with primary PCI, pre-infarction UAP has no beneficial clinical effect during hospitalization or during long-term follow-up.

  16. N-Terminal Pro-B-Type Natriuretic Peptide Levels Inversely Correlated With Heart Rate Variability in Patients With Unstable Angina Pectoris.

    Science.gov (United States)

    Dufang, Ma; Yongcheng, Wang; Ping, Jiang; Yonghui, Yin; Xiao, Li

    2016-05-25

    We explored the relationships between heart rate variability (HRV) and levels of N-terminal Pro-B-type natriuretic peptide (NT-proBNP) in patients with unstable angina pectoris (UA).A total of 90 consecutive patients admitted 100 ms (P = 0.003). With increasing levels of NT-proBNP, both the 24hour monitoring HRV and night-monitoring HRV showed that SDNN and VLF gradually decreased (P < 0.01), and patients in the NT-proBNP lowest tertile group had higher LF values than the other two groups (P < 0.05); however, no difference was found in RMSSD, HF, and TP. During the daytime, the LF, VLF, and TP values were lower in the NTproBNP highest group compared with the lowest tertile group (P < 0.05). NT-proBNP levels correlated negatively with SDNN (r = -0.314, P = 0.003) and VLF (r = -0.397, P < 0.001) but not with other HRV parameters. Multiple regression analysis showed that serum levels of NT-proBNP remained predictive of SDNN (β = -0.060, P = 0.001) and VLF (β = -0.145, P < 0.001), even after adjustment for confounders.Our study showed that the elevated serum levels of NT-proBNP predict reduced HRV parameters, and the increased NT-proBNP levels combined with decreased HRV represent the degree of neurohormonal dysfunction and may be better prognostic predictors for risk stratification in UA patients.

  17. Angina Treatment: Stents, Drugs, Lifestyle Changes -- What's Best?

    Science.gov (United States)

    ... your body. Unstable angina. Unstable angina is either new chest pain or a change in your usual pattern of chest pain or discomfort — such as chest pain that is getting worse, lasting longer, or not being relieved with rest or use of medications. Unstable angina is dangerous and a warning sign ...

  18. Detection of non-ST-elevation myocardial infarction and unstable angina in the acute setting: meta-analysis of diagnostic performance of multi-detector computed tomographic angiography

    Directory of Open Access Journals (Sweden)

    Sarno Giovanna

    2007-12-01

    Full Text Available Abstract Background Multi-detector computed tomography angiography (MDCTA has been increasingly used in the evaluation of the coronary arteries. The purpose of this study was to review the literature on the diagnostic performance of MDCTA in the acute setting, for the detection of non-ST-elevation myocardial infarction (NSTEMI and unstable angina pectoris (UAP. Methods A Pubmed and manual search of the literature published between January 2000 and June 2007 was performed. Studies were included that compared MDCTA with clinical outcome and/or CA in patients with acute chest pain, presenting at the emergency department. More specifically, studies that only included patients with initially negative cardiac enzymes suspected of having NSTEMI or UAP were included. Summary estimates of diagnostic odds ratio (DOR, sensitivity and specificity, negative (NLR and positive likelihood ratio (PLR were calculated on a patient basis. Random-effects models and summary receiver operating curve (SROC analysis were used to assess the diagnostic performance of MDCTA with 4 detectors or more. The proportion of non assessable scans (NAP on MDCTA was also evaluated. In addition, the influence of study characteristics of each study on diagnostic performance and NAP was investigated with multivariable logistic regression. Results Nine studies totalling 566 patients, were included in the meta-analysis: one randomised trial and eight prospective cohort studies. Five studies on 64-detector MDCTA and 4 studies on MDCTA with less than 64 detectors were included (32 detectors n = 1, 16 detectors n = 2, 16 and 4 detectors n = 1. Pooled DOR was 131.81 (95%CI, 50.90–341.31. The pooled sensitivity and specificity were 0.95 (95%CI, 0.90–0.98 and 0.90 (95%CI, 0.87–0.93. The pooled NLR and PLR were 0.12 (95%CI, 0.06–0.21 and 8,60 (95%CI, 5.03–14,69. The results of the logistic regressions showed that none of the investigated variables had influence on the diagnostic

  19. Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study.

    Science.gov (United States)

    Merry, Audrey H H; Boer, Jolanda M A; Schouten, Leo J; Feskens, Edith J M; Verschuren, W M Monique; Gorgels, Anton P M; van den Brandt, Piet A

    2011-03-24

    Few studies investigated the association between smoking, alcohol consumption, or physical activity and the risk of unstable angina pectoris (UAP), while the strength of these associations may differ compared to other coronary diseases such as acute myocardial infarction (AMI). Therefore, we investigated whether the associations of these lifestyle factors with UAP differed from those with AMI. Additionally, we investigated whether these effects differed between subjects with and without a family history of myocardial infarction (MI). The CAREMA study consists of 21,148 persons, aged 20-59 years at baseline and randomly sampled from the Maastricht region in 1987-1997. At baseline, all participants completed a self-administered questionnaire. After follow-up of maximally 16.9 years, 420 AMI and 274 UAP incident cases were registered. Incidence rate ratios (RRs) were estimated using Cox proportional hazards models. For both diseases, smoking increased the risk while alcohol consumption was associated with a protective effect. Associations with both risk factors were stronger for AMI than UAP, although this difference was only statistically significant for smoking. In men, an inverse association was found with physical activity during leisure time which seemed to be stronger for the risk of UAP than of AMI. On the contrary, physical activity during leisure time was associated with an increased risk of both AMI and UAP in women which seemed to be weaker for UAP than for AMI. Except for occupational physical activity in women, no significant interactions on a multiplicative scale were found between the lifestyle factors and family history of MI. Nevertheless, the highest risks were found in subjects with both a positive family history and the most unfavorable level of the lifestyle factors. The strength of the associations with the lifestyle factors did not differ between AMI and UAP, except for smoking. Furthermore, the effects of the lifestyle factors on the risk of

  20. Gender-specific and age-specific differences in unstable angina pectoris admissions: a population-based registry study in Finland.

    Science.gov (United States)

    Kytö, Ville; Sipilä, Jussi; Rautava, Päivi

    2015-10-15

    To evaluate gender-specific and age-specific differences in the occurrence of unstable angina pectoris (UAP) caused admissions. Population-based retrospective registry study in Finland. All consecutive patients aged ≥30 years hospitalised with a primary diagnosis of UAP in 22 hospitals with a coronary catheterisation laboratory during 5/2000-10/2009. Gender-specific and age-specific differences and trends in occurrence of UAP admissions. The study period included 27 282 admissions caused primarily by UAP. Of these, 61.9% occurred to men and 38.1% to women with age-adjusted relative risk (RR) of 1.85 (CI 1.61 to 2.14) for the male gender (p<0.0001). The standardised incidence rate of UAP during the whole study was 92.8 (CI 91.8 to 93.9)/100,000 person-years. The incidence rate increased gradually from 1.3 in the population aged 30-34 years to 268.0/100,000 in the population aged 75-84 years. Men had a 2.4-fold risk for UAP admission compared with women in the general population (incidence rate ratio 2.39; CI 2.24 to 2.56; p<0.0001). Gender difference was present in all age groups. UAP caused 22.4% of acute coronary syndrome admissions and 4.7% of all cardiovascular admissions. UAP was more likely to be the cause of cardiovascular admission in male patients (RR=1.25; CI 1.21 to 1.30, p<0.0001 compared with female patients), but there was no gender difference in acute coronary syndrome admissions. The incidence rate of UAP hospitalisations in the general population declined by an estimated 8% per study-year (p<0.0001). Declining incidence was evident regardless of gender and age. Men have a 2.4-fold overall RR for UAP admission compared to women in the general population. Admissions due to UAP have a declining incidence trend across the adult Finnish population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Endothelial immunomediated reactivity in acute cardiac ischaemia: Role of endothelin 1, interleukin 8 and NT-proBNP in patients affected by unstable angina pectoris.

    Science.gov (United States)

    Caroselli, Costantino; De Rosa, Rosario; Tanzi, Pietro; Rigatelli, Alberto; Bruno, Guglielmo

    2016-09-01

    The role of endothelium in the progression of atheromasic disease has already been demonstrated. Endothelin-1 (ET-1) is released from endothelial cells during acute and chronic vascular damage and it appears to be the strongest vasoconstrictor agent known.The aim of this study is to investigate the amount of endothelial damage in patients with unstable angina (UA), as defined by serum levels of ET-1, to verify a possible correlation with increased ischaemic damage by evaluation of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and interleukin 8 (IL-8) levels.Serum levels of ET-1, IL-8 and NT-proBNP obtained from 10 patients affected by low-risk UA were compared to those belonging to eight healthy subjects. In order to compare the laboratory data pertaining to the two populations, a Student's t-test and a Mann-Whitney U test were performed.Levels of ET-1, IL-8 and NT-proBNP in samples of peripheral blood of patients affected by UA were significantly elevated, compared with those of the control group. The linear correlation analysis demonstrated a positive and significant correlation between levels of ET-1 and IL-8, between levels of ET-1 and NT-proBNP, and between levels of IL-8 and NT-proBNP in subjects affected by UA.Early elevated levels of ET-1, IL-8 and NT-proBNP in patients with UA show a coexistence between ischaemic insults and endothelial damages. A positive and significant linear correlation between levels of ET-1 and IL-8, between levels of ET-1 and NT-proBNP, and between levels of IL-8 and NT-proBNP confirms that an increased ischaemic insult is correlated to inflammation signs and endothelium damage signs.In patients with UA, ischaemia is always associated with a systemic immuno-mediated activity induced by acute endothelial damage. We suggest early administration of ET-1-selective receptor blockers and anti-inflammatory drugs. © The Author(s) 2015.

  2. Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Gorgels Anton PM

    2011-03-01

    Full Text Available Abstract Background Few studies investigated the association between smoking, alcohol consumption, or physical activity and the risk of unstable angina pectoris (UAP, while the strength of these associations may differ compared to other coronary diseases such as acute myocardial infarction (AMI. Therefore, we investigated whether the associations of these lifestyle factors with UAP differed from those with AMI. Additionally, we investigated whether these effects differed between subjects with and without a family history of myocardial infarction (MI. Methods The CAREMA study consists of 21,148 persons, aged 20-59 years at baseline and randomly sampled from the Maastricht region in 1987-1997. At baseline, all participants completed a self-administered questionnaire. After follow-up of maximally 16.9 years, 420 AMI and 274 UAP incident cases were registered. Incidence rate ratios (RRs were estimated using Cox proportional hazards models. Results For both diseases, smoking increased the risk while alcohol consumption was associated with a protective effect. Associations with both risk factors were stronger for AMI than UAP, although this difference was only statistically significant for smoking. In men, an inverse association was found with physical activity during leisure time which seemed to be stronger for the risk of UAP than of AMI. On the contrary, physical activity during leisure time was associated with an increased risk of both AMI and UAP in women which seemed to be weaker for UAP than for AMI. Except for occupational physical activity in women, no significant interactions on a multiplicative scale were found between the lifestyle factors and family history of MI. Nevertheless, the highest risks were found in subjects with both a positive family history and the most unfavorable level of the lifestyle factors. Conclusions The strength of the associations with the lifestyle factors did not differ between AMI and UAP, except for smoking

  3. Comparison of change in coronary atherosclerosis in patients with stable versus unstable angina pectoris receiving statin therapy (from the Treatment With Statin on Atheroma Regression Evaluated by Intravascular Ultrasound With Virtual Histology [TRUTH] study).

    Science.gov (United States)

    Nozue, Tsuyoshi; Yamamoto, Shingo; Tohyama, Shinichi; Fukui, Kazuki; Umezawa, Shigeo; Onishi, Yuko; Kunishima, Tomoyuki; Sato, Akira; Nozato, Toshihiro; Miyake, Shogo; Takeyama, Youichi; Morino, Yoshihiro; Yamauchi, Takao; Muramatsu, Toshiya; Hibi, Kiyoshi; Terashima, Mitsuyasu; Michishita, Ichiro

    2013-04-01

    Although statin-induced regression in coronary atherosclerosis seems to be greater in patients with acute coronary syndrome than in those with stable coronary artery disease, no reports have examined this. The purpose of the present study was to compare the changes in coronary atherosclerosis in patients with stable versus unstable angina pectoris (AP). The effects of 8-month statin therapy on coronary atherosclerosis were evaluated using virtual histology intravascular ultrasound, and analyzable intravascular ultrasound data were obtained from 119 patients (83 patients with stable AP and 36 with unstable AP). A significant decrease in plaque volume was observed in patients with unstable AP (-2.2%, p = 0.02) but not in patients with stable AP. A significant increase in the necrotic-core component (0.30 mm(3)/mm, p = 0.009) was observed only in patients with unstable AP. Significant positive correlations were observed between the percentage of change in platelet-activating factor acetylhydrolase and the percentage of change in plaque volume (r = 0.346, p = 0.05) in patients with unstable AP. No significant correlations were observed in patients with stable AP. Multivariate regression analyses showed that a reduction in platelet-activating factor acetylhydrolase was associated with regression in coronary atherosclerosis, particularly of the fibrous component (β = 0.443, p = 0.003), in patients with unstable AP. In conclusion, regression of the coronary artery plaque volume was greater, although statin therapy did not halt the increases in plaque vulnerability, in patients with unstable AP compared to those with stable AP. A reduction in the serum platelet-activating factor acetylhydrolase level was associated with regression in coronary atherosclerosis, particularly the fibrous plaque volume, in patients with unstable AP. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Complete versus incomplete revascularization with drug-eluting stents for multi-vessel disease in stable, unstable angina or non-ST-segment elevation myocardial infarction: A meta-analysis.

    Science.gov (United States)

    Ando, Tomo; Takagi, Hisato; Grines, Cindy L

    2017-08-01

    To determine whether drug-eluting stent (DES) coronary complete revascularization (CR) confers clinical benefit over incomplete revascularization (IR) in patients with multivessel coronary artery disease (MVD). Clinical benefit of CR over IR in patients with MVD with angina (both stable and unstable) and non-ST-segment elevation myocardial infarction (NSTEMI) in DES has not been well studied. We conducted a systematic online literature search of PUBMED and EMBASE. Literatures that compared the clinical outcomes between CR and IR with exclusively or majority (>80%) using DES in patients without or included only small portion (meta-analysis. CR was associated with lower incident of all-cause mortality (HR 0.71, P = 0.001), major adverse events (HR 0.75, P Meta-regression analysis showed that CR significantly reduced the risk of all-cause mortality in advanced age, triple vessel disease and male sub-groups. CR with DES conferred favorable outcomes compared to IR in MVD patients with stable, unstable angina or NTEMI. Further research to achieve higher CR in MVD patients may lead to improvement in prognosis in these cohorts. © 2017, Wiley Periodicals, Inc.

  5. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial.

    Science.gov (United States)

    Tegn, Nicolai; Abdelnoor, Michael; Aaberge, Lars; Endresen, Knut; Smith, Pål; Aakhus, Svend; Gjertsen, Erik; Dahl-Hofseth, Ola; Ranhoff, Anette Hylen; Gullestad, Lars; Bendz, Bjørn

    2016-03-12

    Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, and these patients are less likely to receive treatment according to guidelines. We aimed to investigate whether this population would benefit from an early invasive strategy versus a conservative strategy. In this open-label randomised controlled multicentre trial, patients aged 80 years or older with NSTEMI or unstable angina admitted to 16 hospitals in the South-East Health Region of Norway were randomly assigned to an invasive strategy (including early coronary angiography with immediate assessment for percutaneous coronary intervention, coronary artery bypass graft, and optimum medical treatment) or to a conservative strategy (optimum medical treatment alone). A permuted block randomisation was generated by the Centre for Biostatistics and Epidemiology with stratification on the inclusion hospitals in opaque concealed envelopes, and sealed envelopes with consecutive inclusion numbers were made. The primary outcome was a composite of myocardial infarction, need for urgent revascularisation, stroke, and death and was assessed between Dec 10, 2010, and Nov 18, 2014. An intention-to-treat analysis was used. This study is registered with ClinicalTrials.gov, number NCT01255540. During a median follow-up of 1·53 years of participants recruited between Dec 10, 2010, and Feb 21, 2014, the primary outcome occurred in 93 (40·6%) of 229 patients assigned to the invasive group and 140 (61·4%) of 228 patients assigned to the conservative group (hazard ratio [HR] 0·53 [95% CI 0·41-0·69], p=0·0001). Five patients dropped out of the invasive group and one from the conservative group. HRs for the four components of the primary composite endpoint were 0·52 (0·35-0·76; p=0·0010) for myocardial infarction, 0·19 (0·07-0·52; p=0·0010) for the need for urgent

  6. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners' perceptions.

    Science.gov (United States)

    Engel, Josien; Heeren, Marie-Julie; van der Wulp, Ineke; de Bruijne, Martine C; Wagner, Cordula

    2014-09-22

    Cardiac risk scores estimate a patient's risk of future cardiac events or death. They are developed to inform treatment decisions of patients diagnosed with unstable angina or non-ST-elevation myocardial infarction. Despite recommending their use in guidelines and evidence of their prognostic value, they seem underused in practice. The purpose of the study was to gain insight in the motivation for implementing cardiac risk scores, and perceptions of health care practitioners towards the use of these instruments in clinical practice. This qualitative study involved semi-structured interviews with 31 health care practitioners at 11 hospitals throughout the Netherlands. Participants were approached through purposive sampling to represent a broad range of participant- and hospital characteristics, and included cardiologists, medical residents, medical interns, nurse practitioners and an emergency physician. The Pettigrew and Whipp Framework for strategic change was used as a theoretical basis. Data were initially analysed through open coding to avoid forcing data into categories predetermined by the framework. Cardiac risk score use was dependent on several factors, including IT support, clinical relevance for daily practice, rotation of staff and workload. Both intrinsic and extrinsic drivers for implementation were identified. Reminders, feedback and IT solutions were strategies used to improve and sustain the use of these instruments. The scores were seen as valuable support systems in improving uniformity in treatment practices, educating interns, conducting research and quantifying a practitioner's own risk assessment. However, health care practitioners varied in their perceptions regarding the influence of cardiac risk scores on treatment decisions. Health care practitioners disagree on the value of cardiac risk scores for clinical practice. Practitioners driven by intrinsic motivations predominantly experienced benefits in policy-making, education and research

  7. Epileptic Angina

    Directory of Open Access Journals (Sweden)

    Sachin Sureshbabu

    2017-01-01

    Conclusion: Pain is a rare manifestation of epilepsy observed in less than 1% of patients. When present, it is usually accompanied by other focal features. This rare occurrence of epileptic seizures masquerading as angina is a novel observation.

  8. Comparison of plaque characteristics in narrowings with ST-elevation myocardial infarction (STEMI), non-STEMI/unstable angina pectoris and stable coronary artery disease (from the ADAPT-DES IVUS Substudy).

    Science.gov (United States)

    Dong, Liang; Mintz, Gary S; Witzenbichler, Bernhard; Metzger, D Christopher; Rinaldi, Michael J; Duffy, Peter L; Weisz, Giora; Stuckey, Thomas D; Brodie, Bruce R; Yun, Kyeong Ho; Xu, Ke; Kirtane, Ajay J; Stone, Gregg W; Maehara, Akiko

    2015-04-01

    Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents (ADAPT-DES) was a prospective, multicenter registry of 8,582 consecutive stable and unstable patients who underwent percutaneous coronary intervention using a drug-eluting stent. We sought to identify key morphologic features leading to ST-segment elevation myocardial infarction (STEMI) versus non-STEMI (NSTEMI) or unstable angina pectoris (UA) versus stable coronary artery disease (CAD) presentation. In the prespecified grayscale and virtual histology (VH) substudy of ADAPT-DES, preintervention imaging identified 676 patients with a single culprit lesion. The relation between lesion morphology and clinical presentation was compared among patients with (1) STEMI, (2) NSTEMI or UA, and (3) stable CAD. Intravascular ultrasound identified more plaque rupture and VH thin-cap fibroatheroma (TCFA) in STEMI lesions compared with NSTEMI/UA or stable CAD lesions; conversely, fibroatheromas appeared more often calcified with a thick fibrous cap in stable CAD. Minimum lumen cross-sectional area (MLA) was smaller with larger plaque burden and positive remodeling in STEMI lesions. Lesions with plaque rupture versus those without plaque rupture showed higher prevalence of VH-TCFA and larger plaque burden with positive remodeling, especially in patients with STEMI. Multivariate analysis showed that in the lesions with plaque rupture, plaque burden at the MLA site was the only independent predictor for STEMI (cutoff of plaque burden = 85%) and in lesions without plaque rupture, MLA was the only independent predictor for STEMI (cutoff of MLA = 2.3 mm(2)). In conclusion, culprit lesions causing STEMI have smaller lumen areas, greater plaque burden, and more plaque rupture or VH-TCFA compared with NSTEMI/UA or stable CAD; in lesions with plaque rupture, only plaque burden predicted STEMI, and in lesions without plaque rupture, only MLA area predicted STEMI. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. The Effects of Xuefu Zhuyu and Shengmai on the Evolution of Syndromes and Inflammatory Markers in Patients with Unstable Angina Pectoris after Percutaneous Coronary Intervention: A Randomised Controlled Clinical Trial

    Science.gov (United States)

    Wang, Jie; Yang, Xiaochen; Chu, Fuyong; Chen, Jianxin; He, Qingyong; Yao, Kuiwu; Teng, Fei; Gao, Yonghong; Xing, Yanhui; Wu, Aiming; Xing, Yanwei

    2013-01-01

    We evaluated the effects of the Xuefu Zhuyu capsule (XFZY) and the Shengmai capsule (SM) on the evolution of syndromes and inflammatory markers in patients with unstable angina pectoris (UAP) after percutaneous coronary intervention (PCI). Ninety patients with UAP after PCI were randomly and equally assigned to three groups: the XFZY group, the SM group, and the placebo group, with 30 patients in each group. Six syndrome factors (including Qi deficiency, yin deficiency, yang deficiency, blood stasis, phlegm, and Qi stagnation) and 4 inflammatory markers (high-sensitivity C-reactive protein (Hs-CRP), endothelins-1 (ET-1), matrix metalloproteinases-9 (MMP-9), and homocysteine (Hcy)) were observed at week 0 and at the 1st, 4th and 12th weeks. In conclusion, the evolution of syndromes present in patients with UAP after PCI followed these trends (1) The deficiency syndromes gradually increased during a 12-week period, but the excess syndromes first gradually decreased and then mildly increased after PCI. (2) XFZY and SM can prevent excess syndromes from increasing in the later stages and prevent deficiency syndromes from increasing in all stages. (3) XFZY and SMcan reduce the levels of the inflammatory markers, especially in the later stages after PCI. PMID:23737852

  10. The Effects of Xuefu Zhuyu and Shengmai on the Evolution of Syndromes and Inflammatory Markers in Patients with Unstable Angina Pectoris after Percutaneous Coronary Intervention: A Randomised Controlled Clinical Trial

    Directory of Open Access Journals (Sweden)

    Jie Wang

    2013-01-01

    Full Text Available We evaluated the effects of the Xuefu Zhuyu capsule (XFZY and the Shengmai capsule (SM on the evolution of syndromes and inflammatory markers in patients with unstable angina pectoris (UAP after percutaneous coronary intervention (PCI. Ninety patients with UAP after PCI were randomly and equally assigned to three groups: the XFZY group, the SM group, and the placebo group, with 30 patients in each group. Six syndrome factors (including Qi deficiency, yin deficiency, yang deficiency, blood stasis, phlegm, and Qi stagnation and 4 inflammatory markers (high-sensitivity C-reactive protein (Hs-CRP, endothelins-1 (ET-1, matrix metalloproteinases-9 (MMP-9, and homocysteine (Hcy were observed at week 0 and at the 1st, 4th and 12th weeks. In conclusion, the evolution of syndromes present in patients with UAP after PCI followed these trends (1 The deficiency syndromes gradually increased during a 12-week period, but the excess syndromes first gradually decreased and then mildly increased after PCI. (2 XFZY and SM can prevent excess syndromes from increasing in the later stages and prevent deficiency syndromes from increasing in all stages. (3 XFZY and SMcan reduce the levels of the inflammatory markers, especially in the later stages after PCI.

  11. Comparação de biomarcadores inflamatórios entre pacientes diabéticos e não-diabéticos com angina instável Comparación de biomarcadores inflamatorios entre pacientes diabéticos y no-diabéticos con angina inestable Comparison of inflammatory biomarkers between diabetic and non-diabetic patients with unstable angina

    Directory of Open Access Journals (Sweden)

    Marçal de Oliveira Huoya

    2009-04-01

    -diabéticos con AI, lo que indica que ese cuadro clínico puede equilibrar la actividad inflamatoria entre los dos grupos y aumentar la concentración de marcadores inflamatorios de fase aguda, independientemente del estado metabólico.BACKGROUND: Studies comparing inflammatory activity between diabetic and non-diabetic individuals with acute coronary syndrome are scarce, and none including only patients with unstable angina (UA has been published to date. OBJECTIVE: We compared serum C-reactive protein (CRP, and interleukin-6(IL-6 between diabetic and non-diabetic patients with unstable angina (UA to determine if difference in inflammatory activity is responsible for a worse prognosis in diabetic patients. We also evaluated the correlation between inflammatory markers and the metabolic profile in diabetic patients and the correlation between inflammatory response and in-hospital outcomes: death, acute myocardial infarction, congestive heart failure, and length of stay in hospital. METHODS: A prospective cohort study of 90 consecutive patients admitted to a chest pain unit with UA and divided into two groups, diabetic and non-diabetic. Serum CRP, IL-6, metabolic profile and leukocyte count were measured at hospital arrival. RESULTS: Forty-two patients (47% were diabetic (age 62±9 vs. 48 (53% non-diabetic (age 63±12. No differences between median C-reactive protein (1.78 vs. 2.23mg/l,p=0.74 and interleukin-6 (0 vs. 0pg/ml,p=0.31 were found between the two groups. There was a positive correlation between CRP and total cholesterol (rs = 0.21,p = 0.05, CRP and LDL-cholesterol (rs=0.22,p=0.04 and between CRP and leukocyte count (rs = 0.32, p = 0.02 in both groups. No associations were found between inflammatory markers and in-hospital outcomes. CONCLUSION: We found no difference in inflammatory activity between diabetic and non-diabetic patients with UA, suggesting that this clinical condition may result in balanced inflammatory activity between the two groups and increase acute

  12. Six-month outcome in unstable angina patients without previous myocardial infarction according to the use of tertiary cardiologic resources. RESCATE Investigators. Recursos Empleados en el Síndrome Coronario Agudo y Tiempos de Espera.

    Science.gov (United States)

    Lupón, J; Valle, V; Marrugat, J; Elosua, R; Serés, L; Pavesi, M; Freixa, R; Sanz, G; Masiá, R; Molina, L; Sala, J; Serra, J

    1999-12-01

    The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes. The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established. A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias. Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p = 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p < 0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67). The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.

  13. Acute effects of nicardipine and esmolol on the cardiac cycle, intracardiac hemodynamic and endothelial shear stress in patients with unstable angina pectoris and moderate coronary stenosis: results from single center, randomized study.

    Science.gov (United States)

    Chen, Shao-Liang; Hu, Zuo-Ying; Zhang, Jun-Jie; Ye, Fei; Kan, Jing; Xu, Tian; Liu, Zhi-Zhong; Zhang, Yao-Jun; Zhang, Jun-Xia; Chen, Mengxuan

    2012-06-01

    This study aimed to compare the acute effects of nicardipine and esmolol on hemodynamic and endothelial shear stress (ESS) in patients with unstable angina (UA) and moderate coronary stenosis (MCS). Nicardipine and esmolol exhibit cardioprotection via different mechanisms. However, their acute effects on hemodynamic and ESS are still unknown. One-hundred sixteen patients with UA and MSC were randomly divided into nicardipine (n = 59) and esmolol (n = 57) groups. Drugs were injected as a bolus followed by continuous infusion to achieve the steady states defined as the mean blood pressure (MBP) reduced by ≥ 10% or a heart-rate change by ≥ 15 bpm, lasting for at least 10 min. The aortic pressure (AP), EKG, blood velocity, right atrial pressure, distal coronary pressure (DCP), systolic time (ST), isovolumetric diastolic time (IVDT), speed filling time (SFT), and ESS were simultaneously calculated at baseline and steady states. Both drugs significantly reduced blood pressure and rate-pressure load. Infusion of nicardipine was associated with negative remodeling of the distal segment (P= 0.005). Esmolol, rather than nicardipine, increased minimal lumen diameter (P= 0.040), prolonged SFT (0.34 ± 0.03 s vs. 0.41 ± 0.03 s, P < 0.001), reduced DCP (P < 0.001) and increased blood velocity (33.65 ± 1.07 cm/s vs. 43.36 ± 1.25 cm/s, P < 0.001) at SFT stages, with increased blood-flow (P < 0.001). Both drugs increased downstream ESS. Esmolol significantly reversed abnormally increased ESS (P < 0.001) and increased upstream ESS compared with nicardipine (P < 0.001). Beyond a similar reduction of AP, patients with UA and MCS could benefit more from the reduction of heart rate induced by esmolol (ChiCTR-TRC-10000964). © 2011 Blackwell Publishing Ltd.

  14. The relationship between red blood cell distribution width and the clinical outcomes in non-ST elevation myocardial infarction and unstable angina pectoris: a 3-year follow-up.

    Science.gov (United States)

    Gul, Mehmet; Uyarel, Huseyin; Ergelen, Mehmet; Karacimen, Denizhan; Ugur, Murat; Turer, Ayca; Bozbay, Mehmet; Ayhan, Erkan; Akgul, Ozgur; Uslu, Nevzat

    2012-08-01

    Red blood cell distribution width (RDW), a marker of variation in the size of the circulating red blood cells, was evaluated in patients with non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP). Higher RDW is associated with mortality in the general population, particularly in those with symptomatic cardiovascular disease, and heart failure. We hypothesized that admission RDW might be predictive of adverse clinical outcomes for patients with NSTEMI and UAP. We prospectively enrolled 310 patients with NSTEMI and UAP (mean age 59.3±11.9 years; 236 men, 74 women) in this study. Admission RDW was measured and the study population was classified on the basis of RDW tertiles. A high RDW (n=95) was defined as a value in the upper third tertile (>14%) and a low RDW (n=215) was defined as any value in the lower two tertiles (≤14%). The patients were followed up for clinical outcomes for up to 3 years after discharge. In the Kaplan-Meier survival analysis, the 3-year mortality rate was 19% in the high RDW group versus 5.6% in the low RDW group (P<0.001). In the receiver operating characteristic curve analysis, an RDW value of more than 14% yielded a sensitivity of 60% and a specificity of 72.5%. A significant association was found between a high admission RDW level and the adjusted risk of cardiovascular mortality (hazard ratio: 3.2, 95% confidence interval: 1.3-7.78, P=0.01). RDW is a readily available clinical laboratory value associated with long-term cardiovascular mortality in NSTEMI and UAP.

  15. Ludwig's angina.

    Science.gov (United States)

    Saifeldeen, K; Evans, R

    2004-03-01

    The case is described of an occurrence of Ludwig's angina with advanced stage of the disease with progressive and rapid airway compromise and fatal consequence. A review of the literature is undertaken to gain a better understanding of the disease, and gives the opportunity for presenting a summary of the key issues regarding this dreaded disease, particularly the immediate management of it in the emergency department.

  16. Timing of angiography with a routine invasive strategy and long-term outcomes in non-ST-segment elevation acute coronary syndrome: a collaborative analysis of individual patient data from the FRISC II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) Trials.

    Science.gov (United States)

    Damman, Peter; van Geloven, Nan; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A A; Clayton, Tim; Pocock, Stuart J; Hirsch, Alexander; Windhausen, Fons; Tijssen, Jan G P; de Winter, Robbert J

    2012-02-01

    This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate. Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk score, study, and the propensity of receiving early angiography using inverse probability weighting. Of 2,721 patients originally randomized to the routine invasive arm, consisting of routine angiography and subsequent revascularization if suitable, 975 underwent early angiography and 1,141 delayed angiography. No difference was observed in 5-year cardiovascular death or myocardial infarction in unadjusted (HR: 1.06, 95% confidence interval [CI]: 0.79 to 1.42, p=0.61) and adjusted (HR: 0.93, 95% CI: 0.75 to 1.16, p=0.54) Cox regression models. In the FIR database of patients presenting with nSTE-ACS, the timing of angiography was not related to long-term cardiovascular mortality or myocardial infarction. (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes [ICTUS]; ISRCTN82153174. Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction [the Third Randomised Intervention Treatment of Angina Trials (RITA-3)]; ISRCTN

  17. Epileptic Angina.

    Science.gov (United States)

    Sureshbabu, Sachin; Nayak, Dinesh; Peter, Sudhir; Sobhana, Chindripu; Mittal, Gaurav

    2017-01-01

    To investigate the probable ictal origin of unexplained episodic chest pain and if possible to lateralize and localize the epileptic focus. A 14 year old boy presented with episodic short lasting localized chest pain. His cardiac and other systemic work-up were normal. MRI brain did not reveal any structural pathology. Video telemetry was done for characterization of the paroxysms. Interictal record showed left fronto-central epileptiform discharges. A left hemispheric, predominantly centroparietal ictal rhythm was identified. The possible localizations of this unusual semiology are somatosensory areas I and II, supplementary sensorimotor area, posterior insula and cingulate cortex. Patient responded remarkably to antiseizure drugs. Pain is a rare manifestation of epilepsy observed in less than 1% of patients. When present, it is usually accompanied by other focal features. This rare occurrence of epileptic seizures masquerading as angina is a novel observation.

  18. Comparison of outcomes of patients ≥ 80 years of age having percutaneous coronary intervention according to presentation (stable vs unstable angina pectoris/non-ST-segment elevation myocardial infarction vs ST-segment elevation myocardial infarction)

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Jensen, Lisette Okkels; Thayssen, Per

    2011-01-01

    ,792 elderly patients (≥ 80 years old) were treated with PCI and the annual proportion increased from 224 (5.4%) in 2002 to 588 (10.2%) in 2009. The clinical indication was stable angina pectoris (SAP) in 30.2%, ST-segment elevation myocardial infarction (STEMI) in 35.0%, UAP/non-STEMI in 29.7.......08 to 4.85), UAP/non-STEMI (hazard ratio 1.95, 95% confidence interval 1.53 to 2.50), and ventricular arrhythmia or congestive heart failure (hazard ratio 2.75, 95% confidence interval 1.92 to 3.92). In patients with SAP target vessel revascularization decreased from 7.1% in 2002 to 2.5% in 2008...

  19. Comparison of outcomes of patients ≥ 80 years of age having percutaneous coronary intervention according to presentation (stable vs unstable angina pectoris/non-ST-segment elevation myocardial infarction vs ST-segment elevation myocardial infarction).

    Science.gov (United States)

    Antonsen, Lisbeth; Jensen, Lisette Okkels; Thayssen, Per; Christiansen, Evald Høj; Junker, Anders; Tilsted, Hans-Henrik; Terkelsen, Christian Juhl; Kaltoft, Anne; Maeng, Michael; Hansen, Knud Noerregaard; Ravkilde, Jan; Lassen, Jens Flensted; Madsen, Morten; Sørensen, Henrik Toft; Thuesen, Leif

    2011-11-15

    Patients ≥ 80 years old with coronary artery disease constitute a particular risk group in relation to percutaneous coronary intervention (PCI). From 2002 through 2008 we examined the annual proportion of patients ≥ 80 years old undergoing PCI in western Denmark, their indications for PCI, and prognosis. From 2002 through 2009 all elderly patients treated with PCI were identified in a population of 3.0 million based on the Western Denmark Heart Registry. Cox regression analysis was used to compare mortality rates according to clinical indications controlling for potential confounding. In total 3,792 elderly patients (≥ 80 years old) were treated with PCI and the annual proportion increased from 224 (5.4%) in 2002 to 588 (10.2%) in 2009. The clinical indication was stable angina pectoris (SAP) in 30.2%, ST-segment elevation myocardial infarction (STEMI) in 35.0%, UAP/non-STEMI in 29.7%, and "ventricular arrhythmia or congestive heart failure" in 5.1%. Overall 30-day and 1-year mortality rates were 9.2% and 18.1%, respectively. Compared to patients with SAP the adjusted 1-year mortality risk was significantly higher for patients presenting with STEMI (hazard ratio 3.86, 95% confidence interval 3.08 to 4.85), UAP/non-STEMI (hazard ratio 1.95, 95% confidence interval 1.53 to 2.50), and ventricular arrhythmia or congestive heart failure (hazard ratio 2.75, 95% confidence interval 1.92 to 3.92). In patients with SAP target vessel revascularization decreased from 7.1% in 2002 to 2.5% in 2008. In conclusion, the proportion of patients ≥ 80 years old treated with PCI increased significantly over an 8-year period. Patients with SAP had the lowest mortality rates and rates of clinically driven target vessel revascularization decreased over time. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. A framework for quality improvement: an analysis of factors responsible for improvement at hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative.

    Science.gov (United States)

    Glickman, Seth W; Boulding, William; Staelin, Richard; Mulgund, Jyotsna; Roe, Matthew T; Lytle, Barbara L; Rumsfeld, John S; Gibler, W Brian; Ohman, E Magnus; Schulman, Kevin A; Peterson, Eric D

    2007-12-01

    Hospitals are under increasing pressure to improve their quality of care. However, a key question remains: how can hospitals best design and implement successful quality improvement (QI) programs? Hospitals currently employ a variety of QI initiatives but have little empirical evidence on which to base their quality efforts. We designed and applied a hospital cross-sectional survey to 212 hospitals participating in CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines), a voluntary QI initiative of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). We factor analysis and an ordinary least squares regression model to determine the key hospital factors most associated with unexpected improvements in institutional QI in the treatment of NSTE ACS. From 2002 to 2004, the following factors had a significant association with unexpected increases in the 2004 QI in NSTE ACS treatment: the use of CRUSADE QI tools, clinical commitment to quality by a cardiology coadvocate, institutional financial commitment to quality, and barriers to QI related to resource availability and cultural resistance to change (all P institutional factors associated with improved quality of care in the treatment of high-risk NSTE ACS. We hope that this evidence-based framework will help guide the development and implementation of future QI programs in order to improve the institutional quality of care for NSTE ACS.

  1. Angina de Prinzmetal Angina de Prinzmetal Prinzmetal's angina

    OpenAIRE

    Eduardo Contreras Zuniga; Juan Esteban Gomez Mesa; Sandra Ximena Zuluaga Martinez; Vanesa Ocampo; Cristian Andres Urrea

    2009-01-01

    Essa síndrome é causada por um espasmo focal de uma artéria coronária epicárdica, levando a isquemia miocárdica grave. Embora freqüentemente acredite-se que o espasmo ocorra em artérias sem estenose, muitos pacientes com angina de Prinzmetal apresentam espasmo adjacente a placas ateromatosas. A causa exata do espasmo não está bem definida, mas pode estar relacionada à hipercontratilidade do músculo liso vascular devido a mitógenos vasoconstrictores, leucotrienos ou serotonina. Em alguns pacie...

  2. Unstable volatility

    DEFF Research Database (Denmark)

    Casas, Isabel; Gijbels, Irène

    2012-01-01

    The objective of this paper is to introduce the break-preserving local linear (BPLL) estimator for the estimation of unstable volatility functions for independent and asymptotically independent processes. Breaks in the structure of the conditional mean and/or the volatility functions are common i...

  3. Ludwig’s Angina: The Original Angina

    Directory of Open Access Journals (Sweden)

    Karim Kassam

    2013-01-01

    Full Text Available Ludwig’s angina was first detailed by the German surgeon Wilhelm Friedrich von Ludwig in 1836. We present a case which needed awake fibreoptic intubation due to severe trismus and a prolonged period intubated in the Intensive Care Unit after incision and drainage of neck spaces and removal of his lower wisdom teeth. He was finally discharged a week after admission and followed up in the outpatient clinic. The case is presented with clinical photographs and a video of the fibreoptic intubation to illustrate the airway.

  4. Angina de Prinzmetal Angina de Prinzmetal Prinzmetal's angina

    Directory of Open Access Journals (Sweden)

    Eduardo Contreras Zuniga

    2009-08-01

    Full Text Available Essa síndrome é causada por um espasmo focal de uma artéria coronária epicárdica, levando a isquemia miocárdica grave. Embora freqüentemente acredite-se que o espasmo ocorra em artérias sem estenose, muitos pacientes com angina de Prinzmetal apresentam espasmo adjacente a placas ateromatosas. A causa exata do espasmo não está bem definida, mas pode estar relacionada à hipercontratilidade do músculo liso vascular devido a mitógenos vasoconstrictores, leucotrienos ou serotonina. Em alguns pacientes, é uma manifestação de distúrbio vasoespástico e está associado à migrânea, fenômeno de Raynaud ou asma induzida por aspirina. Apresentamos um caso associado com depressão transitória do segmento ST.Este síndrome es causado por un espasmo focal de una arteria coronaria epicárdica, llevando a isquemia miocárdica grave. Aunque frecuentemente se crea que el espasmo ocurra en arterias sin estenosis, muchos pacientes con angina de Prinzmetal presentan espasmo adyacente a placas ateromatosas. La causa exacta del espasmo no está bien definida, pero puede estar relacionada a la hipercontractilidad del músculo liso vascular debido a mitógenos vasoconstrictores, leucotrienos o serotonina. En algunos pacientes, es una manifestación de disturbio vasoespástico y está asociado a la migraña, fenómeno de Raynaud o asma inducida por aspirina. Presentamos un caso asociado con depresión transitoria del segmento ST.This syndrome is due to focal spasm of an epicardial coronary artery, leading to severe myocardial ischemia. Although it is frequently thought that the spasm occurs in arteries without stenosis, many Prinzmetal patients have spasm adjacent to atheromatous plaques. The exact cause of the spasm has not been well defined, but it may be related to the hypercontractility of the vascular smooth muscle due to vasoconstrictor mitogens, leukotrienes, or serotonin. In some patients, it is a manifestation of a vasospastic disorder and it

  5. Angina - when you have chest pain

    Science.gov (United States)

    ... gov/ency/patientinstructions/000088.htm Angina - when you have chest pain To use the sharing features on ... discusses how to care for yourself when you have angina. Signs and Symptoms of Angina You may ...

  6. Angina de Prinzmetal

    OpenAIRE

    Contreras Zuniga, Eduardo; Gomez Mesa, Juan Esteban; Zuluaga Martinez, Sandra Ximena; Ocampo, Vanesa; Andres Urrea, Cristian

    2009-01-01

    Essa síndrome é causada por um espasmo focal de uma artéria coronária epicárdica, levando a isquemia miocárdica grave. Embora freqüentemente acredite-se que o espasmo ocorra em artérias sem estenose, muitos pacientes com angina de Prinzmetal apresentam espasmo adjacente a placas ateromatosas. A causa exata do espasmo não está bem definida, mas pode estar relacionada à hipercontratilidade do músculo liso vascular devido a mitógenos vasoconstrictores, leucotrienos ou serotonina. Em alguns pacie...

  7. Ludwig's angina and pneumococcal sepsis.

    Science.gov (United States)

    Gridley, J; Franaszek, J

    1986-01-01

    We present a 75-year-old patient with an unusual bacteriologic cause of Ludwig's angina, Streptococcus pneumoniae. This organism appears more commonly in children. Recognition of Ludwig's angina, its causative organisms, and the necessity for airway management in addition to antibiotic therapy are important to limit its morbidity.

  8. Ludwig angina: forewarned is forearmed.

    Science.gov (United States)

    Kremer, Michael J; Blair, Tracy

    2006-12-01

    While the incidence of Ludwig angina is decreasing, this is an important disease process because failure to control the airway can have catastrophic consequences. Accurate diagnosis, airway control, antibiotic therapy, and, occasionally, surgical management are essential for patient safety. Ludwig angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by hardened induration of the floor and suprahyoid region bilaterally with an elevation of the tongue potentially obstructing the airway. In the preantibiotic era, Ludwig angina was frequently fatal; however, antibiotics and aggressive surgical treatment have significantly lowered mortality.

  9. Behandling af ustabil angina pectoris. En spørgeskemaundersøgelse

    DEFF Research Database (Denmark)

    Nielsen, J D; Stoltenberg, Meredin; Juul, A

    1990-01-01

    Questionnaires about therapy in unstable angina pectoris were sent to 63 Danish medical departments and were answered by 52 departments (82.5%). Nitroglycerin is commonly used but only in half of the departments is Nitroglycerin administered intravenously. Calcium-receptor-blockers are used in more...

  10. Ludwig's angina: an update.

    Science.gov (United States)

    Patterson, H C; Kelly, J H; Strome, M

    1982-04-01

    Despite a reduction in preantibiotic mortality rates that exceeded 50%, Ludwig's angina remains a potentially lethal entity primarily because of rapidly progressive airway obstruction. Since the reports of several large series in the 1940's, there have been put sporadic case reports because of widespread use of antibiotics in orodental infection, improved dental care, as well as adherence to strict diagnostic criteria. Since this entity is now uncommon, unnecessary delay in diagnosis and management may occur and may result in serious complications. This presentation will consist of an historical review, discussion of pathogenesis followed by clinical presentation, bacteriology and treatment, as well as a detailed analysis of our most recent 20 cases. There were no complications and no deaths. The infection resolved with medical therapy in 11 patients, while 9 patients required surgical procedures. Penicillin, clindamycin or chloramphenicol were started initially in all cases. Four of these 9 patients developed a localized abscess, while on antibiotics, which required drainage. Tracheotomy or intubation was necessary in 7 patients. Early and aggressive use of appropriate antibiotics and protection of the airway are the mainstays of a successful treatment regimen. Judicious surgical intervention is indicated in those patients who develop localized abscesses while on antibiotics or are unresponsive to medical management.

  11. Prognostic significance of myocardial imaging with iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid in patients with angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Hatano, Tsuguhisa; Chikamori, Taishiro; Kamada, Tatsuya; Morishima, Takayuki; Hida, Satoshi; Yanagisawa, Hidefumi; Iino, Hitoshi; Yamashina, Akira [Tokyo Medical Coll. (Japan)

    2001-09-01

    To assess the clinical significance of iodine-123 beta-methyl-p-iodophenyl-pentadecanoic acid (BMIPP) single photon emission computed tomography (SPECT), the predictive value of BMIPP imaging in patients with angina pectoris was evaluated. One hundred seventy-four patients who underwent BMIPP imaging in our institution were aged 61.8{+-}11 years. One hundred thirty-five patients had stable angina and 39 had unstable angina at the time of examination. Patients with previous myocardial infarction or myocardial disorders were excluded. Early and delayed images were acquired in BMIPP SPECT, and the images were analyzed visually. Cardiac events were classified into hard and soft events: the former consisted of cardiac death and nonfatal myocardial infarction, and the latter included coronary revascularization and heart failure. The findings of BMIPP imaging were normal in 82 patients and abnormal in 92. During follow-up of 15.5{+-}9.5 months, hard events were observed in 4 patients and soft events in 53. In patients with normal BMIPP imaging, soft events were observed in nine patients, but no hard event was encountered. Furthermore, in patients with both normal BMIPP and stress thallium imagings, no cardiac event was observed during 2 years. In contrast, 4 hard events and 44 soft events occurred in patients with abnormal BMIPP imaging. Patients with abnormal BMIPP imaging had a higher incidence of soft events than those with normal BMIPP imaging, regardless of the type of angina (16/62 vs 3/73, p<0.0005 for stable angina; 28/30 vs 6/9, p<0.0001 for unstable angina). The finding of BMIPP imaging correlates well with the mid-term prognosis of patients with angina pectoris. Since BMIPP SPECT is performed without stress to the patient, this imaging modality is important in evaluating patients with stable or unstable angina. (author)

  12. ANGINA PECTORIS AND NORMAL CORONARY ANGIOGRAPHY*

    African Journals Online (AJOL)

    Thirteen cases of angina pectoris Wilh normal coronary arteriograms are ... Cardiac Clinic. A fourteenth case, a 28-year-old White female, is in- cluded in this report. This patient had typical angina pectoris. She had a story of 6 months' substernal chest ... The diagnosis of angina was made on the history by at least two of us.

  13. Airway management in Ludwig's angina.

    Science.gov (United States)

    Neff, S P; Merry, A F; Anderson, B

    1999-12-01

    A 37-year-old 91 kg man presented with features of Ludwig's angina. Anaesthesia for incision and drainage of his submandibular abscess was undertaken by two specialist anaesthetists with an otorhinolaryngological surgeon prepared for immediate tracheostomy. After preoxygenation, gas induction with sevoflurane in oxygen was followed by a gush of pus into the oral cavity and laryngospam causing acute upper airway obstruction. This resolved with 25 mg of suxamethonium and an endotracheal tube was passed into the trachea with difficulty. Options for management of the difficult airway in Ludwig's angina are discussed.

  14. Angina pectoris efter sumatriptan (Imigran)

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Christiansen, B D

    1992-01-01

    Developed for the treatment of migraine, sumatriptan is an agonist of 5-hydroxytryptamine-1-receptors. Though a pressure sensation is a common complaint, significant ECG changes have not been reported after subcutaneous administration of sumatriptan. A case history is given where angina pectoris ...

  15. Avaliação das pressões sistólica, diastólica e pressão de pulso como fator de risco para doença aterosclerótica coronariana grave em mulheres com angina instável ou infarto agudo do miocárdio sem supradesnivelamento do segmento ST Evaluation of systolic, diastolic, and pulse pressure as risk factors for severe coronary arteriosclerotic disease in women with unstable angina non-ST-elevation acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    José Marconi Almeida de Sousa

    2004-05-01

    Full Text Available OBJETIVO: Avaliar se as pressões, medidas na raiz da aorta, são fatores de risco para doença aterosclerótica coronariana grave em mulheres com angina instável ou infarto agudo do miocárdio sem supradesnivelamento do segmento ST (AI/IAMSS. MÉTODO:As pressões, assim como os fatores de risco para doença arterial coronariana (DAC foram prospectivamente coletados de março/1993 a agosto/2001 em 593 mulheres com diagnóstico de AI/IAMSS submetidas à cinecoronariografia. Lesões coronarianas definidas como graves estenoses > 70%. RESULTADOS: Idade média de 59,2±11,2 anos, significantemente mais alta nas pacientes com DAC: 61,9 ± 10,8 anos vs 56.4 ± 10,8 anos; tabagismo, diabetes e climatério foram mais freqüentes nas pacientes com DAC. As médias das pressões sistólica e arterial média foram iguais nos dois grupos, entretanto as médias das pressões diastólicas do ventrículo esquerdo (17.6 ± 8.7 x 15.1 ± 8.1, p=0.001 e da pressão de pulso aórtica foram significantemente maiores nas pacientes com DAC (75.5 ± 22 x 70 ± 19, p=0.002, enquanto a média da pressão diastólica aórtica foi significantemente mais alta nas pacientes sem DAC (75.3 ± 17.5 x 79.8 ± 16, p=0.003. Na análise multivariada a pressão de pulso > 80 mmHg e pressão sistólica > 165 foram independentemente associadas a DAC com razão de chance de 2.12 e 2.09, p 80 mmHg e pressão sistólica > 165 mmHg determinaram risco duas vezes maior de lesão coronariana grave.OBJECTIVE: To evaluate pressures assessed at the aortic root as risk factors for severe atherosclerotic coronary heart disease in women with unstable angina/compatible clinical history associated with increase in cardiac enzymes (total CPK and CK-MB 2 times greater than the standard value used in the hospital, with the absence of new Q waves on the electrocardiogram (UA/NSTEMI. METHODS: Five hundred and ninety-three female patients with clinical diagnosis of UA/NSTEMI underwent cinecoronariography

  16. The significance of {sup 123}I-BMIPP myocardial SPECT on the evaluation of angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Kurosawa, Kazuhiko; Ohtani, Hiroshi; Saitou, Tomiyoshi; Maruyama, Yukio [Fukushima Medical Coll. (Japan); Katohno, Eiichi; Ohwada, Kenji

    1998-06-01

    Some patients of ischemic heart disease have low uptake in {sup 123}I-labeled beta methyl-iodophenyl pentadecanoic acid (BMIPP) SPECT in spite of normal uptake in thallium-201 (Tl) SPECT. To investigate their clinical significance, we performed both Tl and BMIPP myocardial SPECT in 26 cases with stable angina (n=16) and unstable angina (n=10), and compared with clinical backgrounds electrocardiogram (ECG) and left ventriculography (LVG). In 11 patients of them, the uptake of BMIPP was moderately reduced. We divided 26 cases into two groups according to uptake of BMIPP (normal/reduced). The two groups had no differences in length of angina attack and duration of disease, but they had a significant difference in the abnormality of either ECG or LVG. Three to six months after PTCA, we examined LVG in 18 cases, 12 of 16 cases with the abnormality of LVG showed the improvement of wall motion. We concluded the reduced uptake of BMIPP with normal uptake of Tl was related to more severe ischemia in cases with unstable angina. (author)

  17. Ludwig's angina: a clinical review.

    Science.gov (United States)

    Srirompotong, Somchai; Art-Smart, Thumnu

    2003-08-01

    Ludwig's angina is caused by a rapidly expanding cellulitis of the floor of the mouth and is characterized by a brawny induration of the floor and suprahyoid region (bilaterally), with an elevation of the tongue potentially obstructing the airway. In the pre-antibiotic era, Ludwig's angina was frequently fatal; however, antibiotics and aggressive surgical intervention have significantly reduced mortality. We reviewed nine patients with Ludwig's angina between July 1996 and June 2002, all of whom presented with fever, neck swelling, bilateral submandibular swelling and elevation of the tongue. In eight patients (89%) a dental infection appeared to be the underlying cause. High-dosage intravenous antibiotics directed towards the suspected causative microorganisms were given to all of the patients: two were treated successfully with conservative medical management, while seven underwent surgical drainage (a tracheotomy was necessary in one patient). Routine aerobic cultures were done on samples of drained material and the predominant microorganisms were Streptococcus species in two patients; there were none in the other five. Two patients had post-operative complications, but all recovered.

  18. Angina in Women Can Be Different Than Men

    Science.gov (United States)

    ... Aortic Aneurysm More Angina in Women Can Be Different Than Men Updated:Jun 13,2017 Angina (chest ... the symptoms. So why would angina symptoms be different in women and men? Heart disease in men ...

  19. Ludwig's Angina Following Self Application of an Acidic Chemical ...

    African Journals Online (AJOL)

    Ludwig's angina is a potentially life threatening diffuse cellulitis usually resulting from odontogenic infection. We report a case of Ludwig's angina resulting from self administration of an acidic chemical to treat toothache. Keywords: Toothache, Acid chemical, Ludwig's angina ...

  20. Unstable slope management program.

    Science.gov (United States)

    2009-08-01

    This Rapid Response Project gathered information on existing unstable slope management programs, with a : focus on asset management practices in the United States and overseas. On the basis of this study, the research : team summarized and recommende...

  1. Clinical Characteristics and Outcomes of Patients With Coronary Artery Disease and Angina: Analysis of the Irbesartan in Patients With Heart Failure and Preserved Systolic Function Trial.

    Science.gov (United States)

    Badar, Athar A; Perez-Moreno, Ana Cristina; Hawkins, Nathaniel M; Jhund, Pardeep S; Brunton, Alan P T; Anand, Inder S; McKelvie, Robert S; Komajda, Michel; Zile, Michael R; Carson, Peter E; Gardner, Roy S; Petrie, Mark C; McMurray, John J V

    2015-07-01

    The aim of our study was to investigate the relationship between coronary artery disease (CAD), angina, and clinical outcomes in patients with heart failure and preserved ejection fraction enrolled in the irbesartan in patients with heart failure and preserved systolic function (I-Preserve) trial. The mean follow-up period for the 4128 patients enrolled in I-Preserve was 49.5 months. Patients were divided into 4 mutually exclusive groups according to history of CAD and angina: patients with no history of CAD or angina (n=2008), patients with no history of CAD but a history of angina (n=649), patients with a history of CAD but no angina (n=468), and patients with a history of CAD and angina (n=1003); patients with no known CAD or angina were the reference group. After adjustment for other prognostic variables using Cox proportional-hazard models, patients with CAD but no angina were found to be at higher risk of all-cause mortality (hazard ratio [HR], 1.58 [1.22-2.04]; P<0.01) and sudden death (HR, 2.12 [1.33-3.39]; P<0.01), compared with patients with no CAD or angina. Patients with CAD and angina were also at higher risk of all-cause mortality (HR, 1.29 [1.05-1.59]; P=0.02) and sudden death (HR, 1.83 [1.24-2.69]; P<0.01) compared with the same reference group and had the highest risk of unstable angina or myocardial infarction (HR, 5.84 [3.43-9.95]; P<0.01). Patients with heart failure and preserved ejection fraction and CAD are at higher risk of all-cause mortality and sudden death when compared with those without CAD. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00095238. © 2015 American Heart Association, Inc.

  2. Ludwig's angina: case report and review.

    Science.gov (United States)

    Spitalnic, S J; Sucov, A

    1995-01-01

    Modern dental care and use of antibiotics for oral infections have made Ludwig's angina rare. To avoid acute airway obstruction, emergency physicians must be able to rapidly recognize and treat this condition. A typical case of Ludwig's angina is presented, followed by a review of clinical findings and therapeutic modalities. Emphasis is made on airway management, antibiotics, and surgical drainage.

  3. Pregnancy Complicated by Ludwig's Angina Requiring Delivery

    Directory of Open Access Journals (Sweden)

    Kathleen Moorhead

    2010-01-01

    Full Text Available At 33 weeks of gestation, a 24-year-old developed Ludwig's angina that worsened despite aggressive therapy. This is the first reported case of Ludwig's Angina in pregnancy that required an emergent cesarean section for fetal indications. Delivery may have contributed to improvement in the mother's health status.

  4. Recent advances in the management of chronic stable angina II. Anti-ischemic therapy, options for refractory angina, risk factor reduction, and revascularization

    Directory of Open Access Journals (Sweden)

    Richard Kones

    2010-08-01

    Full Text Available Richard KonesThe Cardiometabolic Research Institute, Houston, Texas, USAAbstract: The objectives in treating angina are relief of pain and prevention of disease ­progression through risk reduction. Mechanisms, indications, clinical forms, doses, and side effects of the traditional antianginal agents – nitrates, ß-blockers, and calcium channel ­blockers – are reviewed. A number of patients have contraindications or remain unrelieved from anginal discomfort with these drugs. Among newer alternatives, ranolazine, recently approved in the United States, indirectly prevents the intracellular calcium overload involved in cardiac ischemia and is a welcome addition to available treatments. None, however, are disease-modifying agents. Two options for refractory angina, enhanced external counterpulsation and spinal cord stimulation (SCS, are presented in detail. They are both well-studied and are effective means of treating at least some patients with this perplexing form of angina. Traditional modifiable risk factors for coronary artery disease (CAD – smoking, hypertension, dyslipidemia, ­diabetes, and obesity – account for most of the population-attributable risk. Individual therapy of high-risk patients differs from population-wide efforts to prevent risk factors from appearing or reducing their severity, in order to lower the national burden of disease. Current American College of Cardiology/American Heart Association guidelines to lower risk in patients with chronic angina are reviewed. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE trial showed that in patients with stable angina, optimal medical therapy alone and percutaneous coronary intervention (PCI with medical therapy were equal in preventing myocardial infarction and death. The integration of COURAGE results into current practice is discussed. For patients who are unstable, with very high risk, with left main coronary artery lesions, in

  5. Painful/unstable shoulder

    International Nuclear Information System (INIS)

    Saez, F.; Negueruela, J.; Martin, J.C.; Elizagaray, E.; Pena, J.M.; Merino, A.

    1991-01-01

    This paper reports on the diagnostic performance of CT-arthrography of the painful/unstable shoulder that was evaluated in more than 300 patients. We have encountered a great variety of painful shoulder pathology, including impingement syndrome, cuff tear arthropathy, lesions of the long head of the biceps tendon, calcifying tendinitis, adhesive capsulitis, dead arm syndrome, and degenerative joint disease. Lesions related to instability include cases of capsular avulsions, disruption of the glenohumeral ligaments, labral pathology, glenoid fractures, Hill-Sachs lesions, and changes in glenoid angulation. CT-arthrography is an accurate exploration for both unstable and painful shoulders

  6. Suppression of exercise-induced angina by magnesium sulfate in patients with variant angina

    International Nuclear Information System (INIS)

    Kugiyama, K.; Yasue, H.; Okumura, K.

    1988-01-01

    The effects of intravenous magnesium on exercise-induced angina were examined in 15 patients with variant angina and in 13 patients with stable effort angina and were compared with those of placebo. Symptom-limited bicycle exercise and thallium-201 myocardial scintigraphy were performed after intravenous administration of 0.27 mmol/kg body weight of magnesium sulfate and after placebo on different days. In all patients, serum magnesium levels after administration of magnesium sulfate were about twofold higher than levels after placebo. Exercise-induced angina associated with transient ST segment elevation occurred in 11 patients with variant angina receiving placebo and in only 2 of these patients receiving magnesium (p less than 0.005). On the other hand, exercise-induced angina was not suppressed by magnesium in any patient with stable effort angina. In these patients there was no significant difference in exercise duration after administration of placebo versus after administration of magnesium. The size of the perfusion defect as measured by thallium-201 scintigraphy was significantly less in patients with variant angina receiving magnesium than that in those receiving placebo (p less than 0.001), whereas it was not significantly different in patients with stable effort angina receiving placebo versus magnesium. In conclusion, exercise-induced angina is suppressed by intravenous magnesium in patients with variant angina but not in patients with stable effort angina. This beneficial effect of magnesium in patients with variant angina is most likely due to improvement of regional myocardial blood flow by suppression of coronary artery spasm

  7. Angina

    Science.gov (United States)

    ... trials from ClinicalTrials.gov . Visit Children and Clinical Studies to hear experts, parents, and children talk about their experiences with clinical research. More Information Related Health Topics Atherosclerosis Coronary Heart Disease Coronary Heart Disease Risk Factors ...

  8. Ludwig's angina: a case report and review.

    Science.gov (United States)

    Dreyer, A F; de Kock, S E; Rantloane, J L

    1990-09-01

    A case of Ludwig's angina which developed after mandibular fractures in a 14-year-old male patient is reported. We emphasise the serious nature of this condition and the aggressive treatment it requires. It is important to recognise cases of Ludwig's angina at an early stage, as well as cases which are at risk of developing into true Ludwig's angina if treatment is delayed. Management should be aimed at maintaining an open airway by nasotracheal intubation or cricothyroidotomy, together with treatment of the infection by removal of the source, drainage of pus and parenteral antibiotic therapy. In addition, investigation and management of contributing medical conditions and timely specialist consultation are essential.

  9. Who Is at Risk for Angina?

    Science.gov (United States)

    ... emotional stress triggers angina. Learn ways to handle stress that can't be avoided. You also can make lifestyle changes that help lower your risk for coronary heart disease . One of the most important changes is to ...

  10. Intestinal angina. Report on two operated cases.

    Science.gov (United States)

    Solheim, K; Rosseland, A; Lund, B L

    1977-01-01

    In spite of the fact that the concept of intestinal angina is more than 70 years old, it is not generally accepted and only 400 cases of elective revascularization of the celiac/mesenteric arteries are reported in the literature. Two typical cases of intestinal angina treated with elective revascularization are presented and the pertinent literature is reviewed. An aggresive approach to the problem, followed by adequate reconstruction, is recommended.

  11. Surgical management of Ludwig's angina.

    Science.gov (United States)

    Greenberg, Simon L L; Huang, Johnson; Chang, Robert S K; Ananda, Subramaniam N

    2007-07-01

    Ludwig's angina (LA) is a dangerous surgical condition that can cause severe airway compromise and death. There is controversy regarding the best way to manage the airway of patients with LA. Options range from conservative management involving close observation and i.v. antibiotics to airway intervention, including tracheostomy and endotracheal intubation using fibre-optic nasoendoscopy. We present evidence supporting a role for conservative airway management in a select subset of patients. This paper reviews 9 years' experience of treating patients with LA at Liverpool Hospital. Twenty-one out of 29 (72%) of our patients were treated conservatively following initial clinical assessment. One of these patients subsequently deteriorated requiring emergency intubation. Of those treated non-conservatively at initial presentation, seven patients were able to be intubated using fibre-optic nasoendoscopy and one patient required tracheostomy under local anaesthesia. A general discussion of issues related to the management of LA is presented. Based on our experience we conclude that there is a subset of patients with LA who can be managed safely with conservative management.

  12. Low education as a risk factor for undiagnosed angina.

    Science.gov (United States)

    McKee, Michael M; Winters, Paul C; Fiscella, Kevin

    2012-01-01

    Early awareness, recognition, and treatment of angina can help prevent or delay an acute myocardial infarction and potentially delay death. A patient's educational level may affect a physician's diagnosis of angina and/or a patient's symptom recognition. The objective of this study was to determine whether low education is a risk factor for undiagnosed angina. This was a cross-sectional observational study based on data from the National Health and Nutrition Examination Survey 2001 to 2008, providing a nationally representative sample of adults ≥40 years of age with angina based on physician diagnosis, presence of angina symptoms based on the Rose Questionnaire, or both. Educational attainment (high school or less vs more than high school) was the independent variable of interest. Undiagnosed angina (angina symptoms in the absence of angina diagnosis) was the dependent variable. We used logistic regression to control for age, sex, race/ethnicity, income, and health care visit during the past year. Low education was associated with undiagnosed angina (odds ratio: 1.43; 95% confidence interval: 1.01-2.03). Other undiagnosed angina predictors included being female, being black, and having no health care visit during the past year. Low education is associated with undiagnosed angina. These results underscore the need for providers to ask about angina symptoms and confirm patients' understanding of their angina diagnosis among those with low education.

  13. Safety and efficacy of angioplasty with intracoronary stenting in patients with unstable coronary syndromes. Comparison with stable coronary syndromes

    Directory of Open Access Journals (Sweden)

    Luís C. L. Correia

    2000-06-01

    Full Text Available OBJECTIVE: To assess safety and efficacy of coronary angioplasty with stent implantation in unstable coronary syndromes. METHODS: Retrospective analysis of in-hospital and late evolution of 74 patients with unstable coronary syndromes (unstable angina or infarction without elevation of the ST segment undergoing coronary angioplasty with stent placement. These 74 patients were compared with 31 patients with stable coronary syndromes (stable angina or stable silent ischemia undergoing the same procedure. RESULTS: No death and no need for revascularization of the culprit artery occurred in the in-hospital phase. The incidences of acute non-Q-wave myocardial infarction were 1.4% and 3.2% (p=0.6 in the unstable and stable coronary syndrome groups, respectively. In the late follow-up (11.2±7.5 months, the incidences of these events combined were 5.7% in the unstable coronary syndrome group and 6.9% (p=0.8 in the stable coronary syndrome group. In the multivariate analysis, the only variable with a tendency to significance as an event predictor was diabetes mellitus (p=0.07; OR=5.2; 95% CI=0.9-29.9. CONCLUSION: The in-hospital and late evolutions of patients with unstable coronary syndrome undergoing angioplasty with intracoronary stent implantation are similar to those of the stable coronary syndrome group, suggesting that this procedure is safe and efficacious when performed in unstable coronary syndrome patients.

  14. Imaging unstable plaque

    International Nuclear Information System (INIS)

    SRIRANJAN, Rouchelle S.; TARKIN, Jason M.; RUDD, James H.; EVANS, Nicholas R.; CHOWDHURY, Mohammed M.

    2016-01-01

    Recent advances in imaging technology have enabled us to utilise a range of diagnostic approaches to better characterise high-risk atherosclerotic plaque. The aim of this article is to review current and emerging techniques used to detect and quantify unstable plaque in the context of large and small arterial systems and will focus on both invasive and non-invasive imaging techniques. While the diagnosis of clinically relevant atherosclerosis still relies heavily on anatomical assessment of arterial luminal stenosis, evolving multimodal cross-sectional imaging techniques that encompass novel molecular probes can provide added information with regard to plaque composition and overall disease burden. Novel molecular probes currently being developed to track precursors of plaque rupture such as inflammation, micro-calcification, hypoxia and neoangiogenesis are likely to have translational applications beyond diagnostics and have the potential to play a part in quantifying early responses to therapeutic interventions and more accurate cardiovascular risk stratification.

  15. Ludwig's angina in the pediatric population.

    Science.gov (United States)

    Lin, Harrison W; O'Neill, Allison; Cunningham, Michael J

    2009-07-01

    As many as 1 in 3 of cases of Ludwig's angina occur in children and adolescents, and pediatricians are therefore ideally situated to detect these individuals at an early stage of their potentially life-threatening disease. The early identification and referral of children afflicted with Ludwig's angina to tertiary care centers allows for the rapid initiation of medical therapy and the consultation of those emergency services critical to providing such patients with optimal diagnostic and therapeutic interventions. This review provides an overview of the anatomical and pathophysiological considerations in Ludwig's angina and describes practical management principles to assist pediatricians in the diagnosis and treatment of this disease. Included in this review is an evidence-based algorithm for airway management.

  16. Effect of raised plasma β endorphin concentrations on peripheral pain and angina thresholds in patients with stable angina

    OpenAIRE

    Jarmukli, N; Ahn, J; Iranmanesh, A; Russell, D

    1999-01-01

    OBJECTIVE—To determine whether changes in plasma concentrations of β endorphins alter angina threshold and peripheral pain threshold in patients with stable angina.
DESIGN—Latin square design comparison of angina thresholds by exercise treadmill test and peripheral pain thresholds using a radiant heat source in eight patients with stable angina under control conditions, after stimulation of pituitary β endorphin release by ketoconazole, after suppression of pituitary β endorphin release by de...

  17. Treatment with verapamil and trandolapril in patients with congestive heart failure and angina pectoris or myocardial infarction. The DAVIT Study Group. Danish Verapamil Infarction Trial

    DEFF Research Database (Denmark)

    Hansen, J F; Hagerup, L; Sigurd, B

    1997-01-01

    In a double-blind, randomized trial in a consecutive group of postinfarct patients in treatment with diuretic agents for congestive heart failure, the 3 month rate of cardiac events (i.e., death, repeat infarction, unstable angina pectoris, or repeat admission because of heart failure) was 14......% in patients treated with verapamil and trandolapril and 35% in patients treated with trandolapril (p = 0.01). In another study of patients with angina pectoris and left ventricular ejection fraction less than 40%, trandolapril plus verapamil improved exercise duration and left ventricular ejection fraction...

  18. Acute management of unstable angina and non-ST segment elevation myocardial infarction

    Science.gov (United States)

    Silva, Fernando Morita Fernandes; Pesaro, Antonio Eduardo Pereira; Franken, Marcelo; Wajngarten, Mauricio

    2015-01-01

    Non-ST segment elevation coronary syndrome usually results from instability of an atherosclerotic plaque, with subsequent activation of platelets and several coagulation factors. Its treatment aims to reduce the ischemic pain, limiting myocardial damage and decreasing mortality. Several antiplatelet and anticoagulation agents have been proven useful, and new drugs have been added to the therapeutic armamentarium in the search for higher anti-ischemic efficacy and lower bleeding rates. Despite the advances, the mortality, infarction and readmission rates remain high. PMID:26466065

  19. Blood rheology of angina pectoris patients with myocardial injury after ischemia reperfusion and its effect on thromboxane B2levels.

    Science.gov (United States)

    Wang, Wenlong; Huang, Xiaohui; Sun, Yiyong; Zhang, Jinying

    2018-01-01

    This study investigated the changes in the blood rheology of patients with angina pectoris and ischemia reperfusion injury and their effect on thromboxane B 2 (TXB 2 ) levels to examine their relationship. Forty patients with unstable angina pectoris who underwent elective percutaneous coronary intervention (PCI) were selected for the unstable angina group (UA group) and forty patients deemed free of coronary heart disease by coronary angiography were selected for the control group. Venous blood samples were drawn from all participants; patients in the UA group had blood drawn 1 day before and 1 day after the PCI procedure. Blood samples were used to analyze blood rheology and examine hemodynamic parameters, at the same time radioimmunoassay was applied to measure the concentrations of serum endothelin-1 (ET-1) and TXB 2 , and an automatic biochemical analyzer was used to detect the content of superoxide dismutase (SOD) and malondialdehyde (MDA). Our results showed the patients in the UA group all presented hyperviscosity; however the levels were higher for the patients in the UA group (after surgery) than for those in the UA group (before surgery). Patients in the control group exhibited normal levels, and the differences among groups were significant in pairwise comparisons (Pangina pectoris and ischemia reperfusion injury. The higher than normal TXB 2 levels can be used as a marker of platelet activation and a reference for clinical risk stratification, thus having great significance for the prevention and treatment of ischemia reperfusion injury and assessment of disease progression.

  20. Treatment of Unstable Ankle Fractures

    OpenAIRE

    Yaniel Truffín Rodríguez; Gerardo Águila Tejeda

    2015-01-01

    Patients with unstable ankle fractures frequently attend the emergency rooms. It is estimated that there are 122 ankle fractures per 100 000 people a year. Surgical treatment of those that are unstable is inevitable since they can not be corrected in a conservative way. Several surgical procedures for repair of such lesions have been described and all of them constitute important tools for the orthopedic surgeon. Therefore, we conducted a literature review to discuss the current management of...

  1. Traditional and Alternative Therapies for Refractory Angina.

    Science.gov (United States)

    Kocyigit, Duygu; Gurses, Kadri Murat; Yalcin, Muhammed Ulvi; Tokgozoglu, Lale

    2017-01-01

    Refractory angina (RFA) is an unfavourable condition that is characterized with persistent angina due to reversible myocardial ischemia in patients with coronary artery disease that remains uncontrollable despite an optimal combination of pharmacological agents and revascularization. Despite significant advances in revascularization techniques and agents used in pharmacological therapy, there is still a significant population suffering from RFA and the global prevalence is even increasing. Anti- anginal treatment and secondary risk-factor modification are the traditional approaches for this group of patients. Furthermore, now there is still a large number of alternative treatment options. In order to review traditional and alternative treatment strategies in patients with RFA, we searched Pubmed for articles in English using the search terms "pharmacological therapy, refractory angina", "alternative therapy, refractory angina" between inception to June 2016. We also went through separately for each alternative treatment modality on Pubmed. To identify further articles, we handsearched related citations in review articles and commentaries. We also included data from the European Society of Cardiology (2013), and the Canadian Society of Cardiology/ Canadian Pain Society (2012) guidelines. Data show that besides traditional pharmacological agents, such as nitrates, beta- blockers or calcium channel blockers, novel antiischemic drugs and if symptoms persist, several non- invasive and/ or invasive alternative strategies may be considered. Impact of some pharmacological agents, such as rho- kinase inhibitors, and novel alternative treatment modalities, such as coronary sinus reducers, stem cell therapy, gene and protein therapy, on outcomes are still under investigation. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  2. Treating angina pectoris by acupuncture therapy.

    Science.gov (United States)

    Xu, Lixian; Xu, Hao; Gao, Wei; Wang, Wei; Zhang, Hui; Lu, Dominic P

    2013-01-01

    Acupuncture therapy on PC 6 (Neiguan) has a therapeutic effect on cardiac and chest ailments including angina pectoris. Additional beneficial acupuncture points are PC 4 (Ximen), HT 7 (Shenmen point), PC 7 (Daling point), PC 5 (Jianshi point), PC 3 (Quze point), CV 17 (Danzhong point), CV 6 (Qihai point), BL 15 (Xinshu point), L 20 (Pishu point), BL 17 (Geshu point), BL23 (Shenshu point), BL18 (Ganshu point), HT 5 (Tongli point), and ST36 (Zusanli point). Acupuncture not only quickly relieve the symptoms of acute angina pectoris, but also improve nitroglycerine's therapeutic effects. Therefore, it is an efficient simple therapeutic method used for emergency and for regular angina treatment. Review of studies on acupuncture therapy has shown effectiveness were between 80% to 96.2% that are almost as effective as conventional drug regimen. When compared with conventional medical treatment, the acupuncture therapy shows the obvious advantage of lacking, adverse side effects commonly associated with the Western anti-anginal drugs such as 1) Nitroglycerine (headache--63% with nitroglycerine patch and 50% with spray; syncope--4%; and dizziness--8% with patch; hypotension--4% with patch; and increased angina 2% with patch). 2) Isosorbide mononitrate (dizziness--3 to 5%; nausea/vomiting--2 to 4% and other reactions including hypotension, and syncope even with small doses). 3) Propranolol (bradycardia, chest pain, hypotension, worsening of AV conduction disturbance, Raynaud's syndrome, mental depression, hyperglycemia, etc.). Many conventional anti-anginal medications cause inter-drug reactions with other medications the patients taking for other diseases. Whereas, acupuncture therapy does not pose such an interference with patient's medications. Nevertheless, surgery is still the treatment of choice when acupuncture or conventional drug therapy fails. Combination of conventional drug therapy and acupuncture would considerably decrease the frequency and the required dosage

  3. Mesenteric angina through superior mesenteric venous thrombosis

    OpenAIRE

    Mohan, Divya; Aijaz, Faisal; Krijgsman, Brandon

    2010-01-01

    We present the case of a 67-year-old male with mesenteric venous thrombosis resulting in mesenteric angina, where early diagnosis made a favourable outcome possible through prompt anticoagulation and bowel rest. Mesenteric venous thrombosis is a relatively rare but important cause of bowel ischaemia, as a delay in diagnosis is associated with high morbidity and mortality. Early diagnosis through computed tomography scanning and subsequent treatment resulted in resolution of the thrombus with ...

  4. Treatment of Angina and Microvascular Coronary Dysfunction

    Science.gov (United States)

    Samim, Arang; Nugent, Lynn; Mehta, Puja K.; Shufelt, Chrisandra; Merz, C. Noel Bairey

    2014-01-01

    Opinion statement Microvascular coronary dysfunction (MCD) is an increasingly recognized cause of cardiac ischemia and angina, more commonly diagnosed in women. Patients with MCD present with the triad of persistent chest pain, ischemic changes on stress testing, and no obstructive coronary artery disease (CAD) on cardiac catheterization. Data from National Heart, Lung and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study has shown that the diagnosis of MCD is not benign, with a 2.5% annual risk of adverse cardiac events including myocardial infarction, stroke, congestive heart failure, or death. The gold standard diagnostic test for MCD is an invasive coronary reactivity test (CRT), which uses acetylcholine, adenosine, and nitroglycerin to test the endothelial dependent and independent, microvascular and macrovascular coronary function. The CRT allows for diagnostic and treatment options as well as further risk stratifying patients for future cardiovascular events. Treatment of angina and MCD should be aimed at ischemia disease management to reduce risk of adverse cardiac events, ameliorating symptoms to improve quality of life, and to decrease the morbidity from unnecessary and repeated cardiac catheterization in patients with open coronary arteries. A comprehensive treatment approach aimed at risk factor managment, including lifestyle counseling regarding smoking cessation, nutrition and physical activity should be initiated. Current pharmacotherapy for MCD can include the treatment of microvascular endothelial dysfunction (statins, angiotensin-converting enzyme inhibitor, low dose aspirin), as well as treatment for angina and myocardial ischemia (beta blockers, calcium channel blockers, nitrates, ranolazine). Additional symptom management techniques can include tri-cyclic medication, enhanced external counterpulsation, autogenic training, and spinal cord stimulation. While our current therapies are effective in the treatment

  5. An upper airway obstruction emergency: Ludwig angina.

    Science.gov (United States)

    Chou, Yu-Kung; Lee, Chao-Yi; Chao, Hai-Hsuan

    2007-12-01

    Ludwig angina remains a potentially lethal disease, rapidly spreading bilateral cellulitis of the submental, sublingual, and submandibular spaces, which bears the threat for rapid airway obstruction. Since the introduction of antibiotics in 1940s, the mortality was reduced significantly. This resulted in the rare occurrence of the disease, leaving many physicians with limited experience of Ludwig angina. Although the occurrence of Ludwig angina in adults is rare, its presence in the pediatric edentulous population is even more uncommon. Because the unfamiliarity with this disease is now increasing, unnecessary delaying diagnosis or inadequate management may occur and may result in serious complications. This presentation will consist of a historical review, discussion of pathophysiology, followed by clinical presentation, etiology, bacteriology, and management. With early diagnosis, airway observation and management, aggressive intravenous antibiotic therapy, and judicious surgical intervention, the disease should resolve without complications. In addition, the source of infection should be determined and eliminated if possible. A thoughtful, individualized management strategy seems to be the most reasonable approach to the disease.

  6. Physics of Unstable Nuclei

    Science.gov (United States)

    Khoa, Dao Tien; Egelhof, Peter; Gales, Sydney; Giai, Nguyen Van; Motobayashi, Tohru

    2008-04-01

    Studies at the RIKEN RI beam factory / T. Motobayashi -- Dilute nuclear states / M. Freer -- Studies of exotic systems using transfer reactions at GANIL / D. Beaumel et al. -- First results from the Magnex large-acceptance spectrometer / A. Cunsolo et al. -- The ICHOR project and spin-isospin physics with unstable beams / H. Sakai -- Structure and low-lying states of the [symbol]He exotic nucleus via direct reactions on proton / V. Lapoux et al. -- Shell gap below [symbol]Sn based on the excited states in [symbol]Cd and [symbol]In / M. Górska -- Heavy neutron-rich nuclei produced in the fragmentation of a [symbol]Pb beam / Zs. Podolyák et al. -- Breakup and incomplete fusion in reactions of weakly-bound nuclei / D.J. Hinde et al. -- Excited states of [symbol]B and [symbol]He and their cluster aspect / Y. Kanada-En'yo et al. -- Nuclear reactions with weakly-bound systems: the treatment of the continuum / C. H. Dasso, A. Vitturi -- Dynamic evolution of three-body decaying resonances / A. S. Jensen et al. -- Prerainbow oscillations in [symbol]He scattering from the Hoyle state of [symbol]C and alpha particle condensation / S. Ohkubo, Y. Hirabayashi -- Angular dispersion behavior in heavy ion elastic scattering / Q. Wang et al. -- Microscopic optical potential in relativistic approach / Z.Yu. Ma et al. -- Exotic nuclei studied in direct reactions at low momentum transfer - recent results and future perspectives at fair / P. Egelhof -- Isotopic temperatures and symmetry energy in spectator fragmentation / M. De Napoli et al. -- Multi-channel algebraic scattering theory and the structure of exotic compound nuclei / K. Amos et al. -- Results for the first feasibility study for the EXL project at the experimental storage ring at GSI / N. Kalantar-Nayestanaki et al. -- Coulomb excitation of ISOLDE neutron-rich beams along the Z = 28 chain / P. Van Duppen -- The gamma decay of the pygmy resonance far from stability and the GDR at finite temperature / G. Benzoni et al

  7. Manual control of unstable systems

    Science.gov (United States)

    Allen, R. W.; Hogue, J. R.; Parseghian, Z.

    1986-01-01

    Under certain operational regimes and failure modes, air and ground vehicles can present the human operator with a dynamically unstable or divergent control task. Research conducted over the last two decades has explored the ability of the human operator to control unstable systems under a variety of circumstances. Past research is reviewed and human operator control capabilities are summarized. A current example of automobile directional control under rear brake lockup conditions is also reviewed. A control system model analysis of the driver's steering control task is summarized, based on a generic driver/vehicle model presented at last year's Annual Manual. Results from closed course braking tests are presented that confirm the difficulty the average driver has in controlling the unstable directional dynamics arising from rear wheel lockup.

  8. Unstable oscillators based hyperchaotic circuit

    DEFF Research Database (Denmark)

    Murali, K.; Tamasevicius, A.; G. Mykolaitis, A.

    1999-01-01

    A simple 4th order hyperchaotic circuit with unstable oscillators is described. The circuit contains two negative impedance converters, two inductors, two capacitors, a linear resistor and a diode. The Lyapunov exponents are presented to confirm hyperchaotic nature of the oscillations in the circ......A simple 4th order hyperchaotic circuit with unstable oscillators is described. The circuit contains two negative impedance converters, two inductors, two capacitors, a linear resistor and a diode. The Lyapunov exponents are presented to confirm hyperchaotic nature of the oscillations...

  9. Ludwig's angina after severe thrombocytopenic purpura associated with dengue fever

    Directory of Open Access Journals (Sweden)

    Maria Antonia Campos

    2014-01-01

    Full Text Available Here, we report a case of Ludwig's angina, which required surgery because of toothache. The patient had dengue and severe thrombocytopenia as confirmed by clinical and laboratory diagnoses. However, dengue is not included among the predisposing factors for Ludwig's angina.

  10. Variant (Prinzmetal's) Form of Angina Pectoris Manifesting in ...

    African Journals Online (AJOL)

    1974-06-08

    , which has been termed the variant or atypical form of angina pectoris. The distribution of the pain is identical with the classic form of angina pectoris, being substernal with radiation to the jaw and down the ulnar surfaces of ...

  11. ORIGINAL ARTICLE Ludwig's Angina: An Analysis of Sixteen Cases ...

    African Journals Online (AJOL)

    Ogunbodede

    ABSTRACT. Objective: To document the prevalence and management of Ludwig's angina in a suburban population. Methods: All consecutive cases of Ludwig's angina seen and managed at the Obafemi. Awolowo University Teaching Hospital, Ile-Ife, Nigeria between 1988 and 2002. Results: There were 16 cases with 10 ...

  12. Unstable Semiclassical Trajectories in Tunneling

    CERN Document Server

    Levkov, D G; Sibiryakov, S M

    2007-01-01

    Some tunneling phenomena are described, in the semiclassical approximation, by unstable complex trajectories. We develop a systematic procedure to stabilize the trajectories and to calculate the tunneling probability, including both the suppression exponent and prefactor. We find that the instability of tunneling solutions modifies the power-law dependence of the prefactor on h as compared to the case of stable solutions.

  13. Proton scattering from unstable nuclei

    Indian Academy of Sciences (India)

    Abstract. Recent improvements in the intensities and optical qualities of radioactive beams have made possible the study of elastic and inelastic proton scattering on unstable nuclei. The design and performances of an innovative silicon strip detector array devoted to such experiments are described. The quality of the data ...

  14. Ludwig's angina and airway considerations: a case report.

    Science.gov (United States)

    Kulkarni, Anand H; Pai, Swarupa D; Bhattarai, Basant; Rao, Sumesh T; Ambareesha, M

    2008-06-20

    Patients with deep neck infections present challenging airways for an anesthesiologist. Patients with Ludwig's angina may die as a result of the inability to effectively manage the airway. Here we discuss the anesthetic management with fiberoptic intubation of a 45-year-old man with Ludwig's angina scheduled for emergency drainage. Awake fiberoptic intubation under topical anesthesia may be the ideal method to secure the airway in advanced cases of Ludwig's angina. When fiberoptic bronchoscopy is not feasible, not available or has failed, an awake tracheostomy may be the preferred option.

  15. Emergency management of Ludwig’s angina: A case report

    Directory of Open Access Journals (Sweden)

    Nur Huda Alimin

    2016-06-01

    Full Text Available Ludwig’s angina is a severe diffuse sellulitis, commonly caused by odontogenic infection, acute on onset, spread rapidly, involving the submandibular, sublingual region bilaterally, and submental region. This case led to the emergency condition because it can cause airway obstruction. The aim of this case report is to describe a case report about diagnosis and management of emergencies Ludwig’s angina. A 40 years old male patient, came to Dr. Hasan Sadikin hospital emergency with pain and swelling at lower jaw, drooling, difficulty to open his mouth and breath. Diagnosed with sepsis accompanied Ludwig’s angina. We managed the patient with close observation, tracheostomy, and source control under local anesthesia. Ludwig’s angina is a rare emergency condition which potentially life-threathening. In this case the patient experienced a significant recovery because immediately management in maintaining airway patency, prevent the spread of infection and further complications.

  16. Severe angina pectoris in asthma attack: a case report.

    Science.gov (United States)

    Nabavizadeh, Seyed Hesamedin; Farahbakhsh, Nazanin; Fazel, Ali; Mosavat, Fereshteh; Anushiravani, Amir

    2016-06-01

    Asthma is a chronic inflammatory disorder of the airways related to the obstruction of reversible airflow. Asthma presents as recurrent attacks of cough and dyspnea. Poor control causes recurrent admissions to the ICU, and mortality is related to poor drug compliance and follow-up. Angina pectoris is a syndrome of recurrent chest discomfort related to myocardial ischemia. The presence of these two disorders rarely has been reported. We reported a 12-year-old boy who was referred with exacerbation of asthma and developed angina pectoris during hospitalization. He had labored breathing and diffuse wheezing. During treatment of the asthma, the patient developed severe chest pain due to shunt formation and coronary hypoxia, caused by the sole administration of ventolin, since oxygen had been disconnected. After receiving appropriate therapy, both his asthma and angina recovered, and, to date, he has not experienced angina pectoris again.

  17. Ludwig's angina: an unusual sequel to endodontic therapy.

    Science.gov (United States)

    Tuffin, J R

    1989-05-01

    Ludwig's angina is an unusual sequel to endodontic treatment: such a case is described. Principles of management are discussed with emphasis placed on the need to secure the airway early. The literature is reviewed.

  18. Unstable resonator with multiple outputs

    Science.gov (United States)

    Konopnicki, M. J.; Smithers, M. E.

    1983-03-01

    Two or more unstable optical resonators can be coupled together by sharing optical elements. The result is then a single compound resonator with multiple outputs. For identical coupled cavities, the transverse structure of the outputs would be identical. In general, there will be misalignments and other aberrations that will vary from cavity to cavity. The cumulative effects of such aberrations are treated using both analytical and numerical approaches. It is shown that the average output of a multioutput resonator is the same as the output of a single uncoupled resonator with aberrations equal to the average of those contained in the multioutput resonator.

  19. Prevalência de angina pectoris em Pelotas, RS Prevalence of angina pectoris in Pelotas, south of Brazil

    Directory of Open Access Journals (Sweden)

    Leonardo Alves

    2010-08-01

    Full Text Available FUNDAMENTO: A cardiopatia isquêmica é a doença responsável pelo maior número de mortes no mundo, sendo a angina sua principal manifestação. OBJETIVO: Determinar a prevalência de angina e de possível angina e sua distribuição conforme as principais características sócio-demográficas entre adultos com idade igual ou maior que 40 anos. MÉTODOS: Estudo transversal de base populacional com moradores da área urbana da cidade de Pelotas (RS entre os meses de outubro e dezembro de 2007. Foi adotado o plano de amostragem por conglomerados em dois estágios - setores censitários e domicílios. As prevalências de angina e de possível angina foram definidas de acordo com o questionário de Rose. Essas condições foram avaliadas conforme as características sócio-demográficas: idade, sexo, cor da pele, condição econômica e escolaridade. Para a coleta dos dados, foram aplicados questionários padronizados por meio de entrevista com os indivíduos em seus domicílios. A taxa de não respondentes foi de 6,8%. RESULTADOS: A prevalência de angina entre os 1.680 indivíduos participantes do estudo foi de 8,2 % (IC 95%: 6,7 - 9,6, enquanto a de possível angina, 12,3% (IC 95%: 10,6 - 14,0. As prevalências de angina e de possível angina foram maiores entre os indivíduos do sexo feminino, de cor da pele preta/parda, de pior condição econômica e de menor escolaridade. A prevalência de angina foi maior entre indivíduos mais velhos. Não se observou diferença para possível angina. CONCLUSÃO: A prevalência de angina e de possível angina mostrou-se alta, acometendo cerca de 20% da população de Pelotas.BACKGROUND: Ischemic heart disease is the leading cause of death in the world and angina is its cardinal manifestation. OBJECTIVE: To determine the prevalence of angina and possible angina and its distribution by main demographic and socioeconomic characteristics among adults 40 years of age or older. METHODS: This is a population

  20. Anipamil prevents ST depression in patients with stable angina pectoris

    DEFF Research Database (Denmark)

    Larsen, C T; Sørum, C; Rasmussen, V

    1993-01-01

    test with > or = 0.10 mV horizontal or down-sloping ST-segment depression and limited by angina pectoris, and at least 10 attacks of angina pectoris in the initial single-blind placebo period. During the placebo period, a total duration of transient myocardial ischemia > or = 0.10 mV during the 24-hour...... once a day is an effective 24-hour antiischemic drug in the treatment of transient myocardial ischemia....

  1. Modern diagnostic capabilities for vasospastic angina diagnostics (intracoronary provocative testing

    Directory of Open Access Journals (Sweden)

    А. А. Обединский

    2017-04-01

    Full Text Available This review is devoted to a topical problem of modern cardiology – techniques of diagnosing vasospastic angina. The results of retrospective and prospective studies on the efficacy and safety of vasospastic angina diagnostics are reviewed. The literature on the prevalence, progression and treatment of this pathology is discussed.Received 13 January 2017. Accepted 6 February 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

  2. Modern diagnostic capabilities for vasospastic angina diagnostics (intracoronary provocative testing)

    OpenAIRE

    А. А. Обединский; С. В. Бугуров; О. В. Крестьянинов; И. А. Нарышкин; Д. Д. Зубарев; И. О. Гражданкин; Р. У. Ибрагимов; В. И. Байструков; Р. А. Найденов; Е. И. Кретов

    2017-01-01

    This review is devoted to a topical problem of modern cardiology – techniques of diagnosing vasospastic angina. The results of retrospective and prospective studies on the efficacy and safety of vasospastic angina diagnostics are reviewed. The literature on the prevalence, progression and treatment of this pathology is discussed.Received 13 January 2017. Accepted 6 February 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

  3. Airway management in Ludwig's angina – a challenge: case report

    OpenAIRE

    Fellini, Roberto Taboada; Volquind, Daniel; Schnor, Otávio Haygert; Angeletti, Marcelo Gustavo; Souza, Olívia Egger de

    2016-01-01

    Abstract Background Ludwig's angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. Objective Describe a case of a patient with Ludwig's angina undergoing surgery, with emphasis on airway management, in addition to reviewing ...

  4. Ludwig's angina and airway considerations: a case report

    OpenAIRE

    Kulkarni, Anand H; Pai, Swarupa D; Bhattarai, Basant; Rao, Sumesh T; Ambareesha, M

    2008-01-01

    Introduction Patients with deep neck infections present challenging airways for an anesthesiologist. Patients with Ludwig's angina may die as a result of the inability to effectively manage the airway. Case presentation Here we discuss the anesthetic management with fiberoptic intubation of a 45-year-old man with Ludwig's angina scheduled for emergency drainage. Conclusion Awake fiberoptic intubation under topical anesthesia may be the ideal method to secure the airway in advanced cases of Lu...

  5. Emergency management of Ludwig’s angina: A case report

    OpenAIRE

    Nur Huda Alimin; Endang Syamsuddin

    2016-01-01

    Ludwig’s angina is a severe diffuse sellulitis, commonly caused by odontogenic infection, acute on onset, spread rapidly, involving the submandibular, sublingual region bilaterally, and submental region. This case led to the emergency condition because it can cause airway obstruction. The aim of this case report is to describe a case report about diagnosis and management of emergencies Ludwig’s angina. A 40 years old male patient, came to Dr. Hasan Sadikin hospital emergency with pain and swe...

  6. LUDWIG’S ANGINA AND ANAESTHETIC DIFFICULTIES: A CASE REPORT

    OpenAIRE

    Sarda Devi; Ibemhal

    2015-01-01

    Patients with deep neck infections present challenging airways for an anesthesiologist . Ludwig’s angina is potentially lethal, rapidly spreading cellulitis involving the floor of the mouth and neck. Without aggressive management it often results in life th reatening upper airway obstruction. Securing the airway remains the top priority in treatment of Ludwig’s angina. Although awake fibreoptic intubation remains the ideal method for securing the airway, but it is not ava...

  7. Ludwig's angina: a place for steroid therapy in its management?

    Science.gov (United States)

    Freund, B; Timon, C

    1992-05-01

    Ludwig's angina is an uncommon but potentially fatal condition which presents as a hard swelling of the floor of the mouth. It spreads rapidly as a gangrenous process that may cause death through local airway obstruction. Ludwig's angina carried a 54% mortality rate in the preantibiotic era which has now been reduced to approximately 4%. Diagnosis is based on history and clinical observation. Currently described treatment involves protecting the airway and managing the infection with antibiotics and surgical drainage when indicated.

  8. LUDWIG’S ANGINA - A NIGHT MARE : OUR EXPERIENCE

    OpenAIRE

    Ritu; Valsamma; Vikrant

    2015-01-01

    INTRODUCTION: Patients with ludwig’s angina present challenging airways for anesthesiologist and may die as a result of inability to manage the airway effectively. Successful airway management is critical, but a safe method to control the airway in these patients is yet to be established. METHODS: We retrospectively studied airway management techniques used in 17 patients of Ludwig’s Angina, who required surgical drainage over a period of 12 months from January 2010...

  9. Unstable decay and state selection

    International Nuclear Information System (INIS)

    McKane, Alan; Tarlie, Martin

    2001-01-01

    The decay of unstable states when several metastable states are available for occupation is investigated using path-integral techniques. Specifically, a method is described that enables the probabilities with which the metastable states are occupied to be calculated by finding optimal paths, and fluctuations about them, in the weak-noise limit. The method is illustrated on a system described by two coupled Langevin equations, which are found in the study of instabilities in fluid dynamics and superconductivity. The problem involves a subtle interplay between nonlinearities and noise, and a naive approximation scheme that does not take this into account is shown to be unsatisfactory. The use of optimal paths is briefly reviewed and then applied to finding the conditional probability of ending up in one of the metastable states, having begun in the unstable state. There are several aspects of the calculation that distinguish it from most others involving optimal paths: (i) the paths do not begin and end on an attractor, and moreover, the final point is to a large extent arbitrary, (ii) the interplay between the fluctuations and the leading-order contribution are at the heart of the method, and (iii) the final result involves quantities that are not exponentially small in the noise strength. This final result, which gives the probability of a particular state being selected in terms of the parameters of the dynamics, is remarkably simple and agrees well with the results of numerical simulations. The method should be applicable to similar problems in a number of other areas, such as state selection in lasers, activationless chemical reactions, and population dynamics in fluctuating environments

  10. Osteoporosis in unstable adult scoliosis

    Energy Technology Data Exchange (ETDEWEB)

    Velis, K.P.; Healey, J.H.; Schneider, R.

    1988-12-01

    New noninvasive techniques as well as conventional methods were used to evaluate skeletal mass in the following three populations of adult white women as follows: (1) 79 subjects with preexisting idiopathic scoliosis designated as unstable (US) because of the associated presence in the lumbar spine of lateral spondylolisthesis with segmental instability; (2) 67 subjects with preexisting idiopathic scoliosis without lateral spondylolisthesis designated as stable (SS); and (3) 248 age-matched nonscoliotic controls. Ages in all three groups were categorized into premenopausal (25-44 years), perimenopausal (45-54 years), and postmenopausal (55-84 years). The results showed higher scoliosis morbidity in the US compared to the SS populations. The prevalence and severity of osteoporosis were markedly increased in US versus SS populations. Femoral neck density determined by dual-photon absorptiometry techniques averaged 26% to 48% lower in all age categories of US patients compared to controls. These changes were found in the youngest age groups, indicating reductions in bone mineral content earlier in the adult life of white women with a specific type of high-morbidity US characterized by the marker of lateral spondylolisthesis.

  11. Volumetric evaluation of coronary plaque in patients presenting with acute myocardial infarction or stable angina pectoris-a multislice computerized tomography study

    DEFF Research Database (Denmark)

    Hammer-Hansen, Sophia; Kofoed, Klaus Fuglsang; Kelbaek, Henning

    2009-01-01

    BACKGROUND: We hypothesized that unstable clinical presentation of coronary artery disease is associated with distinct characteristics of culprit lesions identifiable by multislice computed tomography (MSCT). METHODS: Patients with non-ST-elevation myocardial infarction (NSTEMI) (n = 57) or stable...... angina (SA) pectoris (n = 19) were studied. Coronary culprit lesions in patients with NSTEMI and symptomatic lesions in patients with SA were evaluated with 64-slice MSCT and a volumetric plaque imaging tool. Plaque volumes of lipid, fibrous tissue, or calcification according to signal intensity were...

  12. Bevacizumab-Related Microvascular Angina and Its Management with Nicorandil.

    Science.gov (United States)

    Katoh, Manami; Takeda, Norihiko; Arimoto, Takahide; Abe, Hajime; Oda, Katsutoshi; Osuga, Yutaka; Fujii, Tomoyuki; Komuro, Issei

    2017-10-21

    Bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF)-A, is currently used to treat patients with ovarian or colon cancer. While several cardiovascular toxicities related to bevacizumab-containing regimens have been reported, the effect of bevacizumab on the coronary microcirculation has not been fully elucidated. Here we report a case of 54-year-old female patient who developed microvascular angina after a series of bevacizumab-containing chemotherapeutic regimen. The discontinuation of bevacizumab and nicorandil administration was effective in alleviating her chest discomfort and the ischemic changes on her ECG. This highlights the possibility that coronary microvascular angina can be induced in patients treated with bevacizumab-containing chemotherapy. It should also be noted that nicorandil can be effective in managing microvascular angina.

  13. Ludwig's angina in a 76-year-old man.

    Science.gov (United States)

    Buckley, M F; O'Connor, K

    2009-09-01

    This case is of a 76-year-old man who presented to the emergency department with a 24-h history of a progressive tense, tender midline neck swelling. A computed tomography scan revealed Ludwig's angina and the patient went on to develop respiratory compromise and was admitted to the intensive care unit. The patient's clinical course later became complicated by abscess formation requiring drainage under general anaesthetic. He was eventually discharged home some 9 days after his initial presentation. The emergency medicine management issues surrounding Ludwig's angina are discussed briefly. This case highlights the dynamic airway changes seen in this uncommon condition. Whereas Ludwig's angina has previously been associated in the emergency medicine literature with a younger age group and in patients with a history of dental infection or treatment, this case highlights the fact that it may occur despite these two common associations.

  14. Electromagnetic Radiation Originating from Unstable Electron Oscillations

    DEFF Research Database (Denmark)

    Juul Rasmussen, Jens; Pécseli, Hans

    1975-01-01

    Electromagnetic oscillations in the range 300 – 700 MHz were observed from an unmagnetized argon discharge with an unstable electron velocity distribution function.......Electromagnetic oscillations in the range 300 – 700 MHz were observed from an unmagnetized argon discharge with an unstable electron velocity distribution function....

  15. High probability of disease in angina pectoris patients

    DEFF Research Database (Denmark)

    Høilund-Carlsen, Poul F.; Johansen, Allan; Vach, Werner

    2007-01-01

    BACKGROUND: According to most current guidelines, stable angina pectoris patients with a high probability of having coronary artery disease can be reliably identified clinically. OBJECTIVES: To examine the reliability of clinical evaluation with or without an at-rest electrocardiogram (ECG......) in patients with a high probability of coronary artery disease. PATIENTS AND METHODS: A prospective series of 357 patients referred for coronary angiography (CA) for suspected stable angina pectoris were examined by a trained physician who judged their type of pain and Canadian Cardiovascular Society grade...... in male patients, but it makes the high probability groups so small that the addition appears to be of limited clinical relevance....

  16. Ludwig's angina resulting from the infection of an oral malignancy.

    Science.gov (United States)

    Fischmann, G E; Graham, B S

    1985-10-01

    A case of Ludwig's angina is reported in a 60-year-old woman who was discovered to have squamous-cell carcinoma of the tongue and floor of the mouth during intubation for airway management. This report emphasizes the need to consider infection of oral malignancies of the tongue and floor of the mouth in the etiology of Ludwig's angina when an odontogenous origin cannot be demonstrated. It also illustrates the value of bronchoscopy-directed nasotracheal intubation for diagnosis and airway management in such cases.

  17. Prasugrel versus clopidogrel for patients with unstable angina or non-ST-segment elevation myocardial infarction with or without angiography

    DEFF Research Database (Denmark)

    Wiviott, Stephen D; White, Harvey D; Ohman, E Magnus

    2013-01-01

    Treatment with prasugrel and aspirin improves outcomes compared with clopidogrel and aspirin for patients with acute coronary syndrome who have had angiography and percutaneous coronary intervention; however, no clear benefit has been shown for patients managed first with drugs only. We assessed ...

  18. Frequent sampling by clear venipuncture in unstable angina is a reliable method to assess haemostatic system activity

    NARCIS (Netherlands)

    Biasucci, L.M.; Liuzzo, G.; Caligiuri, G.; Monaco, C.; Quaranta, G.; Sperti, G.; Greef, W. van de; Maseri, A.; Kluft, C.

    1994-01-01

    Sudden limitations in coronary flow account for the majority of cases of UA. Measurement of TAT in peripheral blood represent a reliable marker of an ongoing thrombotic process. The aim of the study was to assess the reliability of frequent blood sampling (Phase A) and to correlate TAT fluctuation

  19. Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris.

    Science.gov (United States)

    Linde, Jesper J; Sørgaard, Mathias; Kühl, Jørgen T; Hove, Jens D; Kelbæk, Henning; Nielsen, Walter B; Kofoed, Klaus F

    2017-02-01

    The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16 %) and during a median follow-up of 19 months (range 12-22 months) 25 patients (10 %) suffered a MACE (cardiac death, non-fatal myocardial infarction and revascularizations). Accuracy for the prediction of MACE expressed as the area under curve (AUC) on receiver-operating characteristic curves was 0.88 (0.83-0.92) for visual assessment of a PD and 0.80 (0.73-0.85) for stress TPR (transmural perfusion ratio). After adjustment for the pretest probability of obstructive coronary artery disease, both detection of a PD and stress TPR were significantly associated with MACE with an adjusted hazard ratio of 39 (95 % confidence interval 11-134), p 10 % of the LV myocardium had a worse prognosis compared to patients with a PD covering <10 % of the LV myocardium, p = 0.0002. The optimal cut-off value of the myocardial PD extent to predict MACE was 5.3 % of the left ventricle [sensitivity 84 % (64-96), specificity 95 % (91-97)]. Myocardial CT perfusion parameters predict mid-term clinical outcome in patients with recent acute-onset chest pain.

  20. Prediction of clinical outcome by myocardial CT perfusion in patients with low-risk unstable angina pectoris

    DEFF Research Database (Denmark)

    Linde, Jesper J; Sørgaard, Mathias; Kühl, Jørgen T

    2017-01-01

    The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, y...... % (64-96), specificity 95 % (91-97)]. Myocardial CT perfusion parameters predict mid-term clinical outcome in patients with recent acute-onset chest pain.......The prognostic implications of myocardial computed tomography perfusion (CTP) analyses are unknown. In this sub-study to the CATCH-trial we evaluate the ability of adenosine stress CTP findings to predict mid-term major adverse cardiac events (MACE). In 240 patients with acute-onset chest pain, yet...... normal electrocardiograms and troponins, a clinically blinded adenosine stress CTP scan was performed in addition to conventional diagnostic evaluation. A reversible perfusion defect (PD) was found in 38 patients (16 %) and during a median follow-up of 19 months (range 12-22 months) 25 patients (10...

  1. Rheology of unstable mineral emulsions

    Directory of Open Access Journals (Sweden)

    Sokolović Dunja S.

    2013-01-01

    Full Text Available In this paper, the rheology of mineral oils and their unstable water emulsion were investigated. The oil samples were domestic crude oil UA, its fractions UA1, UA4 and blend semi-product UP1, while the concentration of oil in water emulsions was in the range from 1 up to 30%. The results were analyzed based on shear stress. The oil samples UA, UA1 and UP1 are Newtonian fluids, while UA4 is pseudoplastic fluid. The samples UA and UA4 show higher value of shear stress (83.75 Pa, 297 Pa, then other two samples UA1 and UP1 (18.41 Pa, 17.52 Pa. Rheology of investigated oils due to its complex chemical composition should be analyzed as a simultaneous effect of all their components. Therefore, structural composition of the oils was determined, namely content of paraffins, naphthenes, aromatics and asphaltenes. All samples contain paraffins, naphthenes and aromatics but only oils UA and UA4 contain asphaltenes as well. All investigated emulsions except 30% EUA4 are Newtonian fluids. The EUA4 30% emulsion shows pseudoplastic behaviour, and it is the only 30% emulsion among investigated ones that achieves lower shear stress then its oil. The characteristics of oil samples that could have an influence on their properties and their emulsion rheology, were determined. These characteristics are: neutralization number, interfacial tension, dielectric constant, and emulsivity. Oil samples UA and UA4 have significantly higher values of neutralization number, dielectric constants, and emulsivity. The sample UA has the lowest value of interface tension and the greatest emulsivity, indicating that this oil, among all investigated, has the highest preference for building emulsion. This could be the reason why 20% and 30% emulsions of the oil UA achieve the highest shear stress among all investigated emulsions.

  2. NEBIVOLOL IN TREATMENT OF STABLE EXERTIONAL ANGINA PECTORIS

    Directory of Open Access Journals (Sweden)

    Y. V. Gavrilov

    2015-12-01

    Full Text Available Aim. To evaluate antianginal and antiischemic efficiency of nebivolol in patients with stable angina pectoris.Material and methods. 100 patients with ischemic heart disease showing stable exertional angina pectoris and having no contraindications to beta-blockers were studied. After 5-7 days of control period 50 randomly selected patients began to take nebivolol in initial dose of 5mg once daily and 50 patients started to take metoprolol in initial dose of 50 mg twice daily. Duration of treatment was 8 weeks. Efficiency of treatment was assessed according to the results of control treadmill assessment and control daily ECG monitoring.Results. 56-day therapy with nebivolol at a dose of 7,5 mg per day results in increase in duration of treadmill test before angina or ST depression (p<0.05. Antianginal and antiischemic effect of nebivolol 7.5 mg once daily is rather similar with that of metoprolol in average daily dose of 175 mg. Nebivolol compared to metoprolol significantly (p<0.05 more effectively reduces the number of silent myocardial ischemia.Conclusion. Nebivolol is an efficient antianginal and antiischemic drug for patients with stable exertional angina pectoris.

  3. NEBIVOLOL IN TREATMENT OF STABLE EXERTIONAL ANGINA PECTORIS

    Directory of Open Access Journals (Sweden)

    Y. V. Gavrilov

    2007-01-01

    Full Text Available Aim. To evaluate antianginal and antiischemic efficiency of nebivolol in patients with stable angina pectoris.Material and methods. 100 patients with ischemic heart disease showing stable exertional angina pectoris and having no contraindications to beta-blockers were studied. After 5-7 days of control period 50 randomly selected patients began to take nebivolol in initial dose of 5mg once daily and 50 patients started to take metoprolol in initial dose of 50 mg twice daily. Duration of treatment was 8 weeks. Efficiency of treatment was assessed according to the results of control treadmill assessment and control daily ECG monitoring.Results. 56-day therapy with nebivolol at a dose of 7,5 mg per day results in increase in duration of treadmill test before angina or ST depression (p<0.05. Antianginal and antiischemic effect of nebivolol 7.5 mg once daily is rather similar with that of metoprolol in average daily dose of 175 mg. Nebivolol compared to metoprolol significantly (p<0.05 more effectively reduces the number of silent myocardial ischemia.Conclusion. Nebivolol is an efficient antianginal and antiischemic drug for patients with stable exertional angina pectoris.

  4. Ginkgo Biloba extract for angina pectoris: a systematic review.

    Science.gov (United States)

    Sun, Tian; Wang, Xian; Xu, Hao

    2015-07-01

    To evaluate the efficacy and safety of Ginkgo Biloba extract for patients with angina pectoris according to the available evidence. Electronic databases were searched for all of the randomized controlled trials (RCTs) of angina pectoris treatments with Ginkgo Biloba extract, either alone or combined with routine Western medicine (RWM), and controlled by untreated, placebo, Chinese patent medicine, or RWM treatment. The RCTs were retrieved from the following electronic databases: PubMed/MEDLINE, ProQuest Health and Medical Complete, Springer, Elsevier, and ProQuest Dissertations and Theses, Wanfang Data, China National Knowledge Infrastructure (CNKI), VIP database, China Biology Medicine (CBM), Chinese Medical Citation Index (CMCI), from the earliest database records to December 2012. No language restriction was applied. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. RevMan 5.1.0 provided by Cochrane Collaboration The data were analysed by using. A total of 23 RCTs (involving 2,529 patients) were included and the methodological quality was evaluated as generally low. Ginkgo Biloba extract with RWM was more effective in angina relief and electrocardiogram improvement than RWM alone. Reported adverse events included epigastric discomfort, nausea, gastrointestinal reaction, and bitter taste. Ginkgo Biloba extract may have beneficial effects on patients with angina pectoris, although the low quality of existing trials makes it difficult to draw a satisfactory conclusion. More rigorous, high quality clinical trials are needed to provide conclusive evidence.

  5. Ludwig's angina. The anaesthetic management of nine cases.

    Science.gov (United States)

    Loughnan, T E; Allen, D E

    1985-03-01

    We reviewed nine patients with Ludwig's angina who required surgical drainage over a 24-month period. This represents the largest series reported in world literature. All of these patients were managed successfully by a combination of tracheal intubation and early surgical intervention. None required tracheostomy, which is the previously recommended procedure of choice for airway management.

  6. Descriptive terms used by Malay patients for exertional angina pectoris.

    Science.gov (United States)

    Khalid, Y; Malina, O; Rofiah, A; Latinah, M; Thahirahtul, A Z; Zaridah, M S; Tan, M H

    1994-09-01

    Description of the chest pain of angina pectoris by patients is commonly used in the diagnosis, evaluation and monitoring of ischaemic heart disease. Whilst certain descriptive terms have been identified as describing angina and not other causes of chest pain, these terms have not been systematically evaluated among local Malaysian patients. Reliance on a translation of the description used by Western patients may not be totally correct in the local context. Seventy-one Malay patients with documented ischaemic heart disease were asked, by questionnaire and by interview, to identify the descriptive terms they used for their angina pectoris. Common terms used by these patients were sempit (constrictive) [56.3%], mencuck (pricking) [54.9%], berat (heavy) [53.5%], panas (burning) [50.7%], menekan (pressing) [46.4%], and pedih (smarting) [43.7%]. Other less common descriptions used were tajam (sharp), mencengkam (strangulating), hempap (compressive), ngilu, hiris (knife-like), lengoh (aching). Two-thirds of the patients used more than three terms to describe their angina pectoris. Direct translation of the description of angina may not only be inaccurate but could also be misleading. It is suggested that the actual words used by the patients in Bahasa Malaysia be recorded in the patient's notes rather than a translation of these. More studies are required to determine whether the terms used by the patients in this study are related to local dialect (in this case Terengganu) or are actually common in Malaysia. Further, similar studies among Chinese and Indian patients are also required.

  7. Emerging clinical role of ranolazine in the management of angina

    Directory of Open Access Journals (Sweden)

    David S Vadnais

    2010-10-01

    Full Text Available David S Vadnais, Nanette K WengerDivision of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USAAbstract: Chronic stable angina is an exceedingly prevalent condition with tremendous clinical, social, and financial implications. Traditional medical therapy for angina consists of beta-blockers, calcium channel blockers, and nitrates. These agents decrease myocardial oxygen demand and ischemia by reducing heart rate, lowering blood pressure, and/or optimizing ventricular loading characteristics. Unique in its mechanism of action, ranolazine is the first new antianginal agent approved for use in the US for chronic angina in over 25 years. By inhibiting the late inward sodium current (INa, ranolazine prevents pathologic intracellular calcium accumulation that leads to ischemia, myocardial dysfunction, and electrical instability. Ranolazine has been proven in multiple clinical trials to reduce the symptoms of angina safely and effectively and to improve exercise tolerance in patients with symptomatic coronary heart disease. These benefits occur without reduction in heart rate and blood pressure or increased mortality. Although ranolazine prolongs the QTc, experimental data indicate that ranolazine may actually be antiarrhythmic. In a large acute coronary syndrome clinical trial, ranolazine reduced the incidence of supraventricular tachycardia, ventricular tachycardia, new-onset atrial fibrillation, and bradycardic events. Additional benefits of ranolazine under investigation include reductions in glycosylated hemoglobin levels and improved left ventricular function. Ranolazine is a proven antianginal medication in patients with symptomatic coronary heart disease, and should be considered as an initial antianginal agent for those with hypotension or bradycardia.Keywords: chronic angina, myocardial ischemia, ranolazine, pharmacotherapy, antianginal, sodium current

  8. Treatment of Unstable Pelvic Ring Injuries.

    Science.gov (United States)

    Kim, Weon-Yoo

    2014-06-01

    Pelvic fractures are classified according to the stability of the pelvic ring. Unlike stable pelvic fractures, which heal without complications, unstable fractures may lead to pelvic ring deformities, which cause severe complications. An orthopedic surgeon must determine the stability of the pelvic ring by radiography and physical examination of the patient in order to ensure early, prompt treatment. This article includes anatomy of the pelvic ring, classification of pelvic ring injuries, its treatment algorithm, and corresponding cases involving unstable pelvic ring injury.

  9. How Unstable Are Fundamental Quantum Supermembranes?

    OpenAIRE

    Kaku, Michio

    1996-01-01

    String duality requires the presence of solitonic $p$-branes. By contrast, the existence of fundamental supermembranes is problematic, since they are probably unstable. In this paper, we re-examine the quantum stability of fundamental supermembranes in 11 dimensions. Previously, supermembranes were shown to be unstable by approximating them with SU(n) super Yang-Mills fields as $n \\rightarrow \\infty$. We show that this instability persists even if we quantize the continuum theory from the ver...

  10. {sup 123}I-BMIPP imaging for detecting culprit-lesion territories in unstable coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Shigetaka; Kato, Kenichi; Tamaki, Toshiyuki; Yumoto, Kazuhiko; Ohta, Yoshiko [Yokohama Rosai Hospital (Japan)

    1999-12-01

    Assessment of post-ischemic myocardium in patients with unstable coronary artery disease (CAD) , i.e. unstable angina and non-Q-wave MI, is necessary to optimized the treatment. To evaluate the effects of acute ischemia on myocardium in patients with unstable CAD, we compared quantitative {sup 123}I-beta-methyl iodophenyl pentadecanoic acid (BMIPP) and rest {sup 201}Tl (Tl) SPECT in 55 patients (mean 62 y., 44 men) with no previous MI. All patients admitted within 12 hr. after the onset. After medical therapy, BMIPP and Tl were separately performed mean 4.8 days after onset. All patients had significant CAD (n=46) or induced vasospasm (n=9) documented by angiography within 5 days after onset. Twenty-five pts had elevated troponin T levels (>range 0.11 ng/ml). The sensitivity for detection of culprit- and vasospasm-induced lesion territories by BMIPP and Tl were 76% and 44%, respectively, p<0.01). In conclusion, rest BMIPP imaging has potential to locate the culprit- and vasospasm-induced lesion territories and quantify the extent of post-ischemic myocardium in patients with unstable CAD even after stabilization of symptom. (author)

  11. [Unstable pertrochanteric fractures, biomechanic, classification and therapy.].

    Science.gov (United States)

    Cech, O; Kostál, R; Váchal, J

    2000-01-01

    The authors deal with unstable pertrochanteric, intertrochanteric and subtrochanteric fractures extending as far as calcar femorale. The treatment of pertrochanteric issues is a serious issue as their total number in the Czech Republic exceeds 5.000 annually and with the exception of those which are contraindicated due to their health condition, all patients are indicated to surgery. In the treatment of unstable pertrochanteric fractures there occurs failure of internal fixation also with the use of implants such as dynamic hip screw or Gamma nail. The cause of unsuccessful treatment of unstable fractures is the defect in calcar femorale - impairment of the weightbearing area of proximal femur and failure of the implant as a result of its cyclic overloading - breakage of the nail, cutting out of the screw from the head in the osteoporotic bone or breaking out of screws fixing the plate to the femoral shaft. For a causal procedure the authors consider the reconstruction of the calcar femorale by a wedge valgus osteotomy of the comminuted zone after the original design of Debrunner and Cech (1969). Simultaneously with reconstruction of the medial cortical support in the calcar femorale the 160 degrees valgization is performed. In the AO classification the authors consider for unstable the fractures of types 31.A2.1, A2.2, A3.3. Significant from the therapeutic viewpoint is the classification of stable fractures (with open reduction the anatomic reconstruction of weight-bearing calcar femorale is possible) and unstable fractures - where with open reduction the defect of calcar femorale persists. For stabilization of unstable the authors recommend fixation by DHS at 150 degrees angle. If need be, this fixation may be combined with lag screws and in case of a simultaneous fracture of greater trochanter and in reverse fractures a trochanteric buttress plate has to be added. Key words: unstable pertrochanteric fractures, nonanatomic valgus reduction, DHS fixation.

  12. Selection of medical treatment in stable angina pectoris

    DEFF Research Database (Denmark)

    Ardissino, D; Savonitto, S; Egstrup, K

    1995-01-01

    pectoris. BACKGROUND: The characteristics of anginal symptoms and the results of exercise testing are considered of great importance for selecting medical treatment in patients with chronic stable angina pectoris. However, little information is available on how this first evaluation may be used to select......, the patients were randomly allocated to double-blind treatment for 6 weeks with either metoprolol (Controlled Release, 200 mg once daily) or nifedipine (Retard, 20 mg twice daily) according to a parallel group design. At the end of this period, exercise tests were repeated 1 to 4 h after drug intake. RESULTS....... CONCLUSIONS: The results of a baseline exercise test, but not the characteristics of anginal symptoms, may offer useful information for selecting medical treatment in stable angina pectoris....

  13. [Anesthetic management of a patient with Ludwig's angina].

    Science.gov (United States)

    Kakinohana, M; Saitoh, T; Fukuzato, Y; Kawamoto, K; Inamura, T

    1999-07-01

    A 71-year-old woman with cellulitis of the floor of the mouth, referred to as "Ludwig's angina", underwent emergency tracheostomy under general anesthesia, for the control of airway narrowing caused by sublingual and submandibular swelling with tongue elevation. Because difficult airway had been suspected by preoperative assessment, feasible options of intubation in our hospital, including laryngeal mask, fiberoptic intubation and transtracheal jet ventilation, were prepared prior to induction of anesthesia. Anesthetic induction was carried out with propofol and suxamethonium, and subsequently tracheal intubation could be performed with difficulty under condition of partial visualization of vocal cord. Anesthetic maintenance with local anesthesia and continuous infusion of propofol 6 mg.kg-1.hr-1 was carried out during tracheostomy procedure, and this procedure was done uneventfully. Because airway control still remains a top priority in Ludwig's angina, feasible options of airway control should be prepared before induction of anesthesia if tracheostomy was required in a patient with this disease.

  14. Successful conservative management of Ludwig's angina in advanced pregnancy.

    Science.gov (United States)

    Soltero, Roxana; Mercado-Alvarado, Joanna

    2009-01-01

    A 20 year-old female in her 32nd week of gestation presented to the Emergency Department with dysphonia and dysphagia associated to a recent recurrence of a periapical abscess. Her oral examination showed trismus, elevated tongue and neck swelling. A clinical diagnosis of Ludwig's angina was reached, and empirical antibiotic coverage was started. The decompression and drainage placement was performed successfully under local anesthesia without airway compromise. At the moment, no clear guidelines exist for the acute treatment of Ludwig's angina. Establishment of a secure airway has long been considered the gold standard, yet new literature suggests a more conservative management. Ascertaining an early diagnosis at the Emergency Department, and involvement of Anesthesia, Obstetrics, and, Ear, Nose and Throat specialist services is vital for materno-fetal wellbeing. Careful evaluation of the airway status in addition to prompt antimicrobial therapy with surgical decompression may represent a plausible alternative in pregnant patients.

  15. Variant angina associated with bitter orange in a dietary supplement.

    Science.gov (United States)

    Gange, Christopher A; Madias, Christopher; Felix-Getzik, Erika M; Weintraub, Andrew R; Estes, N A Mark

    2006-04-01

    The Food and Drug Administration has banned the sale of ephedrine-based weight-loss products because of their association with many cardiovascular adverse effects. Bitter orange is now being used as a stimulant in "ephedra-free" weight-loss supplements but was recently implicated in adverse cardiovascular sequelae. To our knowledge, this report describes the first case of variant angina associated with bitter orange in a dietary supplement.

  16. Update on ranolazine in the management of angina

    Directory of Open Access Journals (Sweden)

    Codolosa JN

    2014-06-01

    Full Text Available J Nicolás Codolosa,1 Subroto Acharjee,1 Vincent M Figueredo1,2 1Einstein Center for Heart and Vascular Health, Einstein Medical Center, 2Jefferson Medical College, Philadelphia, PA, USA Abstract: Mortality rates attributable to coronary heart disease have declined in recent years, possibly related to changes in clinical presentation patterns and use of proven secondary prevention strategies. Chronic stable angina (CSA remains prevalent, and the goal of treatment is control of symptoms and reduction in cardiovascular events. Ranolazine is a selective inhibitor of the late sodium current in myocytes with anti-ischemic and metabolic properties. It was approved by the US Food and Drug Administration in 2006 for use in patients with CSA. Multiple, randomized, placebo-controlled trials have shown that ranolazine improves functional capacity and decreases anginal episodes in CSA patients, despite a lack of a significant hemodynamic effect. Ranolazine did not improve cardiovascular mortality or affect incidence of myocardial infarction in the MERLIN (Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome-TIMI (Thrombolysis In Myocardial Infarction 36 trial, but significantly decreased the incidence of recurrent angina. More recently, ranolazine has been shown to have beneficial and potent antiarrhythmic effects, both on supraventricular and ventricular tachyarrhythmias, largely due to its inhibition of the late sodium current. Randomized controlled trials testing these effects are underway. Lastly, ranolazine appears to be cost-effective due to its ability to decrease angina-related hospitalizations and improve quality of life. Keywords: ranolazine, chronic stable angina, coronary artery disease

  17. Update on ranolazine in the management of angina

    OpenAIRE

    Figueredo, Vincent; Codolosa,Jose; Acharjee,Subroto

    2014-01-01

    J Nicolás Codolosa,1 Subroto Acharjee,1 Vincent M Figueredo1,2 1Einstein Center for Heart and Vascular Health, Einstein Medical Center, 2Jefferson Medical College, Philadelphia, PA, USA Abstract: Mortality rates attributable to coronary heart disease have declined in recent years, possibly related to changes in clinical presentation patterns and use of proven secondary prevention strategies. Chronic stable angina (CSA) remains prevalent, and the goal of treatment is control of sym...

  18. Cardiac shockwave therapy in patients with chronic refractory angina pectoris

    OpenAIRE

    Vainer, J.; Habets, J. H. M.; Schalla, S.; Lousberg, A. H. P.; de Pont, C. D. J. M.; V??, S. A.; Brans, B. T.; Hoorntje, J. C. A.; Waltenberger, J.

    2016-01-01

    Background Cardiac shockwave therapy (CSWT) might improve symptoms and decrease ischaemia burden by stimulating collateral growth in chronic ischaemic myocardium. This prospective study was performed to evaluate the feasibility and safety of CSWT. Methods We included 33 patients (mean age 70???7 years, mean left ventricular ejection fraction 55???12?%) with end-stage coronary artery disease, chronic angina pectoris and reversible ischaemia on myocardial scintigraphy. CSWT was applied to the i...

  19. A case of Ludwig's angina following tooth extraction.

    Science.gov (United States)

    Yeo, J F; Loh, H S

    1982-01-01

    Ludwig's angina developed in an adult Chinese male following a mandibular third molar extraction. Brawny and tender swellings of the floor of the mouth and neck, with the elevation of the tongue, were classically present. The management of this case was based on the current emphasis of early broad-spectrum and antibiotic therapy with the maintenance of an adequate airway. The role of dental infection in this condition was highlighted.

  20. Update on ranolazine in the management of angina.

    Science.gov (United States)

    Codolosa, J Nicolás; Acharjee, Subroto; Figueredo, Vincent M

    2014-01-01

    Mortality rates attributable to coronary heart disease have declined in recent years, possibly related to changes in clinical presentation patterns and use of proven secondary prevention strategies. Chronic stable angina (CSA) remains prevalent, and the goal of treatment is control of symptoms and reduction in cardiovascular events. Ranolazine is a selective inhibitor of the late sodium current in myocytes with anti-ischemic and metabolic properties. It was approved by the US Food and Drug Administration in 2006 for use in patients with CSA. Multiple, randomized, placebo-controlled trials have shown that ranolazine improves functional capacity and decreases anginal episodes in CSA patients, despite a lack of a significant hemodynamic effect. Ranolazine did not improve cardiovascular mortality or affect incidence of myocardial infarction in the MERLIN (Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndrome)-TIMI (Thrombolysis In Myocardial Infarction) 36 trial, but significantly decreased the incidence of recurrent angina. More recently, ranolazine has been shown to have beneficial and potent antiarrhythmic effects, both on supraventricular and ventricular tachyarrhythmias, largely due to its inhibition of the late sodium current. Randomized controlled trials testing these effects are underway. Lastly, ranolazine appears to be cost-effective due to its ability to decrease angina-related hospitalizations and improve quality of life.

  1. [Airway management in Ludwig's angina - a challenge: case report].

    Science.gov (United States)

    Fellini, Roberto Taboada; Volquind, Daniel; Schnor, Otávio Haygert; Angeletti, Marcelo Gustavo; Souza, Olívia Egger de

    Ludwig's angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. Describe a case of a patient with Ludwig's angina undergoing surgery, with emphasis on airway management, in addition to reviewing the articles published in the literature on this topic. Male patient, 21 years, drug addict, admitted by the emergency department and diagnosed with LA. Difficult airway was identified during the anesthetic examination. In additional tests, significant deviation from the tracheal axis was seen. Undergoing bilateral thoracoscopic pleural drainage, we opted for airway management through tracheal intubation using fiberoptic bronchoscopy, and balanced general anesthesia was proposed. There were no complications during the surgical-anesthetic act. After the procedure, the patient remained intubated and mechanically ventilated in the intensive care unit. Airway management in patients with Ludwig's angina remains challenging. The choice of the safest technique should be based on clinical signs, technical conditions available, and the urgent need to preserve the patient's life. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  2. Airway management in Ludwig's angina - a challenge: case report

    Directory of Open Access Journals (Sweden)

    Roberto Taboada Fellini

    Full Text Available Abstract Background Ludwig's angina (LA is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. Objective Describe a case of a patient with Ludwig's angina undergoing surgery, with emphasis on airway management, in addition to reviewing the articles published in the literature on this topic. Case report Male patient, 21 years, drug addict, admitted by the emergency department and diagnosed with LA. Difficult airway was identified during the anesthetic examination. In additional tests, significant deviation from the tracheal axis was seen. Undergoing bilateral thoracoscopic pleural drainage, we opted for airway management through tracheal intubation using fiberoptic bronchoscopy, and balanced general anesthesia was proposed. There were no complications during the surgical-anesthetic act. After the procedure, the patient remained intubated and mechanically ventilated in the intensive care unit. Conclusions Airway management in patients with Ludwig's angina remains challenging. The choice of the safest technique should be based on clinical signs, technical conditions available, and the urgent need to preserve the patient's life.

  3. The sensitivity of the symptom angina pectoris as a marker of transient myocardial ischaemia in chronic stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K

    1987-01-01

    with a history of chronic stable angina pectoris, positive exercise test and/or positive coronary angiography, and a correlation was made between the episodes of chest pain and ST segment change. The patients were grouped according to the results of exercise testing and coronary arteriography, and one group...... was studied with and without antianginal medication. Overall, 195 episodes of angina were noted, only 94 of which (48%) were accompanied by ST segment depression. Pain and ST segment changes were best correlated in patients with a positive exercise test, positive angiography and who were not receiving...... as was previously thought, a finding which supports the use of objective methods in identifying episodes of transient myocardial ischaemia in daily life....

  4. MODERN PHARMACOTHERAPY OF THE STABLE ANGINA: POSSIBILITIES AND PROSPECTS OF NICORANDIL IMPLEMENTATION

    OpenAIRE

    Z. M. Sizova; E. V. Shikh; V. L. Zakharova; E. V. Smirnova

    2010-01-01

    Aim. To evaluate antianginal efficacy and safety of nicorandil for angina attack prevention and relief in patients with ischemic heart disease (IHD) and symptoms of stable angina class 2-3.Material and methods. 30 patients with stable angina class 2-3 (17 men, 13 women; aged 58.6±5.8 y.o.) were included into the study. All patients received amlodipine 10 mg QD within 2 weeks. For angina attack relief patients used nicorandil 10-20 mg and in case of its inefficacy — nitroglycerin. In 2 weeks a...

  5. Optical isotope shifts for unstable samarium isotopes

    International Nuclear Information System (INIS)

    Eastham, D.A.; Walker, P.M.; Griffith, J.A.R.; Evans, D.E.; Grant, I.S.; England, J.G.; Fawcett, M.J.

    1984-01-01

    Using a tunable dye laser beam intersecting a thermal atomic beam, optical isotope shifts and hyperfine splittings have been measured for the four unstable samarium isotopes between 144 Sm and 154 Sm, covering the well known transition region from spherical to deformed shapes. (orig.)

  6. Confiabilidade de sintomas sugestivos de angina em pacientes com doença pulmonar obstrutiva crônica Confiabilidad de síntomas sugestivos de angina en pacientes con enfermedad pulmonar obstructiva crónica Reliability of symptoms suggestive of angina in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Yilmaz Gunes

    2009-05-01

    baseline clinical characteristics who had undergone diagnostic coronary angiography for the first time were reviewed retrospectively. RESULTS: The frequency of significant CAD was significantly lower in COPD patients than in the control group (52.8% vs. 80.2%, p<0.001. Frequencies of CAD risk factors (older age, hypertension, diabetes, smoking history were significantly more frequent among COPD patients having significant CAD. Among patients reporting stable angina pectoris, significant CAD was detected in 32.7% of COPD patients and 71.0% of non-COPD patients (p<0.001. However, among the patients with a diagnosis of unstable angina pectoris, significant CAD was detected in 87.5% of COPD patients and 90.2% of non-COPD patients (p=0.755. CONCLUSION: Diagnosis of CAD in COPD patients by symptomatology may be difficult. However, clinical diagnosis of CAD in the setting of unstable angina is accurate in most of the COPD patients. Therefore, further noninvasive diagnostic methods or careful follow up may be more appropriate for COPD patients reporting stable angina pectoris.

  7. Global variability in angina pectoris and its association with body mass index and poverty.

    Science.gov (United States)

    Liu, Longjian; Ma, Jixiang; Yin, Xiaoyan; Kelepouris, Ellie; Eisen, Howard J

    2011-03-01

    In the absence of a previous global comparison, we examined the variability in the prevalence of angina across 52 countries and its association with body weight and the poverty index using data from the World Health Organization-World Health Survey. The participants with angina were defined as those who had positive results using a Rose angina questionnaire and/or self-report of a physician diagnosis of angina. The body mass index (BMI) was determined as the weight in kilograms divided by the square of the height in meters. The poverty index (a standard score of socioeconomic status for a given country) was extracted from the United Nations' statistics. The associations of angina with the BMI and poverty index were analyzed cross-sectionally using univariate and multivariate analyses. The results showed that the total participants (n = 210,787) had an average age of 40.64 years. The prevalence of angina ranged from 2.44% in Tunisia to 23.89% in Chad. Those participants with a BMI of poverty status was considered. A tendency was seen for underweight status and a poverty index >14.65% to be associated with the risk of having angina, although these associations were not statistically significant in the multilevel models. In conclusion, significant variations were found in the anginal rates across 52 countries worldwide. An increased BMI was significantly associated with the odds of having angina. Published by Elsevier Inc.

  8. Muscle Fibre Types, Ubiquinone Content and Exercise Capacity in Hypertension and Effort Angina

    DEFF Research Database (Denmark)

    Karlsson, Jan; Diamant, Bertil; Folkers, Karl

    1991-01-01

    Farmakologi, hypertension, IHD, skeletal muscle fibre composition, muscle coenzyme Q10, ischaemic heart disease, effort angina, muscle fibre lesion, muscle ubiquinone......Farmakologi, hypertension, IHD, skeletal muscle fibre composition, muscle coenzyme Q10, ischaemic heart disease, effort angina, muscle fibre lesion, muscle ubiquinone...

  9. Ludwig\\'s Angina in a Puerperant: A Case Report. | Mgbeokere ...

    African Journals Online (AJOL)

    Ludwig's angina is a serious infection of the oral cavity and other soft tissues above the hyoid bone. It is associated with brawny ... Antibiotics therapy, incision and drainage and in many cases creation of artificial airways are the corner stone in the treatment protocol of Ludwig's angina. In this report, we present a case of ...

  10. Ludwig's angina: report of a case and review of management issues.

    Science.gov (United States)

    Barakate, M S; Jensen, M J; Hemli, J M; Graham, A R

    2001-05-01

    Ludwig's angina, although uncommon, remains a potentially life-threatening condition because of the risk of impending airway obstruction. Effective treatment is based on early recognition of the clinical process, with the appropriate use of parenteral antibiotics, airway protection techniques, and formal surgical drainage of the infection. We present a case of Ludwig's angina together with a brief review of the relevant literature.

  11. Decay Law of Moving Unstable Particle

    CERN Document Server

    Shirokov, M I

    2004-01-01

    Quantum relativistic decay law of moving unstable particle is analytically calculated in the model case of the Breit-Wigner mass distribution. It turns out that Einstein time dilation of the moving particle decay holds approximately at times when the decay is exponential. The related correction is calculated analytically. Being very small at these times it is practically unobservable. It is shown that Einstein dilation fails for large times t when decay is not exponential. An unstable system of the kind of K_0 meson (which is the superposition of K_s and K_l) is also considered. In this case, the violation of Einstein dilation is shown to be appreciable at all times under some condition.

  12. The Fate of Unstable Circumbinary Planets

    Science.gov (United States)

    Kohler, Susanna

    2016-03-01

    What happens to Tattooine-like planets that are instead in unstable orbits around their binary star system? A new study examines whether such planets will crash into a host star, get ejected from the system, or become captured into orbit around one of their hosts.Orbit Around a DuoAt this point we have unambiguously detected multiple circumbinary planets, raising questions about these planets formation and evolution. Current models suggest that it is unlikely that circumbinary planets would be able to form in the perturbed environment close their host stars. Instead, its thought that the planets formed at a distance and then migrated inwards.One danger such planets face when migrating is encountering ranges of radii where their orbits become unstable. Two scientists at the University of Chicago, Adam Sutherland and Daniel Fabrycky, have studied what happens when circumbinary planets migrate into such a region and develop unstable orbits.Producing Rogue PlanetsTime for planets to either be ejected or collide with one of the two stars, as a function of the planets starting distance (in AU) from the binary barycenter. Colors represent different planetary eccentricities. [Sutherland Fabrycky 2016]Sutherland and Fabrycky used N-body simulations to determine the fates of planets orbiting around a star system consisting of two stars a primary like our Sun and a secondary roughly a tenth of its size that are separated by 1 AU.The authors find that the most common fate for a circumbinary planet with an unstable orbit is ejection from the system; over 80% of unstable planets were ejected. This has interesting implications: if the formation of circumbinary planets is common, this mechanism could be filling the Milky Way with a population of free-floating, rogue planets that no longer are associated with their host star.The next most common outcome for unstable planets is collision with one of their host stars (most often the secondary), resulting inaccretion of the planet

  13. Treatment of Unstable Pelvic Ring Injuries

    OpenAIRE

    Kim, Weon-Yoo

    2014-01-01

    Pelvic fractures are classified according to the stability of the pelvic ring. Unlike stable pelvic fractures, which heal without complications, unstable fractures may lead to pelvic ring deformities, which cause severe complications. An orthopedic surgeon must determine the stability of the pelvic ring by radiography and physical examination of the patient in order to ensure early, prompt treatment. This article includes anatomy of the pelvic ring, classification of pelvic ring injuries, its...

  14. Unstable Jefferson fractures: Results of transoral osteosynthesis.

    Science.gov (United States)

    Hu, Yong; Albert, Todd J; Kepler, Christopher K; Ma, Wei-Hu; Yuan, Zhen-Shan; Dong, Wei-Xin

    2014-03-01

    Majority of C1 fractures can be effectively treated conservatively by immobilization or traction unless there is an injury to the transverse ligament. Conservative treatment usually involves a long period of immobilization in a halo-vest. Surgical intervention generally involves fusion, eliminating the motion of the upper cervical spine. We describe the treatment of unstable Jefferson fractures designed to avoid these problems of both conservative and invasive methods. A retrospective review of 12 patients with unstable Jefferson fractures treated with transoral osteosynthesis of C1 between July 2008 and December 2011 was performed. A steel plate and C1 lateral mass screw fixation were used to repair the unstable Jefferson fractures. Our study group included eight males and four females with an average age of 33 years (range 23-62 years). Patients were followed up for an average of 16 months after surgery. Range of motion of the cervical spine was by and large physiologic: Average flexion 35° (range 28-40°), average extension 42° (range 30-48°). Lateral bending to the right and left averaged 30° and 28° respectively (range 12-36° and 14-32° respectively). The average postoperative rotation of the atlantoaxial joint, evaluated by functional computed tomography scan was 60° (range 35-72°). Total average lateral displacement of the lateral masses was 7.0 mm before surgery (range 5-12 mm), which improved to 3.5 mm after surgery (range 1-6.5 mm). The total average difference of the atlanto-dens interval in flexion and extension after surgery was 1.0 mm (range 1-3 mm). Transoral osteosynthesis of the anterior ring using C1 lateral mass screws is a viable option for treating unstable Jefferson fractures, which allows maintenance of rotation at the C1-C2 joint and restoration of congruency of the atlanto-occipital and atlantoaxial joints.

  15. Nonlinear adaptive neural controller for unstable aircraft

    OpenAIRE

    Suresh, S; Omkar, SN; Mani, V; Sundararajan, N

    2005-01-01

    A model reference indirect adaptive neural control scheme that uses both off-line and online learning strategies is proposed for an,unstable nonlinear aircraft controller design. The bounded-input-bounded-output stability requirement for the controller design is circumvented using an off-line, finite interval of time training scheme. The aircraft model is first identified using a neural network with linear filter (also known as time-delayed neural network) with the available input-output data...

  16. Exercise-based cardiac rehabilitation for adults with stable angina.

    Science.gov (United States)

    Long, Linda; Anderson, Lindsey; Dewhirst, Alice M; He, Jingzhou; Bridges, Charlene; Gandhi, Manish; Taylor, Rod S

    2018-02-02

    A previous Cochrane review has shown that exercise-based cardiac rehabilitation (CR) can benefit myocardial infarction and post-revascularisation patients. However, the impact on stable angina remains unclear and guidance is inconsistent. Whilst recommended in the guidelines of American College of Cardiology/American Heart Association and the European Society of Cardiology, in the UK the National Institute for Health and Care Excellence (NICE) states that there is "no evidence to suggest that CR is clinically or cost-effective for managing stable angina". To assess the effects of exercise-based CR compared to usual care for adults with stable angina. We updated searches from the previous Cochrane review 'Exercise-based cardiac rehabilitation for patients with coronary heart disease' by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, DARE, CINAHL and Web of Science on 2 October 2017. We searched two trials registers, and performed reference checking and forward-citation searching of all primary studies and review articles, to identify additional studies. We included randomised controlled trials (RCTs) with a follow-up period of at least six months, which compared structured exercise-based CR with usual care for people with stable angina. Two review authors independently assessed the risk of bias and extracted data according to the Cochrane Handbook for Systematic Reviews of Interventions. Two review authors also independently assessed the quality of the evidence using GRADE principles and we presented this information in a 'Summary of findings' table. Seven studies (581 participants) met our inclusion criteria. Trials had an intervention length of 6 weeks to 12 months and follow-up length of 6 to 12 months. The comparison group in all trials was usual care (without any form of structured exercise training or advice) or a no-exercise comparator. The mean age of participants within the trials ranged from 50 to 66 years, the

  17. Angina crónica estable. Consideraciones actuales

    Directory of Open Access Journals (Sweden)

    Yanier Coll Muñoz

    2011-03-01

    Full Text Available La angina de pecho crónica estable es un síndrome clínico caracterizado por dolor o malestar precordial secundario a isquemia miocárdica y sin características clínicas de inestabilidad. El debate actual sobre esta entidad clínica incluye tres aspectos fundamentales: diagnóstico, prevalencia e impacto socioeconómico, y tratamiento médico frente a revascularización miocárdica. En los últimos cuatro años se han dado a conocer los resultados de varios estudios multicéntricos de gran importancia que compararon tratamiento médico con revascularización miocárdica y cirugía de revascularización frente a intervención coronaria percutánea; además, han mejorado las técnicas de revascularización y existe abundante información sobre la eficacia de nuevos fármacos antiisquémicos. El presente trabajo tiene como objetivo hacer una revisión de los aspectos actuales más importantes relacionados con la angina de pecho estable y su tratamiento, publicados en la literatura especializada.

  18. Crisis-induced unstable dimension variability in a dynamical system

    International Nuclear Information System (INIS)

    Kubo, Geraldo T.; Viana, Ricardo L.; Lopes, Sergio R.; Grebogi, Celso

    2008-01-01

    Unstable dimension variability is an extreme form of non-hyperbolic behavior in chaotic systems whose attractors have periodic orbits with a different number of unstable directions. We propose a new mechanism for the onset of unstable dimension variability based on an interior crisis, or a collision between a chaotic attractor and an unstable periodic orbit. We give a physical example by considering a high-dimensional dissipative physical system driven by impulsive periodic forcing

  19. Vasospastic angina and microvascular angina are differentially influenced by PON1 A632G polymorphism in the Japanese.

    Science.gov (United States)

    Mashiba, Junko; Koike, George; Kamiunten, Hitoshi; Ikeda, Manami; Sunagawa, Kenji

    2005-12-01

    Ethnicity and smoking are well-known risk factors for the pathogenesis of coronary vasospasm. Oxidative stress induced by smoking plays a crucial role in coronary vasospasm, but is not enough to account for the pathogenesis of coronary vasospasm, indicating that genetic factors are strongly involved. The study group comprised 162 vasospastic angina patients (VSAs), 61 microvascular angina patients (MVAs) and 61 non-responders (NRs) diagnosed by acetylcholine provocation test. Four polymorphisms of the oxidative stress related genes, cytochrome b-245, alpha polypeptide gene (CYBA) C242T and A640G, paraoxonase 1 gene (PON1) A632G, phospholipase A2 group VII gene (PLA2G7) G994T were genotyped. Allele frequency of PON1 632-G was significantly higher in both the VSA with dominant fashion and the MVA with recessive fashion compared with NR. This association was strongly influenced by gender in the MVA only. There were no significant associations between the other polymorphisms and coronary vasospasm. In addition, the allele frequency of PON1 632-G in the Japanese was higher than in Caucasians. There was a significant association between PON1 A632G polymorphism and MVA as well as VSA, but the impact of this on VSA and MVA is different in the Japanese.

  20. The fate of unstable gauge flux compactifications

    Energy Technology Data Exchange (ETDEWEB)

    Burgess, C.P. [McMaster Univ., Hamilton, ON (Canada). Dept. of Physics and Astronomy]|[Perimeter Institute for Theoretical Physics, Waterloo, ON (Canada); Parameswaran, S.L. [Hamburg Univ. (Germany). 2. Inst. fuer Theoretische Physik; Zavala, I. [Bonn Univ. (Germany). Bethe Center for Theoretical Physics and Physikalisches Inst.

    2008-12-15

    Fluxes are widely used to stabilise extra dimensions, but the supporting monopolelike configurations are often unstable, particularly if they arise as gauge flux within a non-abelian gauge sector. We here seek the endpoint geometries to which this instability leads, focussing on the simplest concrete examples: sphere-monopole compactifications in six dimensions. Without gravity most monopoles in non-abelian gauge groups are unstable, decaying into the unique stable monopole in the same topological class. We show that the same is true in Einstein-YM systems, with the new twist that the decay leads to a shrinkage in the size of the extra dimensions and curves the non-compact directions: in D dimensions a Mink{sub D-2} x S{sub 2} geometry supported by an unstable monopole relaxes to AdS{sub D-2} x S{sub 2}, with the endpoint sphere smaller than the initial one. For supergravity the situation is more complicated because the dilaton obstructs such a simple evolution. The endpoint instead acquires a dilaton gradient, thereby breaking some of the spacetime symmetries. For 6D supergravity we argue that it is the 4D symmetries that break, and examine several candidates for the endpoint geometry. By using the trick of dimensional oxidation it is possible to recast the supergravity system as a higher-dimensional Einstein-YM monopole, allowing understanding of this system to guide us to the corresponding endpoint. The result is a Kasner-like geometry conformal to Mink{sub 4} times S{sub 2}, with nontrivial conformal factor and dilaton breaking the maximal 4D symmetry and generating a singularity. Yet the resulting configuration has a lower potential energy than did the initial one, and is perturbatively stable, making it a sensible candidate endpoint for the evolution. (orig.)

  1. Exploring the physics of unstable nuclei

    International Nuclear Information System (INIS)

    Volya, Alexander

    2015-01-01

    In this presentation the Continuum Shell Model (CSM) approach is advertised as a powerful theoretical tool for studying physics of unstable nuclei. The approach is illustrated using 17 O as an example, which is followed by a brief presentation of the general CSM formalism. The successes of the CSM are highlighted and references are provided throughout the text. As an example, the CSM is applied perturbatively to 20 O allowing one to explore the effects of continuum on positions of weakly bound states and low-lying resonances, as well as to discern some effects of threshold discontinuity. (author)

  2. Nuclear Data on Unstable Nuclei for Astrophysics

    International Nuclear Information System (INIS)

    Smith, Michael Scott; Meyer, Richard A; Lingerfelt, Eric; Scott, J.P.; Hix, William Raphael; Ma, Zhanwen; Bardayan, Daniel W.; Blackmon, Jeff C.; Guidry, Mike W.; KOZUB, RAYMOND L.; Chae, Kyung YuK.

    2004-01-01

    Recent measurements with radioactive beams at ORNL's Holifield Radioactive Ion Beam Facility (HRIBF) have prompted the evaluation of a number of reactions involving unstable nuclei needed for stellar explosion studies. We discuss these evaluations, as well as the development of a new computational infrastructure to enable the rapid incorporation of the latest nuclear physics results in astrophysics models. This infrastructure includes programs that simplify the generation of reaction rates, manage rate databases, and visualize reaction rates, all hosted at a new website http://www.nucastrodata.org

  3. Signatures of unstable particles in finite volume

    International Nuclear Information System (INIS)

    Luescher, M.

    1991-05-01

    Unstable particles (resonances) occur in QCD, the Higgs model and many other quantum field theories of interest. Since they are a dynamical phenomenon, showing up in scattering processes of stable particles, it is not obvious how to extract their masses from numerical simulations of the theory in euclidean space. For resonances in the elastic region, a solution to this problem in proposed here on the basis of a recently established relation between the scattering matrix in infinite volume and the two-particle energy spectrum in a periodic box. (orig.)

  4. Meta-analysis of acupuncture therapy for the treatment of stable angina pectoris.

    Science.gov (United States)

    Zhang, Ze; Chen, Min; Zhang, Li; Zhang, Zhe; Wu, Wensheng; Liu, Jun; Yan, Jun; Yang, Guanlin

    2015-01-01

    Angina pectoris is a common symptom imperiling patients' life quality. The aim of this study is to evaluate the efficacy and safety of acupuncture for stable angina pectoris. Clinical randomized-controlled trials (RCTs) comparing the efficacy of acupuncture to conventional drugs in patients with stable angina pectoris were searched using the following database of PubMed, Medline, Wanfang and CNKI. Overall odds ratio (ORs) and weighted mean difference (MD) with their 95% confidence intervals (CI) were calculated by using fixed- or random-effect models depending on the heterogeneity of the included trials. Total 8 RCTs, including 640 angina pectoris cases with 372 patients received acupuncture therapy and 268 patients received conventional drugs, were included. Overall, our result showed that acupuncture significantly increased the clinical curative effects in the relief of angina symptoms (OR=2.89, 95% CI=1.87-4.47, Pacupuncture therapy was superior to conventional drugs. Although there was no significant difference in overall effective rate relating reduction of nitroglycerin between two groups (OR=2.13, 95% CI=0.90-5.07, P=0.09), a significant reduction on nitroglycerin consumption in acupuncture group was found (MD=-0.44, 95% CI=-0.64, -0.24, Pacupuncture therapy than for traditional medicines (MD=2.44, 95% CI=1.64-3.24, Pacupuncture therapy were found. Acupuncture may be an effective therapy for stable angina pectoris. More clinical trials are needed to systematically assess the role of acupuncture in angina pectoris.

  5. Relativistic mean field theory for unstable nuclei

    International Nuclear Information System (INIS)

    Toki, Hiroshi

    2000-01-01

    We discuss the properties of unstable nuclei in the framework of the relativistic mean field (RMF) theory. We take the RMF theory as a phenomenological theory with several parameters, whose form is constrained by the successful microscopic theory (RBHF), and whose values are extracted from the experimental values of unstable nuclei. We find the outcome with the newly obtained parameter sets (TM1 and TMA) is promising in comparison with various experimental data. We calculate systematically the ground state properties of even-even nuclei up to the drip lines; about 2000 nuclei. We find that the neutron magic shells (N=82, 128) at the standard magic numbers stay at the same numbers even far from the stability line and hence provide the feature of the r-process nuclei. However, many proton magic numbers disappear at the neutron numbers far away from the magic numbers due to the deformations. We discuss how to describe giant resonances for the case of the non-linear coupling terms for the sigma and omega mesons in the relativistic RPA. We mention also the importance of the relativistic effect on the spin observables as the Gamow-Teller strength and the longitudinal and transverse spin responses. (author)

  6. Effect of Teriparatide on Unstable Pertrochanteric Fractures

    Directory of Open Access Journals (Sweden)

    Tsan-Wen Huang

    2015-01-01

    Full Text Available We retrospectively analyzed the radiographic and clinical outcomes of unstable pertrochanteric fractures (AO/OTA 31-A2 in 44 patients who underwent dynamic hip screw (DHS fixation and compared the results with 29 patients who received teriparatide in addition to DHS fixation. A significantly shorter time for fracture healing was recorded in the teriparatide-treated group than in the control group. Rates of lag screw sliding, femoral shortening, and varus collapse were all significantly reduced in the teriparatide-treated group. There were no significant differences with regard to superficial wound infection, pneumonia, urinary tract infection, mortality, malunion, and cutting of the lag screw. The mean overall mobility scores were significantly better in the teriparatide-treated group at 3 and 6 months (P<0.001 and P<0.001, resp. but not at 12 months or the last follow-up. The pain scores were also significantly better in the teriparatide-treated group at 3 and 6 months (P=0.040 and P=0.041, resp. but not at 12 months or the last follow-up. Teriparatide improves radiographic outcomes and yields better clinical outcomes at 3 and 6 months postoperatively. The improvement in union time may be important for elderly populations with unstable pertrochanteric fractures to enable them to return to daily activities and reduce morbidity and mortality.

  7. Effect of teriparatide on unstable pertrochanteric fractures.

    Science.gov (United States)

    Huang, Tsan-Wen; Yang, Tien-Yu; Huang, Kuo-Chin; Peng, Kuo-Ti; Lee, Mel S; Hsu, Robert Wen-Wei

    2015-01-01

    We retrospectively analyzed the radiographic and clinical outcomes of unstable pertrochanteric fractures (AO/OTA 31-A2) in 44 patients who underwent dynamic hip screw (DHS) fixation and compared the results with 29 patients who received teriparatide in addition to DHS fixation. A significantly shorter time for fracture healing was recorded in the teriparatide-treated group than in the control group. Rates of lag screw sliding, femoral shortening, and varus collapse were all significantly reduced in the teriparatide-treated group. There were no significant differences with regard to superficial wound infection, pneumonia, urinary tract infection, mortality, malunion, and cutting of the lag screw. The mean overall mobility scores were significantly better in the teriparatide-treated group at 3 and 6 months (P teriparatide-treated group at 3 and 6 months (P = 0.040 and P = 0.041, resp.) but not at 12 months or the last follow-up. Teriparatide improves radiographic outcomes and yields better clinical outcomes at 3 and 6 months postoperatively. The improvement in union time may be important for elderly populations with unstable pertrochanteric fractures to enable them to return to daily activities and reduce morbidity and mortality.

  8. Tracer filamentation at an unstable ocean front

    Science.gov (United States)

    Feng, Yen Chia; Mahadevan, Amala; Thiffeault, Jean-Luc; Yecko, Philip

    2017-11-01

    A front, where two bodies of ocean water with different physical properties meet, can become unstable and lead to a flow with high strain rate and vorticity. Phytoplankton and other oceanic tracers are stirred into filaments by such flow fields, as can often be seen in satellite imagery. The stretching and folding of a tracer by a two-dimensional flow field has been well studied. In the ocean, however, the vertical shear of horizontal velocity is typically two orders of magnitude larger than the horizontal velocity gradient. Theoretical calculations show that vertical shear alters the way in which horizontal strain affects the tracer, resulting in thin, sloping structures in the tracer field. Using a non-hydrostatic ocean model of an unstable ocean front, we simulate tracer filamentation to identify the effect of vertical shear on the deformation of the tracer. In a complementary laboratory experiment, we generate a simple, vertically sheared strain flow and use dye and particle image velocimetry to quantify the filamentary structures in terms of the strain and shear. We identify how vertical shear alters the tracer filaments and infer how the evolution of tracers in the ocean will differ from the idealized two-dimensional paradigm. Support of NSF DMS-1418956 is acknowledged.

  9. TREATMENT OF UNSTABLE FRACTURES OF THE TIBIA

    Directory of Open Access Journals (Sweden)

    Dragan Petković

    2004-07-01

    Full Text Available Unstable fractures of cruris are all those fractures which cannot hold satisfactory position even after orthopedic reposition and imobilization.Bone fragments or fractures which redislocate and whithin 7 days after primary well done reposition and adeqate imobilization are also unstable fractures. These fractures can be treated by orthopedic repozition, by transosal traction through calcaneus or through supramalleolar area.These fractures can also be treated surgically by internal or by external fixation. The safest operative method today is external fixation. Using of Mitkovic external flxator this method minimally traumatizes bone and soft tisue of cruris,the operation is not time consuming and complications as infection and nonunion aresignificantly more rare in comparison to internal fixation. External fixation is minimaly invasive method, preserving both periostal and intramedular blood circulation. Mitkovic system also provides biological conditions, which are very similar to biomechanical features of natural tibia and probably it is one of important factor for qicker fracture healing with big periostal callus fortnation.This external flxation system has additional advantages in comparison to other existing devices, especialy in regard of simplicity of application and possibility of accurate closed intraoperative and postoperative fracture reduction.

  10. Dynamics and statistics of unstable quantum states

    International Nuclear Information System (INIS)

    Sokolov, V.V.; Zelevinsky, V.G.

    1989-01-01

    The statistical theory of spectra formulated in terms of random matrices is extended to unstable states. The energies and widths of these states are treated as real and imaginary parts of complex eigenvalues for an effective non-hermitian hamiltonian. Eigenvalue statistics are investigated under simple assumptions. If the coupling through common decay channels is weak we obtain a Wigner distribution for the level spacings and a Porter-Thomas one for the widths, with the only exception for spacings less than widths where level repulsion fades out. Meanwhile in the complex energy plane the repulsion of eigenvalues is quadratic in accordance with the T-noninvariant character of decaying systems. In the opposite case of strong coupling with the continuum, k short-lived states are formed (k is the number of open decay channels). These states accumulate almost the whole total width, the rest of the states becoming long-lived. Such a perestroika corresponds to separation of direct processes (a nuclear analogue of Dicke coherent superradiance). At small channel number, Ericson fluctuations of the cross sections are found to be suppressed. The one-channel case is considered in detail. The joint distribution of energies and widths is obtained. The average cross sections and density of unstable states are calculated. (orig.)

  11. Accelerator complex for unstable beams at INS

    International Nuclear Information System (INIS)

    Tomizawa, M.; Arai, S.; Doi, M.; Katayama, T.; Niki, K.; Tokuda, N.; Yoshizawa, M.

    1992-11-01

    The construction of the prototype facility of the Exotic arena in the Japan Hadron Project (JHP) is started in 1992 at the Institute for Nuclear Study (INS), University of Tokyo. The purpose of this facility is to study the various technical problems of the Exotic arena, and to perform the experiment on nuclear and astrophysics with unstable nuclear beam. The unstable nuclei produced by bombarding a thick target with 40 MeV proton beam from the existing SF cyclotron are ionized in the ion sources, mass-analyzed by an ISOL, and transported to the accelerator complex. The accelerator complex consists of a split coaxial RFQ and an interdigital H type linac. The construction of accelerator will be completed in fiscal year 1994. The development of the SCRFQ and the IH linac which is suitable to the post-accelerator of the SCRFQ are reported. Charge stripper and the beam matching between the SCRFQ and the IH linac are explained. A buncher is necessary for the matching of longitudinal phase space between the SCRFQ and the IH linac. (K.I.)

  12. Efficacy of anipamil, a phenylalkylamine calcium antagonist, in treatment of angina pectoris

    DEFF Research Database (Denmark)

    Sørum, C; Larsen, C T; Rasmussen, Verner

    1994-01-01

    with > or = 0.1-mV horizontal or downsloping ST-segment depression limited by angina, and (c) at least 10 attacks of angina pectoris in a single-blind 3-week run-in period. Nineteen patients were randomized to enter the study. In 3-week periods, they received either anipamil 80 mg once daily (o.d.), anipamil...... 160 mg o.d., or placebo. At the end of each period, an exercise test was performed. The number of angina pectoris attacks was significantly reduced during treatment with anipamil 80 mg (p ... reduced during treatment with anipamil 80 mg (p Heart rate (HR) at 0...

  13. Gender differences in the management and clinical outcome of stable angina

    DEFF Research Database (Denmark)

    Daly, Caroline; Clemens, Felicity; Sendon, Jose L. Lopez

    2006-01-01

    Background- We sought to examine the impact of gender on the investigation and subsequent management of stable angina and to assess gender differences in clinical outcome at 1 year. Methods and Results- The Euro Heart Survey of Stable Angina enrolled patients with a clinical diagnosis of stable......, 1.13 to 3.85), even after multivariable adjustment for age, abnormal ventricular function, severity of coronary disease, and diabetes. Conclusions- Significant gender bias has been identified in the use of investigations and evidence-based medical therapy in stable angina. Women were also less...

  14. Ludwig's angina in the pediatric population: report of a case and review of the literature.

    Science.gov (United States)

    Britt, J C; Josephson, G D; Gross, C W

    2000-01-30

    Ludwig's angina is a rapidly progressing cellulitis involving the submandibular neck space. It is characterized by brawny induration of the submental region and floor of mouth, bearing the potential for rapid airway obstruction. Airway management, antibiotics, and judicious surgical intervention are the mainstays of successful therapy. We present a case of Ludwig's angina in a 5-year-old child and offer a meta-analysis of pediatric cases of Ludwig's angina described in the literature over the past 30 years. The presentation, etiology, management, and potential complications of this disorder in the pediatric population are discussed.

  15. PRINZMETAL ANGINA PECTORIS IN CLINICAL PRACTICE: POSSIBILITY OF CHRONO-THERAPEUTIC APPROACH AND LIMITATIONS OF COMORBIDITY

    Directory of Open Access Journals (Sweden)

    M. V. Baeva

    2013-12-01

    Full Text Available Prinzmetal Angina (synonyms: vasospastic angina, variant angina in accordance with the definition of, it is caused by coronary artery spasm which occurs during sleep at night, between midnight and early morning and manifested with ST segment elevation on the ECG. Frequent “attachment” to the attacks of a certain period of the sleep period, gives you the opportunity to use chronomedical approaching the treatment of patients suffering from it, as demonstrated by our observation. On the other hand, for adulthood comorbidity is characteristic, and Prinzmetal is no exception, which we wanted to show, studying the clinical case.

  16. Circulating Microparticles and Coronary Plaque Components Assessed by Virtual Histology Intravascular Ultrasound of the Target Lesion in Patients with Stable Angina.

    Directory of Open Access Journals (Sweden)

    Pil-Ki Min

    Full Text Available High levels of microparticles (MPs circulate in the blood of patients with atherosclerotic diseases where they can serve as potential biomarkers of vascular injury and cardiovascular outcome. We used virtual histology intravascular ultrasound (VH-IVUS to evaluate the relationship between the levels of circulating MPs and the coronary plaque composition in patients with stable angina. We included 35 patients with stable angina (22 men, age 64 ± 9 years and a de novo target lesion. Preintervention gray-scale and VH-IVUS analysis was performed across the target lesion. Volumetric analysis was performed over a 10-mm-long segment centered at the minimum luminal site. Blood samples were obtained from the femoral artery before coronary angioplasty. MPs were measured using a solid-phase capture assay from a commercial kit. We divided participants into either a low MPs group or high MPs group based on the median value of MPs. There was no significant difference in baseline characteristics between the groups. The plaque burden and remodeling index were similar between the groups. The presence of VH-IVUS-derived thin-cap fibroatheroma was not different between the groups. The percentage of the necrotic core (NC was significantly higher in the high MPs group than in the low MPs group, both in planar (17.0 ± 8.8% vs. 24.1 ± 6.9%, p = 0.012 and volumetric analyses (17.0 ± 4.8% vs. 22.1 ± 4.3%, p = 0.002. Circulating MPs were positively correlated with the percentage of the NC area at the minimal luminal site (r = 0.491, p = 0.003 and the percentage of the NC volume (r = 0.496, p = 0.002. Elevated levels of circulating MPs were associated with the amount of NC in the target lesion in those with stable angina, suggesting a potential role of circulating MPs as a biomarker for detecting unstable plaque in patients with stable angina.

  17. Effects of acupuncture in moderate, stable angina pectoris

    DEFF Research Database (Denmark)

    Ballegaard, Søren; Pedersen, F; Pietersen, A

    1990-01-01

    In order to evaluate the effects of acupuncture in moderate, stable angina pectoris, 49 patients were randomized to either genuine or sham acupuncture. In sham acupuncture needles were inserted into points within the same spinal segment as in genuine acupuncture, but outside the Chinese meridian...... system. The effect was evaluated from exercise tests, anginal attack rate and nitroglycerin consumption. There were no significant differences between the effects of genuine and sham acupuncture either on exercise test variables or on subjective variables. In patients receiving genuine acupuncture...... there was a significant increase in exercise tolerance (median 9%) and in delay of onset to pain (median 10%). No significant changes were observed in patients receiving sham acupuncture. Within both groups there was a median reduction of 50% in anginal attack rate and nitroglycerin consumption...

  18. Pulmonary artery dilatation: an overlooked mechanism for angina pectoris.

    Science.gov (United States)

    Ginghina, Carmen; Popescu, Bogdan A; Enache, Roxana; Ungureanu, Catalina; Deleanu, Dan; Platon, Pavel

    2008-07-01

    Dilatation of the pulmonary artery may lead to the compression of adjacent structures. Of those, the extrinsic compression of the left main coronary artery is the most worrisome. We present the case of a 48-year-old woman who was diagnosed with pulmonary artery dilatation due to severe, thromboembolic pulmonary hypertension. She also had angina and coronary angiography revealed a 70% ostial stenosis of the left main coronary artery. The presence of this isolated lesion in a young woman without risk factors for atherosclerosis suggests extrinsic compression of the left main coronary artery by the dilated pulmonary artery as the likely mechanism. The patient underwent direct stenting of the left main coronary stenosis with a good result.

  19. An Unusual Case of Suspected Microvascular Angina in a Newborn

    Directory of Open Access Journals (Sweden)

    Stefania Cataldo

    2012-01-01

    Full Text Available Myocardial ischemia in pediatric population is uncommon and usually due to congenital heart disease or extracardiac conditions leading to poor coronary perfusion. A 6-day-old newborn presented with respiratory distress and signs of heart failure. ECG, echocardiography, and laboratory results were consistent with myocardial ischemia. Coronary angiography was performed to exclude anomalous origin of coronary arteries, showing normal coronary artery origin and course. Thrombophilia and extra-cardiac causes were ruled out. Clinical conditions improved with mechanical ventilation and diuretics, enzyme levels lowered, repolarisation and systolic function abnormalities regressed, but ischemic electrocardiographic and echocardiographic signs still presented during intense crying. Becaues of suspicion of microvascular angina, therapy with ASA and beta-blocker was started. At 5 month followup, the baby was in good clinical condition and no more episodes were recorded. We believe it is an interesting case, as no similar cases have been recorded till now.

  20. Invaliderende angina pectoris behandlet med elektrisk rygmarvsstimulation (ERS)

    DEFF Research Database (Denmark)

    Andersen, C; Clemensen, S E; Henneberg, S W

    1992-01-01

    Thirty patients who had severe incapacitating angina pectoris which had not reacted to the conventional therapeutic measures and which required massive daily opioid consumption were treated with electrical spinal cord stimulation (SCS) by means of a completely implantable stimulation system....... The therapeutic effect was good in 87% of the patients who experienced considerably reduced frequency of attacks and markedly reduced opioid consumption (p less than 0.00005). Nine of the patients could reduce opioid consumption and 14 out of 27 could cease their otherwise daily opioid consumption. In four...... patients, the therapeutic effect was unsatisfactory. In the first 22 patients in whom a unipolar electrode was introduced, displacement of the electrode and subsequent reoperation was a frequent problem. This problem disappeared after change to multipolar electrodes as slight changes in placing...

  1. Effects of acupuncture in moderate, stable angina pectoris

    DEFF Research Database (Denmark)

    Ballegaard, Søren; Pedersen, F; Pietersen, A

    1990-01-01

    there was a significant increase in exercise tolerance (median 9%) and in delay of onset to pain (median 10%). No significant changes were observed in patients receiving sham acupuncture. Within both groups there was a median reduction of 50% in anginal attack rate and nitroglycerin consumption......In order to evaluate the effects of acupuncture in moderate, stable angina pectoris, 49 patients were randomized to either genuine or sham acupuncture. In sham acupuncture needles were inserted into points within the same spinal segment as in genuine acupuncture, but outside the Chinese meridian...... system. The effect was evaluated from exercise tests, anginal attack rate and nitroglycerin consumption. There were no significant differences between the effects of genuine and sham acupuncture either on exercise test variables or on subjective variables. In patients receiving genuine acupuncture...

  2. In-flight angina pectoris; an unusual presentation.

    Science.gov (United States)

    Al-Janabi, Firas; Mammen, Regina; Karamasis, Grigoris; Davies, John; Keeble, Thomas

    2018-04-05

    An unusual case of typical angina which occurred on a long haul flight is presented. This case is notable as this was the index presentation, with no previous symptoms prior to this. Physiological changes at altitude can be marked, and include hypoxia, tachycardia and an increase in cardiac output. These changes were enough to expose underlying angina in our patient. A 68 year old man presented with typical cardiac chest pain on a long haul flight. His symptoms first started 10-15 min after take-off and resolved on landing. This was his index presentation, and there were no similar symptoms in the past. Background history included hypercholesterolaemia and benign prostatic hypertrophy only. He led a rather sedentary lifestyle. A CT coronary angiogram showed significant disease in the proximal left anterior descending artery and proximal right coronary artery. He went on to have a coronary angiogram with invasive physiological measurements, which determined both lesions were physiologically significant. Both arteries were treated with drug eluting stents. Since treatment, he once again embarked on a long haul flight, and was completely asymptomatic. The presentation of symptoms in this individual was rather unusual, but clearly caused by significant coronary artery disease. Potentially his sedentary lifestyle was not enough in day-to-day activities to promote anginal symptoms. When his cardiovascular system was physiologically stressed during flight, brought about by hypoxia, raised sympathetic tone and increased cardiac output, symptoms emerged. In turn, when landing, with atmospheric conditions normalised, physiological stress was removed, and symptoms resolved. Clinically therefore, one should not exclude symptoms that occur with differing physiological states, such as stress and altitude, as they are also potential triggers for myocardial ischaemia, despite absence of day-to-day symptoms.

  3. Impact of pre-infarction angina on angiographic and echocardiographic outcomes in patients with acute ante

    Directory of Open Access Journals (Sweden)

    Ahmed El Missiri

    2016-09-01

    Conclusions: For patients suffering from a first attack of acute anterior wall STEMI, pre-infarction angina is associated with a better Killip class at presentation, better TIMI flow grade after PPCI, less incidence of TMP 0 flow grade.

  4. Treatment of refractory chest angina with spinal electrical stimulator: literature review

    International Nuclear Information System (INIS)

    Gomezese, Omar F; Paola, Aranda; Echeverria, Luis E; Saibi, Jose F; Calderon, Jaime; Barrera, Juan G

    2008-01-01

    There is a group of patients with chronic refractory chest angina, who are not ideal candidates for surgical or percutaneous revascularization and who although having a good medical handling continues to experience severe episodes of angina. The spinal electrical stimulator is a neuromodulators used as an alternative to treat these patients. The objective is to realize a review of scientific literature regarding the spinal electric stimulation in the treatment of chest angina, its mechanism of action, benefits and its cost effectiveness. Materials and methods: using the Cochrane methodology, a search of articles published from January 1980 to January 2007 in Medline using the terms spinal cord stimulation, was realized. The papers considered most pertinent were selected. Conclusions: the anti-ischemic effect of the electrical spinal stimulator reduces the episodes of chest angina, improves the quality of life and the tolerance to exercise, diminishes the hospital stay and delays the appearance of ischemic signs

  5. Ventricular repolarization alterations in women with angina pectoris and suspected coronary microvascular dysfunction

    DEFF Research Database (Denmark)

    Dose, Nynne; Michelsen, Marie Mide; Mygind, Naja Dam

    2018-01-01

    OBJECTIVES: CMD could be the explanation of angina pectoris with no obstructive CAD and may cause ventricular repolarization changes. We compared T-wave morphology and QTc interval in women with angina pectoris with a control group as well as the associations with CMD. METHODS: Women with angina...... pectoris and no obstructive coronary artery disease (n=138) and age-matched controls were compared in regard to QTc interval and morphology combination score (MCS) based on T-wave asymmetry, flatness and presence of T-wave notch. CMD was assessed as a coronary flow velocity reserve (CFVR) by transthoracic...... was attenuated after multivariable adjustment (p=0.08). CONCLUSION: This study suggests that women with angina pectoris have alterations in T-wave morphology as well as longer QTc interval compared with a reference population. CMD might be an explanation....

  6. Angina and exertional myocardial ischemia in diabetic and nondiabetic patients: assessment by exercise thallium scintigraphy

    International Nuclear Information System (INIS)

    Nesto, R.W.; Phillips, R.T.; Kett, K.G.; Hill, T.; Perper, E.; Young, E.; Leland, O.S. Jr.

    1988-01-01

    Patients with diabetes mellitus and coronary artery disease are thought to have painless myocardial ischemia more often than patients without diabetes. We studied 50 consecutive patients with diabetes and 50 consecutive patients without diabetes, all with ischemia, on exercise thallium scintigraphy to show the reliability of angina as a marker for exertional ischemia. The two groups had similar clinical characteristics, treadmill test results, and extent of infarction and ischemia, but only 7 patients with diabetes compared with 17 patients without diabetes had angina during exertional ischemia. In diabetic patients the extent of retinopathy, nephropathy, or peripheral neuropathy was similar in patients with and without angina. Angina is an unreliable index of myocardial ischemia in diabetic patients with coronary artery disease. Given the increased cardiac morbidity and mortality in such patients, periodic objective assessments of the extent of ischemia are warranted

  7. Dental Calculus Links Statistically to Angina Pectoris: 26-Year Observational Study.

    Directory of Open Access Journals (Sweden)

    Birgitta Söder

    Full Text Available Dental infections, such as periodontitis, associate with atherosclerosis and its complications. We studied a cohort followed-up since 1985 for incidence of angina pectoris with the hypothesis that calculus accumulation, proxy for poor oral hygiene, links to this symptom.In our Swedish prospective cohort study of 1676 randomly selected subjects followed-up for 26 years. In 1985 all subjects underwent clinical oral examination and answered a questionnaire assessing background variables such as socio-economic status and pack-years of smoking. By using data from the Center of Epidemiology, Swedish National Board of Health and Welfare, Sweden we analyzed the association of oral health parameters with the prevalence of in-hospital verified angina pectoris classified according to the WHO International Classification of Diseases, using descriptive statistics and logistic regression analysis.Of the 1676 subjects, 51 (28 women/23 men had been diagnosed with angina pectoris at a mean age of 59.8 ± 2.9 years. No difference was observed in age and gender between patients with angina pectoris and subjects without. Neither was there any difference in education level and smoking habits (in pack years, Gingival index and Plaque index between the groups. Angina pectoris patients had significantly more often their first maxillary molar tooth extracted (d. 16 than the other subjects (p = 0.02. Patients also showed significantly higher dental calculus index values than the subjects without angina pectoris (p = 0.01. Multiple regression analysis showed odds ratio 2.21 (95% confidence interval 1.17-4.17 in the association between high calculus index and angina pectoris (p = 0.015.Our study hypothesis was confirmed by showing for the first time that high dental calculus score indeed associated with the incidence of angina pectoris in this cohort study.

  8. Ludwig's angina and ketoacidosis as a first manifestation of diabetes mellitus

    OpenAIRE

    Infante Cossío, Pedro; Fernández Hinojosa, Esteban; Mangas Cruz, Miguel Ángel; González Pérez, Luis Miguel

    2010-01-01

    Ludwig?s angina is a serious and rapidly progressive infectious process that spreads through the floor of the mouth and neck. In this paper we present an infrequent case of a patient who suffered an odontogenic infection with poor response to the previous treatment, which evolved towards a Ludwig?s angina combined with ketoacidosis in the context of a diabetes mellitus not known before. According to the literature reviewed, this case report represents the first contribution of a Ludwig?s ...

  9. [The prevalence of angina and cardiovascular risk factors in the different autonomous communities of Spain: the PANES Study. Prevalencia de Angina en España].

    Science.gov (United States)

    López-Bescós, L; Cosín, J; Elosua, R; Cabadés, A; de los Reyes, M; Arós, F; Diago, J L; Asín, E; Castro-Beiras, A; Marrugat, J

    1999-12-01

    The study of angina prevalence has received little attention in the analysis of the dimension of coronary heart disease. The aim of this study was to determine the prevalence of angina and cardiovascular risk factors in the 45- to 74-year-old population of the different autonomous regions of Spain. A sample of 10,248 subjects was recruited. Sampling was stratified by gender and age groups (45-54, 55-64 and 65 to 74 years), and proportional to the population distribution of the different autonomous regions. A multistage sampling was performed, firstly 200 villages were randomly selected, secondly three different socio-economic household were chosen. Sample unit was neighbouring households. Rose questionnaire of angina and a structured questionnaire to collect socio-demographic and risk factor variables were administered. Angina prevalence in the 45- to 74-year-old Spanish population was 7.5%. The autonomous regions with the higher and lower prevalence were Baleares (11.4%) and Basque Country (3.1%), respectively. The Pearson correlation coefficient between angina prevalence and ischemic heart disease or cardiovascular disease mortality in men and women was 0.52 and 0.55, and 0.31 and 0.44, respectively. The self reported prevalence of hypertension, dyslipemia, diabetes and smoking was 31.1%, 24.2%, 14.3% and 34.6% respectively. Angina prevalence in Spain is similar to that of developed countries although significant differences were observed among the autonomous regions of Spain. These differences correlate with those observed in ischemic heart disease or cardiovascular mortality among them and are associated with the cardiovascular risk factors prevalence which also varies among communities.

  10. Pole mass, width, and propagators of unstable fermions

    International Nuclear Information System (INIS)

    Kniehl, B.A.; Sirlin, A.

    2008-01-01

    The concepts of pole mass and width are extended to unstable fermions in the general framework of parity-nonconserving gauge theories, such as the Standard Model. In contrast with the conventional on-shell definitions, these concepts are gauge independent and avoid severe unphysical singularities, properties of great importance since most fundamental fermions in nature are unstable particles. General expressions for the unrenormalized and renormalized dressed propagators of unstable fermions and their field-renormalization constants are presented. (orig.)

  11. On the Velocity of Moving Relativistic Unstable Quantum Systems

    Directory of Open Access Journals (Sweden)

    K. Urbanowski

    2015-01-01

    Full Text Available We study properties of moving relativistic quantum unstable systems. We show that in contrast to the properties of classical particles and quantum stable objects the velocity of freely moving relativistic quantum unstable systems cannot be constant in time. We show that this new quantum effect results from the fundamental principles of the quantum theory and physics: it is a consequence of the principle of conservation of energy and of the fact that the mass of the quantum unstable system is not defined. This effect can affect the form of the decay law of moving relativistic quantum unstable systems.

  12. Slinky Mechanics: Static Shapes and Unstable States

    Science.gov (United States)

    Holmes, Douglas; Borum, Andy; Moore, Billy; Plaut, Raymond; Dillard, David

    2014-03-01

    The floppy nature of a tumbling Slinky has captivated children and adults alike for over half a century. Highly flexible, the spring will walk down stairs, turn over in your hands, and-much to the chagrin of children everywhere-become easily entangled. The Slinky is an educational tool for demonstrating standing waves, and a structural inspiration due to its ability to extend to many times beyond its initial length without imparting plastic strain on the material. In this work, we provide a mechanical model that captures the static equilibrium configurations of the Slinky in terms of its geometric and material properties. We present both continuous and discrete models to capture a Slinky's static equilibria and unstable transitions. We compare these with experimental results obtained for the Slinky's static equilibrium shapes. We emphasize the importance of modeling coil contact, and determine the critical criteria for the Slinky to topple over in terms of a tilt angle, and the vertical displacement of one bale of coils. Finally, we provide a general description of highly flexible helical springs by considering the nondimensional potential energy of the spring, which characterizes the ``Slinkiness'' of a spring.

  13. Combination therapy with metoprolol and nifedipine versus monotherapy in patients with stable angina pectoris. Results of the International Multicenter Angina Exercise (IMAGE) Study

    DEFF Research Database (Denmark)

    Savonitto, S; Ardissiono, D; Egstrup, K

    1996-01-01

    (which reduces myocardial oxygen consumption) and a dihydropyridine calcium antagonist (which increases coronary blood flow) is a logical approach to the treatment of stable angina pectoris. However, it is not clear whether, in individual patients, this combined therapy is more effective than monotherapy...

  14. Angina pectoris in patients with HIV/AIDS: prevalence and risk factors

    Directory of Open Access Journals (Sweden)

    Josefina Cláudia Zirpoli

    Full Text Available INTRODUCTION: The incidence of ischemic heart disease is higher in patients with HIV/AIDS. However, the frequency of angina pectoris in these patients is still not known. Literature about this subject is still scarce. OBJECTIVE: To evaluate the prevalence of angina pectoris and risk factors for coronary disease and to examine the association between traditional risk factors and HIV-related risk factors and angina pectoris. METHOD: An epidemiological cross-sectional study, analyzed as case-control study, involving 584 patients with HIV/AIDS. Angina pectoris was identified by Rose questionnaire, classified as definite or possible. Information regarding risk factors was obtained through a questionnaire, biochemical laboratory tests, medical records and anthropometric measures taken during consultations at AIDS treatment clinics in Pernambuco, Brazil, from June 2007 to February 2008. To adjust the effect of each factor in relation to others, multiple logistic regression was used. RESULTS: There was a preponderance of men (63.2%; mean ages were 39.8 years for men, 36.8 years for women. The prevalence of definite and possible angina were 11% and 9.4%, respectively, totaling 20.4%, with independent associations between angina and smoking (OR = 2.88; 95% CI: 1.69-4.90, obesity (OR = 1.62; 95% CI: 0.97-2.70, family history of heart attack (OR = 1.70; 95% CI: 1.00-2.88, low schooling (OR = 2.11; 95% CI: 1.24-3.59, and low monthly income (OR = 2.93; 95% CI: 1.18-7.22, even after adjustment for age. CONCLUSION: This study suggests that angina pectoris is underdiagnosed, even in patients with medical monitoring, revealing lost opportunities in identification and prevention of cardiovascular morbidity.

  15. Crisis and unstable dimension variability in the bailout embedding ...

    Indian Academy of Sciences (India)

    indicating unstable dimension variability (UDV) in the system. The presence of unstable dimension ... flow dynamics is embedded in a larger set of equations which includes the differ- ences between the particle and ... map is taken as the base map, which is a prototypical area preserving system. In this paper we confine our ...

  16. Crisis and unstable dimension variability in the bailout embedding ...

    Indian Academy of Sciences (India)

    length distribution of times before bursts give rise to a power law with the exponent β = −1/3. The maximum Lyapunov exponent near the crisis fluctuates around zero indicating unstable dimension variability (UDV) in the system. The presence of unstable dimension variability is confirmed by the behaviour of the probability ...

  17. Unstable ground in western North Dakota

    Science.gov (United States)

    Trimble, Donald E.

    1979-01-01

    Unstable ground in western North Dakota is mainly the result of mass-wasting processes. The units most affected are mudstones, siltstones, and sandstones of the Fort Union Formation. Ground instability generally is indicated by landslides, soil slides, or subsidence. Landslides are mostly of the slump-earthflow type and are localized along the flanks of the high buttes in southwestern North Dakota, including HT (Black) Butte, Chalky Buttes, Sentinel Butte, and East and West Rainy Buttes, and along parts of the valleys of the Des Lacs, Missouri, Little Missouri, and Heart Rivers. Landslides are sparse elsewhere. Soil slides are common in the areas south and southwest of the maximum position of the Pleistocene glacial ice margin on slopes of 15 degrees or more, and have taken place on some slopes as gentle as five degrees. The weathered, exposed surface of the Fort Union Formation seems to be especially susceptible to soil slides. Soil slides constitute the major type of ground instability in southwestern North Dakota. Subsidence is of two types: (1) subsidence over old underground mine workings, and (2) subsidence over naturally ignited and burned underground coal beds. Major subsidence has taken place over old, underground workings near Beulah, Wilton, Lehigh, Haynes, and Belfield, and lesser subsidence near Scranton, and west and north of Bowman. Thickness of overburden above the coal in all these areas is believed to be less than 30 m (100 ft). Subsidence has not taken place over old underground workings along the Des Lacs and-Souris valleys northwest of Minot, where the thickness of overburden is more than 60 m (200 ft). Spectacular subsidence has occurred over a burning underground coal bed at Burning Coal Vein Park near the Little Missouri River, northwest of Amidon.

  18. Noncontiguous double-level unstable spinal injuries.

    Science.gov (United States)

    Takami, Masanari; Okada, Motohiro; Enyo, Yoshio; Iwasaki, Hiroshi; Yamada, Hiroshi; Yoshida, Munehito

    2017-01-01

    Noncontiguous double-level unstable spinal injuries (NDUSI) are uncommon and have not been well described. In this study, we aimed to better understand the patterns of NDUSI, in order to recommend proper diagnostic and treatment methods, as well as to raise awareness among traumatologists about the possibility of these uncommon injuries. A total of 710 consecutive patients with spine fractures were treated for >9 years since 2007 at a single regional trauma center. Of them, 18 patients with NDUSI were reviewed retrospectively. The incidence of NDUSI was 2.5 % of all spine fractures. In 17 of 18 patients (94.7 %), NDUSI was caused by a high-energy trauma. Nine patients (50.0 %) exhibited complete neurological deficit. Spinal cord injury occurred in the cranial injured region in all American Spinal Injury Association grade A cases. In one case, a second fracture was overlooked at the initial examination. NDUSI are common in cases of high-energy trauma and should be taken into consideration at the initial examination. A second fracture may be easily overlooked because of the high frequency of concomitant severe spinal cord injury in the cranial injured region and/or loss of consciousness due to associated injuries. To avoid overlooking injuries, full spine computed tomography is useful at the initial examination. Operative reduction and internal fixation with instrumentation through a posterior approach is recommendable for cases of NDUSI. In elderly patients, a very rapid stabilizing surgery should be planned before aspiration pneumonia occurs or the pulmonary condition worsens.

  19. Managing risk in an unstable world.

    Science.gov (United States)

    Bremmer, Ian

    2005-06-01

    With emerging markets like China and politically unstable countries like Saudi Arabia figuring more than ever into companies' investment calculations, business leaders are turning to political risk analysis to measure the impact of politics on potential markets, minimize risks, and make the most of global opportunities. But political risk is more subjective than its economic counterpart. It is influenced by the passage of laws, the foibles of government leaders, and the rise of popular movements. So corporate leaders must grapple not just with broad, easily observable trends but also with nuances of society and even quirks of personality. And those hard-to-quantify factors must constantly be pieced together into an ongoing narrative within historical and regional contexts. As goods, services, information, ideas, and people cross borders today with unprecedented velocity, corporations debating operational or infrastructural investments abroad increasingly need objective, rigorous assessments. One tool for measuring and presenting stability data, for example, incorporates 20 composite indicators of risk in emerging markets and scores risk variables according to both their structural and their temporal components. The indicators are then organized into four equally weighted subcategories whose ratings are aggregated into a single stability score. Countries are ranked on a scale of zero (a failed state) to100 (a fully institutionalized, stable democracy). Companies can buy political risk analyses from consultants or, as some large energy and financial services organizations have done, develop them in-house. Either way, a complete and accurate picture of any country's risk requires analysts with strong reportorial skills; timely, accurate data on a variety of social and political trends; and a framework for evaluating the impact of individual risks on stability.

  20. Critical evaluation of ivabradine for the management of chronic stable angina

    Directory of Open Access Journals (Sweden)

    Khan W

    2011-09-01

    Full Text Available Waqas Khan, Jeffrey S BorerDivision of Cardiovascular Medicine and the Department of Medicine, State University of New York Downstate Medical Center and College of Medicine, Brooklyn and New York, NY, USAAbstract: Angina pectoris is the most common symptom of coronary artery disease (CAD. Angina results from an imbalance between myocardial oxygen supply and demand. Heart rate (HR reduction can beneficially alter both elements of this imbalance by increasing diastolic filling time and reducing myocardial oxygen demand. Therefore, HR reduction is an accepted approach to angina prevention. ß-blockers, calcium-channel blockers, and long-acting nitrates are currently the cornerstones in prevention and management of stable angina. However, use of these treatments may be limited by adverse effects or development of tolerance. Thus, additional approaches to angina prevention may be useful for many patients with CAD. The discovery of the f-channel and the resulting current, If, that modulates the rate of spontaneous diastolic depolarization of sinoatrial nodal (SAN myocytes led to the study of these channels as targets for lowering HR. This resulted in the development of a novel agent, ivabradine, a selective and specific If inhibitor. Ivabradine slows the slope of diastolic depolarization of the action potential in the SAN cells, decreasing HR at rest and during exercise, but has no other cardiovascular effects. In different subpopulations with chronic stable angina, ivabradine markedly improves exercise capacity and significantly decreases the number of ambient angina attacks. In a post-hoc analysis of the BEAUTIFUL trial (morBidity-mortality EvAlUaTion of the If inhibitor ivabradine in patients with coronary disease and left-ventricULar dysfunction, ivabradine also reduced mortality, myocardial infarctions, and heart failure hospitalizations among patients with angina. To date, the drug has been well tolerated; transient visual disturbances and

  1. Usefulness of myocardial scintigraphy using cigarette smoking and isosorbide dinitrate in patients with angina pectoris

    International Nuclear Information System (INIS)

    Igarashi, Takeki; Horimoto, Masashi; Funayama, Naoki

    1989-01-01

    Cigarette smoking is not only one of the most important risk factors for coronary artery disease, but also anginal attacks often occur during smoking. Coronary vasoconstriction is considered to be one of the mechanisms which cause anginal episodes. Thirty patients with angina pectoris, 27 men and 3 women, were investigated. Group I comprised 22 patients with rest angina and group II consisted of 8 patients with effort angina. Five minutes after smoking one cigarette, a first study of 20l Tl myocardial SPECT was performed. Consequently, after sublingual administration of isosorbide denitrate, a second SPECT was done. Most cases improved and it was recognized as positive when changes of localized perfusion defects were observed between both SPECTs. In the group I, 19 out of 22 patients (86%) were positive, but in the group II, 2 out of 8 (25%) were positive. The differences were statistically significant (p<0.05). By the examination of coronarty angiography in 20 patients, the result of myocardial scintigraphy using cigarette smoking and isosorbide dinitrate seemed inversely proportional to the severity of narrowing of the coronary artery. In addition, background factors including risk factors were also compared for both groups. Because the result of this myocardial scintigraphy was positive in the rest angina group and in the group with minimal coronary arteriogrpahic abnormalities, it seggests that myocardial scintigraphy using cigarette smoking and isosorbide dinitrate is useful as a non-invasive auxiliary diagnostic method to detect coronary spasm or coronary vasoconstriction-prone angina pectoris including silent myocardial ischemia. (author)

  2. Ludwig's angina: report of two cases and review of the literature from 1945 to January 1979.

    Science.gov (United States)

    Hought, R T; Fitzgerald, B E; Latta, J E; Zallen, R D

    1980-11-01

    Two cases of Ludwig's angina treated successfully led us to review the main English language literature from 1945 to January 1979. The most common cause of Ludwig's angina is dental, and the organism cultured most often is streptococcus. However, other avenues of infection and numerous pathogens have been implicated in this disease. Penicillin remains the preferred primary antibiotic, with combinations of this drug and other antibiotics being used by various authors. In both the pre-antibiotic and antibiotic era, the airway remains the prime concern of the surgeon in the management of this potentially life-threatening disease. Of the 75 cases reviewed, there were seven deaths, but four of these patients had pre-existing fatal systemic problems and Ludwig's angina was not the cause of death. The other three deaths were due to Ludwig's angina, yielding a 4% mortality rate. Thus, aggressive management of Ludwig's angina, with respect to airway, antibiotics, and early surgical intervention, has resulted in a significant drop in the mortality rate of this disease which once led "almost uniformly to a fatal ending."

  3. Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Roe, Matthew T; Hochman, Judith S

    2015-01-01

    -cause mortality (12.2% vs 11.7%; P = .88), and Global Use of Strategies to Open Occluded Arteries severe/life-threatening/moderate bleeding (3.8% vs 2.8%; P = .74) through 30 months were similar in women versus men. After adjustment, women had significantly lower risk for ischemic outcomes and all-cause mortality...

  4. Early invasive vs conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis

    NARCIS (Netherlands)

    O'Donoghue, Michelle; Boden, William E.; Braunwald, Eugene; Cannon, Christopher P.; Clayton, Tim C.; de Winter, Robbert J.; Fox, Keith A. A.; Lagerqvist, Bo; McCullough, Peter A.; Murphy, Sabina A.; Spacek, Rudolf; Swahn, Eva; Wallentin, Lars; Windhausen, Fons; Sabatine, Marc S.

    2008-01-01

    CONTEXT: Although an invasive strategy is frequently used in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS), data from some trials suggest that this strategy may not benefit women. OBJECTIVE: To conduct a meta-analysis of randomized trials to compare the effects of an

  5. Contrapulsación externa aumentada, un tratamiento no invasivo recomendado para la angina refractaria, valoración de la clase funcional y la calidad de vida

    Directory of Open Access Journals (Sweden)

    Fernán Mendoza

    2017-05-01

    Conclusiones: La terapia de contrapulsación externa aumentada, mejora la calidad de vida y la clase funcional de angina y disnea en pacientes con angina refractaria y se convierte en un procedimiento no invasivo seguro y eficaz.

  6. Newer Therapies for Management of Stable Ischemic Heart Disease With Focus on Refractory Angina.

    Science.gov (United States)

    Singh, Mukesh; Arora, Rohit

    Ischemic heart disease remains a major public health problem nationally and internationally. Stable ischemic heart disease (SIHD) is one of the clinical manifestations of ischemic heart disease and is generally characterized by episodes of reversible myocardial demand/supply mismatch, related to ischemia or hypoxia, which are usually inducible by exercise, emotion, or other stress and reproducible-but which may also be occurring spontaneously. Improvements in the treatment of acute coronary syndromes along with increasing prevalence of cardiovascular risk factors, including diabetes and obesity, have led to increasing population of patients with SIHD. A significant number of these continue to have severe angina despite medical management and revascularization procedures performed and may progress to refractory angina. This article reviews the newer therapies in the treatment of SIHD with special focus in treating patients with refractory angina.

  7. Bilateral submandibular gland infection presenting as Ludwig's angina: first report of a case.

    Science.gov (United States)

    Honrado, C P; Lam, S M; Karen, M

    2001-04-01

    We diagnosed and treated a case of Ludwig's angina in a 45-year-old man who had edema of the floor of mouth and the tongue along with bilateral submandibular sialadenitis and sialolithiasis. We secured the patient's airway via nasal fiberoptic intubation in the surgical intensive care unit and administered intravenous antibiotics. The edema subsided, and the patient was extubated on the third postoperative day and discharged shortly thereafter. To our knowledge, this is the first reported case of a patient with bilateral submandibular sialadenitis and sialolithiasis presenting as Ludwig's angina. Despite the decreasing incidence of this disease, Ludwig's angina remains an important disease process because a failure to control the airway can have disastrous consequences. Proper diagnosis, airway control, antibiotic therapy, and occasionally surgical management are essential to ensure the safety of the patient.

  8. Ludwig's Angina-A Controversial Surgical Emergency: How We Do It.

    Science.gov (United States)

    Hasan, Wael; Leonard, David; Russell, John

    2011-01-01

    Objectives. To review the current protocols used for management of Ludwig's angina and to assess the efficacy of conservative measures in these cases. Methods. A retrospective review of patients who were admitted to our institution for management of Ludwig's angina between 2003 and 2010. Results. Two patients were identified. Both were managed successfully with conservative measures and close airway observation. None needed an emergency intubation or surgical tracheostomy. There were no mortalities, and both had a short hospital stay. Conclusion. Recently, management of Ludwig's angina has evolved from aggressive airway management into a more conservative one. This is based on close airway observation on a specialised airway unit and a serial clinical airway assessment. Improved imaging modalities, antibiotic therapy, surgical skills, and clinical experience are the key factors behind this change in practice.

  9. Ludwig's angina and ketoacidosis as a first manifestation of diabetes mellitus.

    Science.gov (United States)

    Infante-Cossío, Pedro; Fernández-Hinojosa, Esteban; Mangas-Cruz, Miguel-Angel; González-Pérez, Luis-Miguel

    2010-07-01

    Ludwig's angina is a serious and rapidly progressive infectious process that spreads through the floor of the mouth and neck. In this paper we present an infrequent case of a patient who suffered an odontogenic infection with poor response to the previous treatment, which evolved towards a Ludwig's angina combined with ketoacidosis in the context of a diabetes mellitus not known before. According to the literature reviewed, this case report represents the first contribution of a Ludwig's angina and ketoacidosis as an initial manifestation of a diabetes mellitus. The airway management, the antibiotic prescription and the surgical drainage allowed the healing of the patient without medical complications. Factors of co-morbidity like the diabetes mellitus together with focus tooth of infection may eventually turn into serious medical complications as the diabetic ketoacidosis and develop potentially lethal cervical infections.

  10. Invasive angiography and revascularization in patients with stable angina following prior coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Joshi, Francis R; Biasco, Luigi; Pedersen, Frants

    2017-01-01

    BACKGROUND: There are limited data to guide the optimum approach to patients presenting with angina after coronary artery bypass grafting (CABG). Although often referred for invasive angiography, the effectiveness of this is unknown; angina may also result from diffuse distal or micro......-vascular coronary disease and it is not known how often targets for intervention are identified. METHODS: Retrospective review of 50,460 patients undergoing angiography in East Denmark between January 2010 and December 2014. Clinical and procedural data were prospectively stored in a regional electronic database....... Follow-up data were available for all patients, by means of records linked to each Danish social security number. RESULTS: In patients with prior CABG and stable angina (n = 2,309), diagnostic angiography led to revascularization in 574 (24.9%) cases. Chronic kidney disease (HR 1.93 [1.08-3.44], P = 0...

  11. Efficacy of a device to narrow the coronary sinus in refractory angina

    DEFF Research Database (Denmark)

    Verheye, Stefan; Jolicœur, E Marc; Behan, Miles W

    2015-01-01

    BACKGROUND: Many patients with coronary artery disease who are not candidates for revascularization have refractory angina despite standard medical therapy. The balloon-expandable, stainless steel, hourglass-shaped, coronary-sinus reducing device creates a focal narrowing and increases pressure...... in the coronary sinus, thus redistributing blood into ischemic myocardium. METHODS: We randomly assigned 104 patients with Canadian Cardiovascular Society (CCS) class III or IV angina (on a scale from I to IV, with higher classes indicating greater limitations on physical activity owing to angina) and myocardial.......6 points; P=0.03). There were no significant between-group differences in improvement in exercise time or in the mean change in the wall-motion index as assessed by means of dobutamine echocardiography. At 6 months, 1 patient in the treatment group had had a myocardial infarction; in the control group, 1...

  12. Restrictions in the realisation of multipass unstable resonators

    International Nuclear Information System (INIS)

    Strakhov, S Yu

    2009-01-01

    Main restrictions in the realisation of multipass unstable resonators caused by intracavity losses and large-scale aberrations are considered. The influence of intracavity losses on the laser radiation power and divergence is analysed based on the numerical simulation of an unstable resonator. The efficiency criterion for the unstable multipass resonator is proposed, which is proportional to the radiation brightness and takes into account the influence of the misalignment, thermal deformation and the main parameters of the active medium and resonator on the parameters of laser radiation. (resonators)

  13. Temporary sympathectomy in chronic refractory angina: a randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Denby, Christine; Groves, David G; Eleuteri, Antonio; Tsang, Hoo Kee; Leach, Austin; Hammond, Clare; Bridson, John D; Fisher, Michael; Elt, Matthew; Laflin, Robert; Fisher, Anthony C

    2015-08-01

    Temporary sympathectomy by injection of bupivacaine at the site of the left stellate ganglion is used in the management of refractory angina at several UK centres. Although patients frequently report significant reduction in symptoms, efficacy has not been established by double-blind, randomised placebo-controlled trial (RCT). To investigate the efficacy of the procedure for the first time by a double-blind RCT. Consecutive patients referred to the authors' National Health Service (NHS) angina centre who were candidates for temporary sympathectomy were invited to participate in a trial. A total of 65 patients were randomised to receive either bupivacaine or saline injections. Identical syringes were prepared remotely, blinding patients and staff from randomisation. Cardiac autonomic function was measured 3 hours pre- and post-injection using new heart rate variability (HRV) analyses. Angina episodes were recorded contemporaneously by patients in study diaries in the 7-day periods pre- and post-injection. In 51 patients suitable for analysis, no significant differences between the active and placebo groups were found in patient-recorded frequency or intensity of angina episodes pre- and post-injection. However, across both groups combined, a significant difference was found in the frequency of angina episodes pre- and post-injection. The reduction in frequency of angina episodes produced by this procedure may not be due to drug pharmacology. It may be a placebo response or due to the mechanical effects of the injection of fluid. There is a need for further work using a larger patient cohort considering both mechanical and psychological factors.

  14. Coronary arteriography and left ventriculography during spontaneous and exercise-induced ST segment elevation in patients with variant angina

    International Nuclear Information System (INIS)

    Matsuda, Y.; Ozaki, M.; Ogawa, H.; Naito, H.; Yoshino, F.; Katayama, K.; Fujii, T.; Matsuzaki, M.; Kusukawa, R.

    1983-01-01

    The present study is an angiographic demonstration of coronary artery spasm during both spontaneous and exercise-induced angina in three patients with variant angina. In each case, clinical, ECG, coronary angiographic, and left ventriculographic observations were made at rest, during spontaneous angina, and during exercise-induced angina. The character of chest pain was similar during spontaneous and exercise-induced episodes. ST segment elevation was present in the anterior ECG leads during both episodes. The left anterior descending coronary artery became partially or totally obstructed during both types of attacks. When coronary spasm was demonstrated during both types of attacks, left ventriculography disclosed akinetic or dyskinetic wall motion in the area supplied by the involved artery. In those patients with reproducible exercise-induced ST segment elevation and chest pain, thallium-201 scintigraphy showed areas of reversible anteroseptal hypoperfusion. Thus in selected patients exercise-induced attacks of angina were similar to spontaneous episodes

  15. MODERN PHARMACOTHERAPY OF THE STABLE ANGINA: POSSIBILITIES AND PROSPECTS OF NICORANDIL IMPLEMENTATION

    Directory of Open Access Journals (Sweden)

    Z. M. Sizova

    2010-01-01

    Full Text Available Aim. To evaluate antianginal efficacy and safety of nicorandil for angina attack prevention and relief in patients with ischemic heart disease (IHD and symptoms of stable angina class 2-3.Material and methods. 30 patients with stable angina class 2-3 (17 men, 13 women; aged 58.6±5.8 y.o. were included into the study. All patients received amlodipine 10 mg QD within 2 weeks. For angina attack relief patients used nicorandil 10-20 mg and in case of its inefficacy — nitroglycerin. In 2 weeks all patients were randomized in 2 groups. Patients of the 1st group (n=15 received nicorandil 20 mg TID, patients of the 2nd group (n=15 — amlodipine 10 mg QD. The study duration was 3 months. The efficiency evaluation was based on the analysis of hemodynamic indicators (heart rate, blood pressure, bioelectric heart activity (electrocardiogram, velocity exercise tolerance test, ambulatory blood pressure monitoring indicators. The pain severity was defined with Borg's scale, and the quality of life — with General Health Questionnaire (GHQ-28. Therapy safety was evaluated in according to laboratory tests results.Results. Frequency of angina attacks reduced by 60% (р<0.05 and 47% (р<0.05 in 12 weeks of nicorandil and amlodipine therapy, respectively. Duration of angina decreased by 38% and 37% (р<0.05 in 12 weeks of nicorandil and amlodipine therapy, respectively. Eexercise duration before angina attack onset increased by 56% (р<0.05 in 1 month of nicorandil therapy. A number of myocardial ischemia episodes reduced by 64% (р<0.05 and 54% (р<0.05 due to nicorandil and amlodipine therapy, respectively. General GHQ-28 score decreased by 54% (р<0.05 and 44% (р<0.05 in patients of the 1st and the 2nd groups, respectively. Tolerability of nicorandil was good in 13 (86.7% and satisfactory in 2 (13.3% patients.Conclusion. Nicorandil can be prescribed both for the prevention and for relief of angina attacks in IHD patients.

  16. Economic burden of chronic conditions among households in Myanmar: the case of angina and asthma.

    Science.gov (United States)

    Htet, Soe; Alam, Khurshid; Mahal, Ajay

    2015-11-01

    Non-communicable diseases (NCDs) are becoming a major source of the national disease burden in Myanmar with potentially serious economic implications. Using data on 5484 households from the World Health Survey (WHS), this study assessed the household-level economic burden of two chronic conditions, angina and asthma, in Myanmar. Propensity score matching (PSM) and coarsened exact matching (CEM) methods were used to compare household out-of-pocket (OOP) spending, catastrophic and impoverishment effects, reliance on borrowing or asset sales to finance OOP healthcare payments and employment among households reporting a member with angina (asthma) to matched households, with and without adjusting for comorbidities. Sensitivity analyses were carried out to assess the impacts of alternative assumptions on common support and potential violations of the assumption of independence of households being angina (asthma) affected and household economic outcomes, conditional on the variables used for matching (conditional independence). Households with angina (asthma) reported greater OOP spending (angina: range I$1.94-I$4.31; asthma: range I$1.53-I$2.01) (I$1 = 125.09 Myanmar Kyats; I$=International Dollar) almost half of which was spending on medicines; higher rates of catastrophic spending based on a 20% threshold ratio of OOP to total household spending (angina: range 6-7%; asthma: range 3-5%); greater reliance on borrowing and sale of assets to finance healthcare (angina: range 12-14%; asthma: range 40-49%); increased medical impoverishment and lower employment rates than matched controls. There were no statistically differences in OOP expenses for inpatient care between angina-affected (asthma-affected) households and matched controls. Our results were generally robust to multiple methods of matching. However, conclusions for medical impoverishment impacts were not robust to potential violations of the conditional independence assumption. Myanmar is expanding public

  17. [Anaemia as a cause of haemodynamic angina in a patient with chronic ischaemic heart disease].

    Science.gov (United States)

    Miguéns Blanco, I; Bravo Amaro, M

    2014-01-01

    Ischaemic heart disease is the leading cause of mortality and morbidity and one of the primary causes of morbidity in Spain. The variability in the clinical presentation of this condition at both primary care and emergency services level requires a careful history and a thorough physical examination. In the case presented, the main symptoms of angina and dyspnea reported in the anamnesis, and the obvious pallor in the physical examination, were the key data to identify anaemia as a cause of angina. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  18. Transient myocardial ischemia after abrupt withdrawal of antianginal therapy in chronic stable angina

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    In 47 patients with chronic stable angina and proven coronary artery disease, abrupt withdrawal of beta-adrenoceptor blocking agents either as monotherapy or in combination with calcium antagonists (group 1, n = 25) was compared with abrupt withdrawal of calcium antagonist monotherapy (group 2, n...... less than 0.05). These results indicate that a rebound increase in ischemic activity (mainly silent) occurs after abrupt withdrawal of beta-receptor blockade in patients with chronic stable angina. This increase in ischemic activity may be caused by increased myocardial oxygen demand....

  19. Combination therapy with metoprolol and nifedipine versus monotherapy in patients with stable angina pectoris. Results of the International Multicenter Angina Exercise (IMAGE) Study

    DEFF Research Database (Denmark)

    Savonitto, S; Ardissiono, D; Egstrup, K

    1996-01-01

    OBJECTIVES: This study was designed to investigate whether combination therapy with metoprolol and nifedipine provides a greater anti-ischemic effect than does monotherapy in individual patients with stable angina pectoris. BACKGROUND: Combination therapy with a beta-adrenergic blocking agent....... METHODS: Two hundred eighty patients with stable angina pectoris were enrolled in a double-blind trial in 25 European centers. Patients were randomized (week 0) to metoprolol (controlled release, 200 mg once daily) or nifedipine (Retard, 20 mg twice daily) for 6 weeks; placebo or the alternative drug...... was then added for a further 4 weeks. Exercise tests were performed at weeks 0, 6 and 10. RESULTS: At week 6, both metoprolol and nifedipine increased the mean exercise time to 1-mm ST segment depression in comparison with week 0 (both p metoprolol was more effective than nifedipine (p

  20. The effect of nonlinearity on unstable zones of Mathieu equation

    Science.gov (United States)

    Saryazdi, M. Gh

    2017-03-01

    Mathieu equation is a well-known ordinary differential equation in which the excitation term appears as the non-constant coefficient. The mathematical modelling of many dynamic systems leads to Mathieu equation. The determination of the locus of unstable zone is important for the control of dynamic systems. In this paper, the stable and unstable regions of Mathieu equation are determined for three cases of linear and nonlinear equations using the homotopy perturbation method. The effect of nonlinearity is examined in the unstable zone. The results show that the transition curves of linear Mathieu equation depend on the frequency of the excitation term. However, for nonlinear equations, the curves depend also on initial conditions. In addition, increasing the amplitude of response leads to an increase in the unstable zone.

  1. Stabilizing unstable steady states using extended time-delay autosynchronization.

    Science.gov (United States)

    Chang, Austin; Bienfang, Joshua C.; Hall, G. Martin; Gardner, Jeff R.; Gauthier, Daniel J.

    1998-12-01

    We describe a method for stabilizing unstable steady states in nonlinear dynamical systems using a form of extended time-delay autosynchronization. Specifically, stabilization is achieved by applying a feedback signal generated by high-pass-filtering in real time the dynamical state of the system to an accessible system parameter or variables. Our technique is easy to implement, does not require knowledge of the unstable steady state coordinates in phase space, automatically tracks changes in the system parameters, and is more robust to broadband noise than previous schemes. We demonstrate the controller's efficacy by stabilizing unstable steady states in an electronic circuit exhibiting low-dimensional temporal chaos. The simplicity and robustness of the scheme suggests that it is ideally suited for stabilizing unstable steady states in ultra-high-speed systems. (c) 1998 American Institute of Physics.

  2. Optimal Sensor and Actuator Location for Unstable Systems

    DEFF Research Database (Denmark)

    Shaker, Hamid Reza; Tahavori, Maryamsadat

    2013-01-01

    proposed so far, only support stable systems. However, in industrial practices it is often the case that the system, which is needed to be controlled, is not stable. The method which is proposed in this paper is a general method in the sense that it supports both stable and unstable systems. The technique...... is successfully used for determining the optimal sensor locations of the linearized Continuous Stirred-Tank Reactor unstable model....

  3. Aspirin inhibits human telomerase activation in unstable carotid plaques

    OpenAIRE

    LI, FANGMING; GUO, YI; JIANG, XIN; ZHONG, JIANXIN; LI, GUANDONG; SUN, SHENGGANG

    2013-01-01

    The activation of telomerase in unstable plaques is an important factor in atherosclerosis, and may be predictive of the risk of cerebrovascular diseases. Human telomerase reverse transcriptase (hTERT) is a subunit of telomerase that is essential for telomerase activation. The aim of the present study was to investigate whether aspirin inhibits the activation of telomerase and hTERT in unstable carotid plaques. Polymorphonuclear neutrophils (PMNs) derived from carotid plaques were isolated fr...

  4. Study on unstable fracture characteristics of light water reactor piping

    International Nuclear Information System (INIS)

    Kurihara, Ryoichi

    1998-08-01

    Many testing studies have been conducted to validate the applicability of the leak before break (LBB) concept for the light water reactor piping in the world. It is especially important among them to clarify the condition that an inside surface crack of the piping wall does not cause an unstable fracture but ends in a stable fracture propagating only in the pipe thickness direction, even if the excessive loading works to the pipe. Pipe unstable fracture tests performed in Japan Atomic Energy Research Institute had been planned under such background, and clarified the condition for the cracked pipe to cause the unstable fracture under monotonous increase loading or cyclic loading by using test pipes with the inside circumferential surface crack. This paper examines the pipe unstable fracture by dividing it into two parts. One is the static unstable fracture that breaks the pipe with the inside circumferential surface crack by increasing load monotonously. Another is the dynamic unstable fracture that breaks the pipe by the cyclic loading. (author). 79 refs

  5. Chronic stable angina is associated with lower health-related quality of life: evidence from Chinese patients.

    Directory of Open Access Journals (Sweden)

    Jing Wu

    Full Text Available OBJECTIVES: To compare health-related quality of life (HRQoL between patients with stable angina and the general population in China and to examine factors associated with HRQoL among patients with stable angina. METHODS: A cross-sectional HRQoL survey of stable angina patients recruited from 4 hospitals (n = 411 and the general population recruited from 3 Physical Examination Centers (n = 549 was conducted from July to December, 2011 in two large cities, Tianjin and Chengdu. HRQoL was assessed using the EQ-5D, EQ-VAS, and SF-6D instruments. The health status specific to patients with stable angina was assessed using the Seattle Angina Questionnaire (SAQ. Information on socio-demographic, clinical, and lifestyle factors were also collected. Nested regressions were performed to explore how these factors were associated with HRQoL in patients with stable angina. RESULTS: Compared with the general population (44.2 ± 10 years, 49.9% females, stable angina patients (68.1 ± 12 years, 50.4% females had significantly lower HRQoL scores in EQ-5D utility index (0.75 ± 0.19 vs. 0.90 ± 0.20, p<0.05, SF-6D utility index (0.68 ± 0.12 vs. 0.85 ± 0.11, p<0.05, and EQ-VAS (71.2 ± 12.3 vs. 83.9 ± 10.9, p<0.05. The differences remained (-0.05 for EQ-5D, -9.27 for EQ-VAS and -0.13 for SF-6D after controlling for socio-economic characteristics. SAQ scores showed that stable angina patients experienced impaired disease-specific health status, especially in angina stability (40.5 ± 34.6. Nested regressions indicated stable angina-specific health status explained most of the variation in HRQoL, among which disease perception, physical limitation, and angina stability were the strongest predictors. More physical exercise and better sleep were positively related with HRQoL. CONCLUSIONS: Compared to the general population, stable angina patients were associated with lower HRQoL and lower health utility scores, which were largely impacted by clinical symptoms

  6. Neutron Capture Experiments on Unstable Nuclei

    Energy Technology Data Exchange (ETDEWEB)

    Jon M. Schwantes; Ralf Sudowe; Heino Nitsche; Darleane C. Hoffman

    2003-12-16

    A primary objective of this project is to study neutron capture cross sections for various stable and unstable isotopes that will contribute to the Science Based Stockpile Stewardship (SBSS) program by providing improved data for modeling and interpretation of nuclear device performance. The information obtained will also be important in astrophysical modeling of nucleosynthesis. During this reporting period, the emphasis has been on preparing a radioactive target of {sup 155}Eu (half-life = 4.7 years), and several stable targets, including isotopically separated {sup 154}Sm, {sup 151}Eu, and {sup 153}Eu. Measurements of their neutron capture cross sections will be conducted in collaboration with researchers at the Los Alamos Neutron Science Center (LANSCE) facility using the Detector for Advanced Neutron Capture Experiments (DANCE). A suitable backing material (beryllium) for the targets has been selected after careful calculations of its contribution to the background of the measurements. In addition, a high voltage plating procedure has been developed and optimized. Stable targets of {sup 151}Eu and {sup 153}Eu and a target of natural Eu ({approx}50% {sup 151}Eu and {approx}50% {sup 153}Eu) have each been plated to a mass thickness of >1 mg/cm{sup 2} and delivered to the DANCE collaboration at Los Alamos National Laboratory (LANL). Natural Eu targets will be tested first to confirm that the target dimensions and backing are appropriate prior to performing measurements on the extremely valuable targets of separated isotopes. In order to prepare a target of the radioactive {sup 155}Eu, it must first be separated from the {sup 154}Sm target material that was irradiated in a very high neutron flux of 1.5x1015 neutrons/cm{sup 2}/s for 50 days. The reaction is {sup 154}Sm (n,f){sup 155}Sm (half-life = 22 minutes) {sup 155}Eu. Considerable progress has been made in developing a suitable high-yield and high-purity separation method for separating Eu from targets

  7. Different Plaque Composition and Progression in Patients with Stable and Unstable Coronary Syndromes Evaluated by Cardiac CT

    Directory of Open Access Journals (Sweden)

    Maiken Glud Dalager

    2015-01-01

    Full Text Available Objective. To compare the quantity, subtype, and progression of atherosclerosis by cardiac computed tomography (CT and intravascular ultrasound (IVUS in patients with stable (SAP and unstable angina pectoris or non-ST-elevation myocardial infarction (UAP/n-STEMI. Methods. Forty patients with SAP and 20 with UAP/n-STEMI underwent cardiac CT and angiography with IVUS at baseline and after one year. Atherosclerotic segments were divided into calcified, mixed, or noncalcified subtypes, and significant stenoses were registered. Results. Thirty-two SAP and 15 UAP/n-STEMI patients completed the CT follow-up. At baseline, the number of atherosclerotic segments was higher in UAP/n-STEMI than in SAP (P=0.039. UAP/n-STEMI patients had more segments with noncalcified plaques (P=0.0005 whereas SAP patients had more segments with calcified plaques (P=0.013. The number of segments with significant stenosis did not differ between the groups, but noncalcified plaques more frequently caused significant stenoses in UAP/n-STEMI than in SAP patients (P=0.0002. After one year the number of segments with atherosclerosis increased in SAP patients (P=0.0001. The number of atherosclerotic segments remained unchanged in UAP/n-STEMI patients. However, composition was altered as the number of segments with noncalcified plaques decreased (P=0.018. IVUS data confirmed the CT findings. Conclusion. Quantity, subtype, and progression of atherosclerosis differ between SAP and UAP/n-STEMI patients.

  8. Different Plaque Composition and Progression in Patients with Stable and Unstable Coronary Syndromes Evaluated by Cardiac CT

    Science.gov (United States)

    Dalager, Maiken Glud; Bøttcher, Morten; Thygesen, Jesper; Andersen, Gratien; Bøtker, Hans Erik

    2015-01-01

    Objective. To compare the quantity, subtype, and progression of atherosclerosis by cardiac computed tomography (CT) and intravascular ultrasound (IVUS) in patients with stable (SAP) and unstable angina pectoris or non-ST-elevation myocardial infarction (UAP/n-STEMI). Methods. Forty patients with SAP and 20 with UAP/n-STEMI underwent cardiac CT and angiography with IVUS at baseline and after one year. Atherosclerotic segments were divided into calcified, mixed, or noncalcified subtypes, and significant stenoses were registered. Results. Thirty-two SAP and 15 UAP/n-STEMI patients completed the CT follow-up. At baseline, the number of atherosclerotic segments was higher in UAP/n-STEMI than in SAP (P = 0.039). UAP/n-STEMI patients had more segments with noncalcified plaques (P = 0.0005) whereas SAP patients had more segments with calcified plaques (P = 0.013). The number of segments with significant stenosis did not differ between the groups, but noncalcified plaques more frequently caused significant stenoses in UAP/n-STEMI than in SAP patients (P = 0.0002). After one year the number of segments with atherosclerosis increased in SAP patients (P = 0.0001). The number of atherosclerotic segments remained unchanged in UAP/n-STEMI patients. However, composition was altered as the number of segments with noncalcified plaques decreased (P = 0.018). IVUS data confirmed the CT findings. Conclusion. Quantity, subtype, and progression of atherosclerosis differ between SAP and UAP/n-STEMI patients. PMID:26339610

  9. Lack of indication of myocardial cell damage after myocardial ischaemia in patients with severe stable angina

    DEFF Research Database (Denmark)

    Hansen, Knud Nørregaard; Egstrup, K; Nielsen, J R

    1992-01-01

    To evaluate myocardial cell damage in relation to spontaneous and exercise-induced ischaemia, release of myoglobin, creatine kinase (CK) and its isoenzyme MB (CK-MB) into the serum was estimated in 10 patients with severe stable angina. All patients had a positive exercise test, significant steno...

  10. Alternating Wolff-Parkinson-White syndrome associated with attack of angina

    International Nuclear Information System (INIS)

    Mangiafico, R.A.; Petralito, A.; Grimaldi, D.R.

    1990-01-01

    In a patient with Wolff-Parkinson-White syndrome and an inferior-posterior bypass tract, transient restoration of normal conduction occurred during an attack of angina. The ECG pattern of inferior posterior ischemia was present when the conduction was normal. Thallium scintigraphy showed a reversible posterolateral perfusion defect. The possible mechanisms for production of intermittent preexcitation are discussed

  11. Efficacy of a Device to Narrow the Coronary Sinus in Refractory Angina

    NARCIS (Netherlands)

    Verheye, Stefan; Jolicoeur, E. Marc; Behan, Miles W.; Pettersson, Thomas; Sainsbury, Paul; Hill, Jonathan; Vrolix, Mathias; Agostoni, Pierfrancesco; Engstrom, Thomas; Labinaz, Marino; de Silva, Ranil; Schwartz, Marc; Meyten, Nathalie; Uren, Neal G.; Doucet, Serge; Tanguay, Jean-Francois; Lindsay, Steven; Henry, Timothy D.; White, Christopher J.; Edelman, Elazer R.; Banai, Shmuel

    2015-01-01

    BACKGROUND Many patients with coronary artery disease who are not candidates for revascularization have refractory angina despite standard medical therapy. The balloon-expandable, stainless steel, hourglass-shaped, coronary-sinus reducing device creates a focal narrowing and increases pressure in

  12. Mechanisms of angina pectoris in syndrome X assessed by myocardial perfusion dynamics and heart rate variability

    NARCIS (Netherlands)

    Meeder, JG; Blanksma, PK; Crijns, HJGM; Anthonio, RL; Pruim, J; Brouwer, J; DeJong, RM; VanderWall, EE; Vaalburg, W; Lie, KI

    1995-01-01

    The fundamental abnormality in syndrome X (angina pectoris, ischaemia-like stress ECG despite angiographically normal coronary arteries) might be patchily distributed increased tone in pre-arteriolar coronary vessels with compensatory release of adenosine. The aim of this study was to confirm this

  13. pectorIs of labetalol in with angina Beneficial effect hypertensive ...

    African Journals Online (AJOL)

    1983-01-15

    Jan 15, 1983 ... exercise or on pertormance of the cold pressor test. Labetalol significantly reduced blood pressure levels during isometric exercise but did not reduce the systolic pressure- heart rate product. Labetalol improved the angina without evidence of causing a reduction of cardiac work (and presumably oxygen.

  14. Transient myocardial ischemia after abrupt withdrawal of antianginal therapy in chronic stable angina

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    In 47 patients with chronic stable angina and proven coronary artery disease, abrupt withdrawal of beta-adrenoceptor blocking agents either as monotherapy or in combination with calcium antagonists (group 1, n = 25) was compared with abrupt withdrawal of calcium antagonist monotherapy (group 2, n...

  15. Tissue Doppler echocardiography improves the diagnosis of coronary artery stenosis in stable angina pectoris

    DEFF Research Database (Denmark)

    Hoffmann, Soren; Jensen, Jan Skov; Iversen, Allan Zeeberg

    2012-01-01

    Aim To determine if colour tissue Doppler imaging (TDI) performed at rest in patients with suspected stable angina pectoris (SAP) is able to predict the presence of significant coronary artery disease (CAD). METHODS AND RESULTS: This study comprises 296 consecutive patients with clinically...

  16. Clinical validation of a quality of life questionnaire in angina pectoris patients.

    Science.gov (United States)

    Marquis, P; Fayol, C; Joire, J E

    1995-11-01

    Angina pectoris impairs patients' quality of life. In order to assess its impact on quality of life, a questionnaire was developed using a literature review and interviews with patients and clinicians. It consisted of a general profile (SF-36) which measured functional status, well-being, perceived health, and a specific index, the Angina Pectoris Quality of Life Questionnaire, supplemented by new items. The acceptability, internal consistency reliability and clinical validity of this 70-item questionnaire were analysed in a cross-sectional study. Of 197 coronary patients approached, 93% (n = 184) agreed to participate and 86% (n = 170) returned the mailed questionnaire. Mean age of patients was 67 years (+/- 10); 79% were male and 70% were retired. Sixty patients were asymptomatic and 110 reported anginal crises (Canadian Cardiovascular Society Classification: class I: 48; II: 37; III: 13; IV: 0; V: 12). Globally, angina pectoris was found to affect each quality of life concept measured: physical functioning, well-being, and perceived health. Quality of life profiles worsened in accordance with increasing severity of the condition, as stratified by angina pectoris class. Asymptomatic patients reported better general and specific profiles. These results support the feasibility and usefulness of evaluating quality of life using the questionnaire. The validation of the data is very encouraging and enables the questionnaire to be used in clinical trials.

  17. Management of Ludwig's angina in pregnancy: a review of 10 cases ...

    African Journals Online (AJOL)

    All the patients presented during the third trimester of their pregnancy and odontogenic infections were responsible for 80% (8/10) of the Ludwig's angina. There were 20% mortality among the patients and this was significant for those with underlying systemic conditions (P = 0.02). The time of presentation was not significant ...

  18. Invasive angiography and revascularization in patients with stable angina following prior coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Joshi, Francis R; Biasco, Luigi; Pedersen, Frants

    2017-01-01

    . Follow-up data were available for all patients, by means of records linked to each Danish social security number. RESULTS: In patients with prior CABG and stable angina (n = 2,309), diagnostic angiography led to revascularization in 574 (24.9%) cases. Chronic kidney disease (HR 1.93 [1.08-3.44], P = 0...

  19. Is surgical airway necessary for airway management in deep neck infections and Ludwig angina?

    Science.gov (United States)

    Wolfe, Mary M; Davis, James W; Parks, Steven N

    2011-02-01

    Deep neck infections are potentially life-threatening conditions because of airway compromise. Management requires early recognition, antibiotics, surgical drainage, and effective airway control. The Surgical Education and Self-Assessment Program 12 states that awake tracheostomy is the treatment of choice for these patients. With advanced airway control techniques such as retrograde intubation, GlideScope, and fiberoptic intubation, surgical airway is not required. A retrospective analysis of all deep neck abscesses treated from December 1999 to July 2006 was performed. All patients who underwent urgent or emergent surgery for Ludwig angina and submental, submandibular, sublingual, and parapharyngeal abscesses (Current Procedural Terminology codes 41015, 41016, 41017, 42320, and 42725) were included in our review. Charts were studied for age, presence of true Ludwig angina, presence of airway compromise, airway management, morbidity/mortality, and the requirement for surgical airway. Of 29 patients, 6 (20%) had symptoms consistent with true Ludwig angina. Nineteen (65.5%) had evidence of airway compromise. Eight (42%) of these 19 patients required advanced airway control techniques. No patient required a surgical airway, and no mortality resulted from airway compromise. Advance airway control techniques were required more often in patients with airway compromise (P Ludwig angina and deep neck abscesses requires good clinical judgment. Patients with deep neck infections and symptoms of airway compromise may be safely managed with advanced airway control techniques. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Management of Ludwig's angina with small neck incisions: 18 years experience.

    Science.gov (United States)

    Bross-Soriano, Daniel; Arrieta-Gómez, José R; Prado-Calleros, Héctor; Schimelmitz-Idi, Jose; Jorba-Basave, Santiago

    2004-06-01

    To review Ludwig's angina medical and surgical approach with small incisions. Retrospective, open, noncomparative, longitudinal. All patients with Ludwig's angina who received medical, metabolic, airway management, and surgical treatment from January 1, 1983 to December 31, 2000. Antibiotic treatment, surgical treatment, hospitalization time, associated diseases, etiologic factors, recuperation time. Age range was 18 to 87 years, with a female-to-male ratio of 1.1:1 (68 females, 53 males). Thirty patients belonged to middle or high socioeconomic status. The primary site of infection was odontogenic in 107 of the patients. All the patients were managed with surgical drainage made within the first 12 hours after hospital admission. The most common antibiotic treatments were the combination of clindamycin with crystalline penicillin G. The hospital stay for more than half of patients was 6 days or less. In 62 patients we found extension into the parapharyngeal space and in 32 cases we found retropharyngeal extension of the Ludwig's angina. Forty-six patients had or were diagnosed as having diabetes mellitus. Tracheotomy was required in 34 patients. The airway of the rest of patients was controlled with nasotracheal intubation. Only 33 patients had major complications, such as mediastinitis, sepsis, or death. Drainage using small incisions is a safe and effective method as part of treatment of Ludwig's angina.

  1. A re-evaluation of the role of tracheostomy in Ludwig's angina.

    Science.gov (United States)

    Allen, D; Loughnan, T E; Ord, R A

    1985-06-01

    Ten cases of Ludwig's angina that required surgical decompression in addition to intravenous antibiotic therapy are reviewed. The vocal cords were visualized in all ten patients following deep inhalational anesthesia to relieve trismus. Only one case required tracheostomy, which has previously been recommended as the treatment of choice for airway management; the other nine were intubated under direct vision.

  2. Transcoronary sinus administration of autologous bone marrow in patients with chronic refractory stable angina

    International Nuclear Information System (INIS)

    Vicario, J.; Campos, C.; Piva, J.; Faccio, F.; Gerardo, L.; Becker, C.; Ortega, H.H.; Pierini, A.; Lofeudo, C.; Novero, R.; Licheri, A.; Milesi, R.; Perez Balino, N.; Monti, A.; Amin, A.; Pfeiffer, H.; De Giovanni, E.; Fendrich, I.

    2004-01-01

    Purpose: Based on our preclinic studies with autologous unfractionated bone marrow (AUBM) via coronary sinus with transitory occlusion, a clinic study in patients with chronic stable angina was designed. The objectives were to evaluate safety, tolerance and feasibility. Methods and materials: A multicenter prospective study with inclusion and exclusion criteria defined by an Independent Clinical Committee was carried out. Fourteen patients underwent transcoronary sinus administration of freshly aspirated and filtered AUBM (60-120 ml). Safety and tolerance were evaluated. Feasibility was evaluated with Seattle Angina Questionnaire (SAQ), Canadian Cardiovascular Society (CCS) angina classification (baseline-Day 180), myocardial perfusion (baseline-Day 90) with independent core laboratory and coronary angiography (baseline and Day 30). Results: There were no changes in the safety and tolerance parameters. Preliminary clinical efficacy at Day 180 disclosed a significant improvement of 38%, evaluated by the SAQ. The CCS angina classification shows that the mean angina class was 3.0±0.55 at baseline and improved to 2.0±0.00 at Day 180 (P<.001). Semiquantitative radionuclide perfusion imaging (core lab) showed a significant improvement at Day 90 in 13/14 patients, with a mean improvement of 24% at rest (P<.01) and 33% at stress (P<.05). Coronary angiography showed more collateral vessels in 9/14 patients. Conclusions: We can conclude that AUBM via coronary sinus with transitory occlusion is tolerable and safe. Significant improvement in the myocardial perfusion at Day 90 and in the quality of life at Day 180 was observed

  3. Immediate and long-term clinical outcome after spinal cord stimulation for refractory stable angina pectoris.

    Science.gov (United States)

    Di Pede, Francesco; Lanza, Gaetano Antonio; Zuin, Guerrino; Alfieri, Ottavio; Rapati, Massimo; Romanò, Massimo; Circo, Antonio; Cardano, Paola; Bellocci, Fulvio; Santini, Massimo; Maseri, Attilio

    2003-04-15

    The treatment of patients with angina pectoris refractory to medical therapy and unsuitable for revascularization procedures has yet not been well standardized. Previous retrospective studies and small prospective studies have suggested beneficial effects of spinal cord stimulation (SCS) in these patients. We created a Prospective Italian Registry of SCS to evaluate the short- and long-term clinical outcome of patients who underwent SCS device implantation because of severe refractory angina pectoris. Overall, 104 patients were enrolled in the registry (70 men, aged 68 +/- 17 years), most of whom (83%) had severe coronary artery disease. Average follow-up was 13.2 +/- 8 months. Overall, 17 patients (16%) died, 8 (8%) due to cardiac death. Among clinical variables, only age was found to be significantly associated both with total mortality (p = 0.04) and cardiac mortality (p = 0.02) on Cox regression analysis. A significant improvement of anginal symptoms (> or =50% reduction of weekly anginal episodes, compared with baseline) occurred in 73% of patients, and Canadian Cardiovascular Society angina class improved by > or =1 class in 80% and by > or =2 classes in 42% of patients, with a relevant reduction in the rate of hospital admission and days spent in the hospital because of angina (p <0.0001 for both). No life-threatening or clinically serious complications were observed. The most frequent side effect consisted of superficial infections, either at the site of puncture of electrode insertion or of the abdominal pocket, which occurred in 6 patients. In conclusion, our prospective data point out that SCS can be performed safely and is associated with a sustained improvement of anginal symptoms in a relevant number of patients with refractory stable angina pectoris.

  4. Unstable genes unstable mind: beyond the central dogma of molecular biology.

    Science.gov (United States)

    Hegde, Mahabaleshwar V; Saraph, Arundhati A

    2011-08-01

    Schizophrenia has a polygenic mode of inheritance and an estimated heritability of over 80%, but success in understanding its genetic underpinnings to date has been modest. Unlike in trinucleotide neurodegenerative disorders, the phenomenon of genetic anticipation observed in schizophrenia or bipolar disorder has not been explained. For the first time, we provide a plausible molecular explanation of genetic anticipation and pathophysiology of schizophrenia, at least in part, with supporting evidence. We postulate that abnormally increased numbers of CAG repeats in many genes being expressed in the brain, coding for glutamine, cumulatively press for higher demand of glutamine in the respective brain cells, resulting in a metabolic crisis and dysregulation of the glutamate-glutamine cycle. This can adversely affect the functioning of both glutamate and GABA receptors, which are known to be involved in psychosis, and may also affect glutathione levels, increasing oxidative stress. The resulting psychosis (gain in function), originating from unstable genes, is described as an effect "beyond the central dogma of molecular biology". The hypothesis explains genetic anticipation, as further expansions in subsequent generations may result in increased severity and earlier occurrence. Many other well described findings provide proof of concept. This is a testable hypothesis, does not deny any known facts and opens up new avenues of research. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Thunderclap-like headache triggered by micturition and angina as an initial manifestation of bladder pheochromocytoma. A case report

    Directory of Open Access Journals (Sweden)

    You Jin Han

    Full Text Available CONTEXT: Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis and angina. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. CASE REPORT: This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by micturition and angina as an initial manifestation. CONCLUSION: This case study suggests that thunderclap headache and angina occurring concurrently with sudden blood pressure elevation during or immediately after micturition are important diagnostic clues for bladder pheochromocytoma.

  6. Ranolazine for the treatment of chronic stable angina: a cost-effectiveness analysis from the UK perspective

    OpenAIRE

    Coleman, Craig I; Freemantle, Nick; Kohn, Christine G

    2015-01-01

    Objectives To estimate the cost-effectiveness of ranolazine when added to standard-of-care (SoC) antianginals compared with SoC alone in patients with stable coronary disease experiencing ?3 attacks/week. Setting An economic model utilising a UK health system perspective, a 1-month cycle-length and a 1-year time horizon. Participants Patients with stable coronary disease experiencing ?3 attacks/week starting in 1 of 4 angina frequency health states based on Seattle Angina Questionnaire Angina...

  7. Effects of Unstable Links on AODV Performance in Real Testbeds

    Directory of Open Access Journals (Sweden)

    Borgia Eleonora

    2007-01-01

    Full Text Available A link between a pair of nodes is defined unstable if it is characterized by a packet loss which is not negligible in one or both directions. The presence of unstable links in multihop ad hoc networks is very likely and it depends on several factors (e.g., different transmission capabilities of the devices, interferences caused by additional wireless devices. Their management by the routing protocols is of paramount importance since they negatively affect applications performance. In our previous experimental studies, we found that AODV is characterized by very low performance in some specific situations and, in this work, we demonstrate that it mainly depends on the wrong management of unstable links as valid routes. We present some policies that have been proposed in literature to avoid this problem, and we validate two of them through experimental results, exploiting also a direct comparison with the proactive routing protocol OLSR. Our results show that AODV is not able to avoid the use of unstable links, even when an alternative stable route exists. In the same conditions, OLSR outperforms AODV by correctly managing unstable links. In fact, it is able to guarantee a higher packet delivery ratio to the application by using the most stable path to reach the destination.

  8. Unstable three dimensional nuclear matter in stochastic mean field approach

    International Nuclear Information System (INIS)

    Colonna, M.; Chomaz, Ph.

    1993-01-01

    A semi-classical stochastic mean-field approach is discussed. In the case of unstable infinite nuclear matter, the characteristic time of the exponential growing of fluctuations and the diffusion coefficients associated to the unstable modes are calculated in the framework of the Boltzmann-Langevin theory. In order to make realistic 3D calculations feasible, the complicated Boltzmann-Langevin theory is suggested to be replaced by a simpler stochastic meanfield approach corresponding to a standard Boltzmann evolution, complemented by a simple noise chosen to reproduce the dynamics of the most unstable modes. Finally, it is explained how to approximately implement this method by simply tuning the noise associated to the use of a finite number of test particles in Boltzmann-like calculations. (authors) 17 refs., 5 figs

  9. External Fixation of Unstable Distal Radius Fracture. A Case Report

    OpenAIRE

    Yaniel Truffin Rodríguez; Rafael Esmandy Gámez Arregoitía; Indira L. Gómez Gil; José Julio Requeiro Morejón

    2014-01-01

    Unstable fracture of the distal radius is a common injury. If not properly treated, it can cause major disturbance in the radiocarpal joint and impaired hand function. A case of a 42-year-old patient of rural origin without a history of previous conditions treated at the Gustavo Aldereguía Lima Hospital in Cienfuegos is presented. He suffered a fall on the outstretched hand, which led to an unstable fracture of the left distal radius. Emergency surgery consisting of manual fracture reduction ...

  10. Constellation of arterial hypertension and stable angina pectoris, influence of adipokines and inflammation, the place of amlodipine

    OpenAIRE

    Tashchuk, V.K.

    2018-01-01

    The dynamics of C-reactive protein and leptin indices in patients with arterial hypertension and stable angina pectoris were studied in thus article in comparison with the effects of calcium antagonists.

  11. PRESENTACIÓN DE UN CASO CON SÍNDROME X O ANGINA MICROVASCULAR / Report of a case with cardiac syndrome X or microvascular angina

    Directory of Open Access Journals (Sweden)

    Dayan A. García Cuesta

    2013-04-01

    Full Text Available Resumen: El término síndrome X o angina microvascular se emplea habitualmente para definir a un grupo de pacientes que presentan dolor torácico característico, depresión del segmento ST durante el esfuerzo y arterias coronarias angiográficamente normales. Muchos datos apuntan a un posible origen isquémico de los síntomas. Es más frecuente en mujeres y en casi el 50 % de ellas, el dolor anginoso se atribuye específicamente a cambios en la microvasculatura coronaria. Debido a que el pronóstico no es tan benigno como se creía hace años, en pacientes con angina y coronarias epicárdicas normales, se impone una evaluación clínica (incluyendo un cuidadoso análisis de los factores de riesgo e imagenológica, con el propósito de detectar isquemia funcionalmente significativa. La enfermedad coronaria microvascular es, por tanto, una enfermedad que requiere atención por parte del médico de asistencia. En este artículo se presenta una paciente con este diagnóstico, y se muestran las imágenes electrocardiográficas, ecocardiográfica, ergométricas y angiográficas. / Abstract: The term cardiac syndrome X or microvascular angina is commonly used to describe a group of patients who show a typical chest pain, ST segment depression during exercise and angiographically normal coronary arteries. Many data suggest the symptoms may have an ischemic origin. It is more common in women, and, in almost 50% of them, anginal pain is specifically attributed to changes in the coronary microvasculature. The prognosis is not as benign as it was believed for years; therefore, in patients with angina and a normal epicardial coronary, a clinical and imaging assessment is necessary (including a careful analysis of risk factors in order to detect a functionally significant ischemia. Therefore, coronary microvascular disease is a condition that requires attention by the attending physician. A patient with this diagnosis is reported in this article, and

  12. Persistence of recruitable coronary collaterals in the absence of coronary vasospasm in a patient with variant angina

    International Nuclear Information System (INIS)

    Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide

    1998-01-01

    Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries.

  13. Positive and negative psychological correlates, gender specific and traditional factors for first onset angina in a sample of pakistani women

    International Nuclear Information System (INIS)

    Rafiq, R.; Anjum, A.

    2015-01-01

    Coronary Heart Disease (CHD) occurs to a greater extent in developed than developing countries like Pakistan. Our understanding of risk factors leading to this disease in women, are largely derived from studies carried out on samples obtained from developed countries. Since prevalence of CHD in Pakistan is growing, it seems pertinent to infer risk and protective factors prevalent within the Pakistani women. This case control study investigated the role of psychological, traditional and gender specific risk and protective factors for Angina in a sample of Pakistani women aged between 35-65 years. Methods: Female patients admitted with first episode of Angina fulfilling the study inclusion/exclusion criteria were recruited within the first three days of stay in the hospital. One control per case matched on age was recruited. Translated versions of standardized tools: Life Orientation Test (LOT), The Hope Scale, Subjective Happiness Scale and Depression, Anxiety and Stress Scale (DASS) were used to measure the psychological variables. Information on medical conditions like diabetes, hypertension, family history of IHD, presence and absence of menopause and use of oral contraceptive pills was obtained from the participants. Body Mass Index for cases and controls was calculated separately with the help of height and weight recorded for the participants. Results: Multivariate logistic regression analyses revealed that depression, anxiety and stress are risk factors, were as optimism and hope are protective predictors of Angina. 64% and 85 % of variance in Angina were attributed to psychological factors. Menopause, diabetes and hypertension are significantly associated with the risk of Angina, explaining 37% and 49 % of variance in Angina. The study provides evidence for implementation of gender specific risk assessment and preventive strategies for Angina. The study gives directions for large scale prospective, epidemiological, longitudinal as well as interventional

  14. Cardiac rehabilitation: a good measure to improve quality of life in peri- and postmenopausal women with microvascular angina

    OpenAIRE

    Wojciech Szot; Joanna Zając; Magdalena Kostkiewicz; Jakub Owoc; Iwona Bojar

    2015-01-01

    Cardiac Syndrome X (CSX) was considered a stable coronary syndrome, yet due to its nature, CSX symptoms often have a great impact on patients’ Quality of Life (QoL). According to ESC 2013 stable coronary artery disease criteria, CSX was replaced by Microvascular Angina (MA).Unfortunately, most CSX or MA patients, after classical angina (involving main coronary vessels) has been ruled out, often do not receive proper treatment. Indications for pharmacological treatment of MA patients were intr...

  15. Persistence of Recruitable Coronary Collaterals in the Absence of Coronary Vasospasm in a Patient with Variant Angina

    International Nuclear Information System (INIS)

    Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide

    1998-01-01

    Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries

  16. Use of myocardial perfusion imaging to predict the effectiveness of coronary revascularisation in patients with stable angina pectoris

    International Nuclear Information System (INIS)

    Johansen, Allan; Hoeilund-Carlsen, Poul Flemming; Moeldrup, Mette; Christensen, Henrik Wulff; Vach, Werner; Haghfelt, Torben

    2005-01-01

    Coronary revascularisation is the treatment of choice in patients with stable angina who have significant stenoses. From a pathophysiological point of view, however, mitigation of angina is to be expected only in the presence of reversible ischaemia. Therefore it was the aim of this study to examine the effect of revascularisation on stable angina in relation to the myocardial perfusion imaging (MPI) pattern prior to intervention. Three hundred and eighty-four patients (58.0±8.8 years) referred for angiography underwent MPI. Prior to MPI and at 2-year follow-up, patients were classified as having typical angina, atypical angina, non-cardiac chest pain or no pain, and the severity of chest pain was graded according to the Canadian Cardiovascular Society (CCS) criteria. The patients themselves estimated their pain on a visual analogue scale. Management was based on symptoms and angiographic findings, since the results of MPI were not communicated. Among the 240 patients who were not revascularised, 79% had typical or atypical angina at study entrance versus 40% at follow-up. In comparison, 93% of the 144 revascularised patients had typical or atypical angina before intervention versus only 36% at follow-up. This additional advantage of invasive therapy was present only in patients with reversible defects; revascularisation had no additional effect in patients with normal perfusion or irreversible defects. Similarly, additional, significant reductions in CCS class and visual analogue score were observed exclusively in patients with reversible defects. In patients referred for coronary angiography owing to known or suspected stable angina, revascularisation was significantly more effective than medical treatment exclusively in patients with reversible ischaemia. (orig.)

  17. Use of myocardial perfusion imaging to predict the effectiveness of coronary revascularisation in patients with stable angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Johansen, Allan [Odense University Hospital, Department of Clinical Physiology and Nuclear Medicine, Odense (Denmark); Odense University Hospital, Department of Nuclear Medicine, Odense (Denmark); Hoeilund-Carlsen, Poul Flemming; Moeldrup, Mette [Odense University Hospital, Department of Clinical Physiology and Nuclear Medicine, Odense (Denmark); Christensen, Henrik Wulff [Nordic Institute of Chiropractic and Clinical Biomechanics, Odense (Denmark); Vach, Werner [University of Southern Denmark, Department of Statistics, Odense (Denmark); Haghfelt, Torben [Odense University Hospital, Department of Cardiology, Odense (Denmark)

    2005-12-01

    Coronary revascularisation is the treatment of choice in patients with stable angina who have significant stenoses. From a pathophysiological point of view, however, mitigation of angina is to be expected only in the presence of reversible ischaemia. Therefore it was the aim of this study to examine the effect of revascularisation on stable angina in relation to the myocardial perfusion imaging (MPI) pattern prior to intervention. Three hundred and eighty-four patients (58.0{+-}8.8 years) referred for angiography underwent MPI. Prior to MPI and at 2-year follow-up, patients were classified as having typical angina, atypical angina, non-cardiac chest pain or no pain, and the severity of chest pain was graded according to the Canadian Cardiovascular Society (CCS) criteria. The patients themselves estimated their pain on a visual analogue scale. Management was based on symptoms and angiographic findings, since the results of MPI were not communicated. Among the 240 patients who were not revascularised, 79% had typical or atypical angina at study entrance versus 40% at follow-up. In comparison, 93% of the 144 revascularised patients had typical or atypical angina before intervention versus only 36% at follow-up. This additional advantage of invasive therapy was present only in patients with reversible defects; revascularisation had no additional effect in patients with normal perfusion or irreversible defects. Similarly, additional, significant reductions in CCS class and visual analogue score were observed exclusively in patients with reversible defects. In patients referred for coronary angiography owing to known or suspected stable angina, revascularisation was significantly more effective than medical treatment exclusively in patients with reversible ischaemia. (orig.)

  18. Wear Behavior of an Unstable Knee: Stabilization via Implant Design?

    Directory of Open Access Journals (Sweden)

    Jörn Reinders

    2014-01-01

    Full Text Available Background. Wear-related failures and instabilities are frequent failure mechanisms of total knee replacements. High-conforming designs may provide additional stability for the joint. This study analyzes the effects of a ligamentous insufficiency on the stability and the wear behavior of a high-conforming knee design. Methods. Two simulator wear tests were performed on a high-conforming total knee replacement design. In the first, a ligamentous-stable knee replacement with a sacrificed anterior cruciate ligament was simulated. In the second, a ligamentous-unstable knee with additionally insufficient posterior cruciate ligament and medial collateral ligament was simulated. Wear was determined gravimetrically and wear particles were analyzed. Implant kinematics was recorded during simulation. Results. Significantly higher wear rates (P≤0.001 were observed for the unstable knee (14.58±0.56 mg/106 cycles compared to the stable knee (7.97 ± 0.87 mg/106 cycles. A higher number of wear particles with only small differences in wear particle characteristics were observed. Under unstable knee conditions, kinematics increased significantly for translations and rotations (P≤0.01. This increase was mainly attributed to higher tibial posterior translation and internal rotations. Conclusion. Higher kinematics under unstable test conditions is a result of insufficient stabilization via implant design. Due to the higher kinematics, increased wear was observed in this study.

  19. Unstable oscillatory Pierce modes of neutralized electron beams

    International Nuclear Information System (INIS)

    Cary, J.R.; Lemons, D.S.

    1982-01-01

    Oscillatory modes of the Pierce system have been calculated. These modes are found to have growth rates comparable to the previously investigated purely growing modes. When these modes are included, it is found that the Pierce system is unstable for most values of ω/sub p/ L/V 0 >π

  20. Control of an under activated unstable nonlinear object

    DEFF Research Database (Denmark)

    Andersen, Nils Axel; Skovgaard, L.; Ravn, Ole

    2001-01-01

    This paper presents a comprehensive comparative study of several nonlinear controllers for stabilisation of the under actuated unstable nonlinear object known as the Acrobot in the literature. The object is a two DOF robot arm only actuated at the elbow. The study compares several control...

  1. Characterization of Unstable Rock Slopes Through Passive Seismic Measurements

    Science.gov (United States)

    Kleinbrod, U.; Burjanek, J.; Fäh, D.

    2014-12-01

    Catastrophic rock slope failures have high social impact, causing significant damage to infrastructure and many casualties throughout the world each year. Both detection and characterization of rock instabilities are therefore of key importance. An analysis of ambient vibrations of unstable rock slopes might be a new alternative to the already existing methods, e.g. geotechnical displacement measurements. Systematic measurements have been performed recently in Switzerland to study the seismic response of potential rockslides concerning a broad class of slope failure mechanisms and material conditions. Small aperture seismic arrays were deployed at sites of interest for a short period of time (several hours) in order to record ambient vibrations. Each measurement setup included a reference station, which was installed on a stable part close to the instability. Recorded ground motion is highly directional in the unstable parts of the rock slope, and significantly amplified with respect to stable areas. These effects are strongest at certain frequencies, which were identified as eigenfrequencies of the unstable rock mass. In most cases the directions of maximum amplification are perpendicular to open cracks and in good agreement with the deformation directions obtained by geodetic measurements. Such unique signatures might improve our understanding of slope structure and stability. Thus we link observed vibration characteristics with available results of detailed geological characterization. This is supported by numerical modeling of seismic wave propagation in fractured media with complex topography.For example, a potential relation between eigenfrequencies and unstable rock mass volume is investigated.

  2. The effect of nonlinearity on unstable zones of Mathieu equation

    Indian Academy of Sciences (India)

    Mathieu equation is a well-known ordinary differential equation in which the excitation term appears as the non-constant coefficient. The mathematical modelling of many dynamic systems leads to Mathieu equation. The determination of the locus of unstable zone is important for the control of dynamic systems. In this paper ...

  3. Randomized double-blind comparison of metoprolol, nifedipine, and their combination in chronic stable angina

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    In a randomized double-blind study, treatment with either metoprolol, nifedipine, or their combination was compared for effects on ischemic variables and heart rate obtained during ambulatory monitoring in 42 patients with chronic stable angina. All patients had severe chronic stable angina...... of at least 6 months' duration despite medical treatment, and exhibited coronary artery stenosis of 75% in one or more coronary arteries. Metoprolol reduced the frequency of total (p less than 0.01) and asymptomatic ischemic episodes (p less than 0.05), the duration of ischemia (p less than 0.......05), and the ischemic burden (p less than 0.05), which contrasted to the lack of any similar significant effect during nifedipine monotherapy. During combination therapy, there was a tendency to further improvement, which did not reach statistical significance compared with metoprolol monotherapy. Heart rate...

  4. Percutaneous Device to Narrow the Coronary Sinus: Shifting Paradigm in the Treatment of Refractory Angina?

    Directory of Open Access Journals (Sweden)

    Daniela Benedetto

    2016-10-01

    Full Text Available Refractory angina pectoris is defined as a chronic debilitating condition characterized by the presence of chronic anginal symptoms due to a severe obstructive and/or diffuse coronary artery disease that cannot be controlled by the combination of medical therapy and / or revascularization (percutaneous or surgical. In addition the presence of myocardial ischemia as a cause of the symptoms must have been documented. The coronary sinus Reducer (CSR is a recently introduced percutaneous device to treat patients with severe anginal symptoms refractory to optimal medical therapy and not amenable to conventional revascularization. The purpose of this review is to describe the current evidence from available studies measuring the clinical effect of the CSR implantation on the health and well-being of patients with refractory angina.

  5. Improving diagnosis and treatment of women with angina pectoris and microvascular disease

    DEFF Research Database (Denmark)

    Prescott, Eva; Abildstrøm, Steen Zabell; Aziz, Ahmed

    2014-01-01

    BACKGROUND: The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk. METHODS: All women with angina referred to invasive angiographic......, advanced echocardiographic modalities at rest and during stress, and invasive measures of CFR and coronary vascular reactivity. The study will include 2000 women who will be followed for 5 years for cardiovascular outcomes. RESULTS: By May 2013, 1685 women have been screened, 759 eligible patients...... identified, 530 contacted, and 299 (56%) agreed to participate. Among the first 50 patients, Doppler CFR was successfully measured in 49 (98%). CONCLUSIONS: Among women with suspected ischemic heart disease and no obstructive coronary artery disease, non-invasive Doppler CFR is feasible as a routine...

  6. A novel approach to modeling unstable EOR displacements. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Peters, E.J.

    1994-04-01

    Most enhanced oil recovery schemes involve the displacement of a more dense and more viscous oil by a less dense and less viscous fluid in a heterogeneous porous medium. The interaction of heterogeneity with the several competing forces, namely, viscous, capillary, gravitational, and dispersive forces, can conspire to make the displacements unstable and difficult to model and to predict. The objective of this research was to develop a systematic methodology for modeling unstable fluid displacements in heterogeneous media. Flow visualization experiments were conducted using X-ray computed tomography imaging and a video imaging workstation to gain insights into the dynamics of unstable displacements, acquire detailed quantitative experimental image data for calibrating numerical models of unstable displacements, and image and characterize heterogeneities in laboratory cores geostatistically. High-resolution numerical models modified for use on vector-architecture supercomputers were used to replicate the image data. Geostatistical models of reservoir heterogeneity were incorporated in order to study the interaction of hydrodynamic instability and heterogeneity in reservoir displacements. Finally, a systematic methodology for matching the experimental data with the numerical models and scaling the laboratory results to other systems were developed. The result is a new method for predicting the performance of unstable EOR displacements in the field based on small-scale displacements in the laboratory. The methodology is general and can be applied to forecast the performance of most processes that involve fluid flow and transport in porous media. Therefore, this research should be of interest to those involved in forecasting the performance of enhanced oil recovery processes and the spreading of contaminants in heterogeneous aquifers.

  7. Effects of ambient temperature, humidity, and other meteorological variables on hospital admissions for angina pectoris.

    Science.gov (United States)

    Abrignani, Maurizio G; Corrao, Salvatore; Biondo, Giovan B; Lombardo, Renzo M; Di Girolamo, Paola; Braschi, Annabella; Di Girolamo, Alberto; Novo, Salvatore

    2012-06-01

    Seasonal peaks in cardiovascular disease incidence have been widely reported, suggesting weather has a role. The aim of our study was to determine the influence of climatic variables on angina pectoris hospital admissions. We correlated the daily number of angina cases admitted to a western Sicilian hospital over a period of 12 years and local weather conditions (temperature, humidity, wind force and direction, precipitation, sunny hours and atmospheric pressure) on a day-to-day basis. A total of 2459 consecutive patients were admitted over the period 1987-1998 (1562 men, 867 women; M/F - 1:8). A seasonal variation was found with a noticeable winter peak. The results of Multivariate Poisson analysis showed a significant association between the daily number of angina hospital admission, temperature, and humidity. Significant incidence relative ratios (95% confidence intervals/measure unit) were, in males, 0.988 (0.980-0.996) (p = 0.004) for minimal temperature, 0.990 (0.984-0.996) (p = 0.001) for maximal humidity, and 1.002 (1.000-1.004) (p = 0.045) for minimal humidity. The corresponding values in females were 0.973 (0.951-0.995) (p < 0.017) for maximal temperature and 1.024 (1.001-1.048) (p = 0.037) for minimal temperature. Environmental temperature and humidity may play an important role in the pathogenesis of angina, although it seems different according to the gender. These data may help to understand the mechanisms that trigger ischemic events and to better organize hospital assistance throughout the year.

  8. SOLAR ACTIVITY AND PECULIARITIES OF THE RHEOLOGICAL PROPERTIES OF THE BLOOD IN PATIENTS WITH ANGINA PECTORIS

    Directory of Open Access Journals (Sweden)

    T.N. Afanasjeva

    2008-03-01

    Full Text Available The peculiarities of the rheological properties of the blood are studied in patients with non-stable angina pectohs in different perbds of solar activity. It has been established, that in high solar activity hemorheological disorders are characterized by increase of blood viscosity and compensatory decrease oferythrocyte aggregation and increase of their deformation. In low solar activity less perceptible hyperviscositywas accompanied by significant increase oferythrocyte aggregation and decrease of their deformity capacity.

  9. The Neuromatrix Theory of Pain and Angina during Exercise Stress Testing: Results from the PIMI Study

    Science.gov (United States)

    2011-05-27

    L. J. (2008). Pain management in fibromyalgia . Current Opinion in Rheumatology, 20(3), 246-250. Croft, P., Lewis, M., & Hannaford, P. (2003). Is...Angina Questionnaire in South Asian and European origin populations: a comparative study in Newcastle, UK. International Journal of Epidemiology , 30(5...J., Walters, E. E., & Wang, P.S. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS

  10. A 10-year prognostic model for patients with suspected angina attending a chest pain clinic.

    Science.gov (United States)

    Sekhri, Neha; Perel, Pablo; Clayton, Tim; Feder, Gene S; Hemingway, Harry; Timmis, Adam

    2016-06-01

    Diagnostic models used in the management of suspected angina provide no explicit information about prognosis. We present a new prognostic model of 10-year coronary mortality in patients presenting for the first time with suspected angina to complement the Diamond-Forrester diagnostic model of disease probability. A multicentre cohort of 8762 patients with suspected angina was followed up for a median of 10 years during which 233 coronary deaths were observed. Developmental (n=4412) and validation (n=4350) prognostic models based on clinical data available at first presentation showed good performance with close agreement and the final model utilised all 8762 patients to maximise power. The prognostic model showed strong associations with coronary mortality for age, sex, chest pain typicality, smoking status, diabetes, pulse rate, and ECG findings. Model discrimination was good (C statistic 0.83), patients in the highest risk quarter accounting for 173 coronary deaths (10-year risk of death: 8.7%) compared with a total of 60 deaths in the three lower risk quarters. When the model was simplified to incorporate only Diamond-Forrester factors (age, sex and character of symptoms) it underestimated coronary mortality risk, particularly in patients with reversible risk factors. For the first time in patients with suspected angina, a prognostic model is presented based on simple clinical factors available at the initial cardiological assessment. The model discriminated powerfully between patients at high risk and lower risk of coronary death during 10-year follow-up. Clinical utility was reflected in the prognostic value it added to the updated Diamond-Forrester diagnostic model of disease probability. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Optimal treatment of chronic angina in patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Kaur H

    2014-07-01

    Full Text Available Harjinder Kaur,1 Kully Sandhu,2 Awais Jabbar,3 Azfar G Zaman3,4 1City Hospitals Sunderland, Sunderland, UK; 2University Hospital of North Staffordshire, Stoke-on-Trent, UK; 3Freeman Hospital, Newcastle-upon-Tyne, UK; 4Institute of Cellular Medicine, Newcastle University, Newcastle, UK Abstract: Type 2 diabetes mellitus (T2DM trebles the risk of developing coronary artery disease (CAD; once CAD has developed, the risk of acute coronary syndromes (ACS and clinical risk associated with a coronary event, both double in diabetic patients. Patients with T2DM have more extensive CAD and present at a younger age; therefore, identification and management of chronic angina in these patients presents an opportunity to limit both cardiovascular symptoms and adverse outcomes. This article reviews the role of screening and treatment for chronic angina in patients with T2DM. There is a strong evidence base for modifying lifestyle as a way of reducing adverse cardiovascular outcomes in the diabetic population and this article reviews evidence of lifestyle modification as an important and necessary adjunct to pharmacologic intervention. Management of chronic stable angina is addressed by looking at treatments that reduce ischemic symptoms and those that reduce adverse cardiovascular outcomes. Trials specific to the diabetic population are limited, with information largely obtained from the diabetic subgroup analysis of large intervention trials. The growing diabetic population with increased propensity to cardiovascular disease mandates trials specifically in this patient population. Revascularization in patients with diabetes is associated with more complications than in the non-diabetic population. Recent trials specific to this population suggest surgical revascularization to be associated with better long-term outcomes and therefore, this article reviews the evidence for the optimal mode of revascularization in this population. Keywords: type 2 diabetes

  12. Decreased Diagnostic Accuracy of Multislice Coronary Computed Tomographic Angiography in Women with Atypical Angina Symptoms

    OpenAIRE

    Wen-Ying Jin; Xiu-Juan Zhao; Hong Chen

    2016-01-01

    Background: Multislice computed tomography (MSCT) coronary angiography (CAG) is a noninvasive technique with a reported high diagnostic accuracy for coronary artery disease (CAD). Women, more frequently than men, are known to develop atypical angina symptoms. The purpose of this study was to investigate whether the diagnostic accuracy of MSCT in women with atypical presentation differs from that in men. Methods: We enrolled 396 in-hospital patients (141 women and 255 men) with suspected or pr...

  13. Anaesthetic management of case of Ludwig’s angina: Forewarned is forearmed

    OpenAIRE

    Shaikh, Safiya Imtiaz; B M, Sarala; Bhosale, Raghavendra

    2014-01-01

    Ludwig's angina and deep neck infections are potentially lethal entities because of their tendency to cause oedema, distortion, and obstruction of the airway and may arise as a consequence of airway management mishaps. In the early stages of the disease, patients may be managed with observation and intravenous antibiotics. Advanced infections, however, require the airway to be secured in addition to immediate surgical drainage. This is complicated by pain, trismus, airway oedema, and tongue d...

  14. Ludwig's angina in children anesthesiologist's nightmare: Case series and review of literature

    OpenAIRE

    Maitree Pandey; Manpreet Kaur; Manoj Sanwal; Aruna Jain; Sunil K Sinha

    2017-01-01

    Ludwig's angina is potentially lethal, rapidly spreading cellulitis of the floor of mouth and neck. The anticipated difficult airway becomes even more challenging when it occurs in children. In children, the larynx is positioned relatively higher in the neck, and one does not have the option for blind nasal intubation or awake fiberoptic, which otherwise is the technique of choice in adult patients. We present the clinical course of 16 children and highlight various problems encountered durin...

  15. COMPARISON BETAXOLOL AND METOPROLOL TARTRATE THERAPIES IN PATIENTS WITH ARTERIAL HYPERTENSION ASSOCIATED WITH STABLE ANGINA

    Directory of Open Access Journals (Sweden)

    A. A. Anderzhanova

    2016-01-01

    Full Text Available Aim. To compare antihypertensive, antianginal and antiischemic efficacy of β1-selective adrenoblockers (betaxolol and metoprolol tartrate in patients with arterial hypertension (HT of 1-2 degree associated with stable angina class II.Material and methods. 100 patients (aged 23-66 y.o. with HT associated with stable angina or without angina were involved in the study. Patients were randomized into 2 groups (G1 and G2. G1 patients were treated with betaxolol, and G2 patients – with metoprolol tartrate. Ambulatory BP and electrocardiogram monitoring, exercise stress-test, echocardiography, evaluating of respiratory function, blood analysis was performed initially and in 30 and 90 days of treatment.Results. Target BP level was reached in 44 (88% patients treated with betaxolol (average daily dose 10±4 mg. 34 patients of G1 took 10 mg daily. Target BP level was reached in 41 (82% patients treated with metoprolol tartrate (average daily dose 150±27 mg. 30 patients of G2 took 150 mg daily. Exercise tolerance increased and a number of ischemic ST segment depressions reduced significantly in both groups. There were no significant differences in antihypertensive, antianginal, and antiischemic efficacy between groups.Conclusion. Betaxolol advantage is an ability to maintain target BP level more than 24 hours. A possibility to take betaxolol once a day raises patient’s compliance with therapy.

  16. ENDOTHELIAL DYSFUNCTION IN STABLE ANGINA AND MYOCARDIAL INFARCTION COMBINED WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

    Directory of Open Access Journals (Sweden)

    M. A. Popova

    2015-01-01

    Full Text Available The research objective is to determine the state of endothelium-dependent and endothelium-independent vasodilatation in patients with coronary heart disease (CHD associated with chronic obstructive pulmonary disease (COPD.Material and methods. In the cross-sectional study included 122 patients with CHD associated with COPD: 68 people of them are patients with stable angina without acute coronary events in history and 54 patients with acute ST segment elevation myocardial infarction (STEMI. Comparison group comprised 53 patients with stable angina and 51 patients after STEMI without concomitant COPD. Patients were included if they met the following inclusion criteria: male, age <60 years, verified forms of CHD (stable angina, STEMI, documented with COPD without exacerbation and forced expiratory volume in 1 second > 30% in the groups with CHD and COPD. Arterial endothelial function was tested with high-resolution ultrasonography: brachial artery diameter was measured at rest, after flow increase (which causes endothelium-dependent dilatation, and after administration of sublingual nitroglycerin (an endothelium-independent dilator.Results. We found that endothelial dysfunction in patients with acute and chronic forms of CHD in combination with COPD are more pronounced than in isolated CHD.Conclusion. Expressed depression functional vascular reserve in patients with CHD associated with COPD, should be taken into account when conducting individualized therapy of these patients.

  17. Exercise-induced thallium-201 myocardial perfusion defects in angina pectoris without significant coronary artery stenosis

    International Nuclear Information System (INIS)

    Nakazato, Masayasu; Maruoka, Yuji; Sunagawa, Osahiko; Kinjo, Kunihiko; Tomori, Masayuki; Fukiyama, Koshiro

    1990-01-01

    We performed exercise thallium-201 myocardial scintigraphy in 32 patients with angina pectoris to study the incidence of perfusion defects, who had no significant organic stenosis on coronary angiography. None of them had myocardial infarction or cardiomyopathy. Thallium-201 myocardial scintigraphy and 12-lead ECG recording were performed during supine bicycle ergometer exercise. Perfusion defects in thallium-201 scintigrams in SPECT images were assessed during visual analysis by two observers. In the coronary angiograms obtained during intravenous infusion of nitroglycerin, the luminal diameter of 75% stenosis or less in the AHA classification was regarded as an insignificant organic stenosis. Myocardial perfusion defects in the thallium-201 scintigrams were detected in eight (25%) of the 32 patients. Six of these eight patients had variant angina documented during spontaneous attacks with ST elevations in standard 12-lead ECGs. Perfusion defects were demonstrated at the inferior or infero-posterior regions in six patients, one of whom had concomitant anteroseptal defect. The defects were not always accompanied by chest pain. All but one patient demonstrating inferior or inferoposterior defects showed ST depression in leads II, III and aV F on their ECGs, corresponding to inferior wall ischemia. The exception was a case with right bundle branch block. Thus, 25% of the patients with angina pectoris, who had no evidence of significant organic stenosis on their coronary angiograms, exhibited exercise-induced perfusion defects in their thallium-201 scintigrams. Coronary spasms might have caused myocardial ischemia in these patients. (author)

  18. Decreased Diagnostic Accuracy of Multislice Coronary Computed Tomographic Angiography in Women with Atypical Angina Symptoms.

    Science.gov (United States)

    Jin, Wen-Ying; Zhao, Xiu-Juan; Chen, Hong

    2016-09-20

    Multislice computed tomography (MSCT) coronary angiography (CAG) is a noninvasive technique with a reported high diagnostic accuracy for coronary artery disease (CAD). Women, more frequently than men, are known to develop atypical angina symptoms. The purpose of this study was to investigate whether the diagnostic accuracy of MSCT in women with atypical presentation differs from that in men. We enrolled 396 in-hospital patients (141 women and 255 men) with suspected or proven CAD who successively underwent both MSCT and invasive CAG. CAD was defined as any coronary stenosis of ≥50% on conventional invasive CAG, which was used as the reference standard. The patients were divided into typical and atypical groups based on their symptoms of angina pectoris. The diagnostic accuracy of MSCT, including its sensitivity, specificity, negative predictive value, and positive predictive value (PPV), was calculated to determine the usefulness of MSCT in assessing stenoses. The diagnostic performance of MSCT was also assessed by constructing receiver operating characteristic (ROC) curves. The PPV (91% vs. 97%, χ2 = 5.705, P accuracy (87% vs. 93%, χ2 = 5.093,Pwomen than in men. Atypical presentation was an independent influencing factor on the diagnostic accuracy of MSCT in women (odds ratio = 4.94, 95% confidence intervals: 1.16-20.92, Walds = 4.69, P women with typical angina pectoris had higher PPV (98% vs. 74%, χ2 = 17.283. P accuracy (93% vs. 72%, χ2 = 9.571, P accuracy.

  19. Exercise-induced thallium-201 myocardial perfusion defects in angina pectoris without significant coronary artery stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Nakazato, Masayasu; Maruoka, Yuji; Sunagawa, Osahiko; Kinjo, Kunihiko; Tomori, Masayuki; Fukiyama, Koshiro (Ryukyu Univ., Nishihara, Okinawa (Japan). School of Medicine)

    1990-01-01

    We performed exercise thallium-201 myocardial scintigraphy in 32 patients with angina pectoris to study the incidence of perfusion defects, who had no significant organic stenosis on coronary angiography. None of them had myocardial infarction or cardiomyopathy. Thallium-201 myocardial scintigraphy and 12-lead ECG recording were performed during supine bicycle ergometer exercise. Perfusion defects in thallium-201 scintigrams in SPECT images were assessed during visual analysis by two observers. In the coronary angiograms obtained during intravenous infusion of nitroglycerin, the luminal diameter of 75% stenosis or less in the AHA classification was regarded as an insignificant organic stenosis. Myocardial perfusion defects in the thallium-201 scintigrams were detected in eight (25%) of the 32 patients. Six of these eight patients had variant angina documented during spontaneous attacks with ST elevations in standard 12-lead ECGs. Perfusion defects were demonstrated at the inferior or infero-posterior regions in six patients, one of whom had concomitant anteroseptal defect. The defects were not always accompanied by chest pain. All but one patient demonstrating inferior or inferoposterior defects showed ST depression in leads II, III and aV{sub F} on their ECGs, corresponding to inferior wall ischemia. The exception was a case with right bundle branch block. Thus, 25% of the patients with angina pectoris, who had no evidence of significant organic stenosis on their coronary angiograms, exhibited exercise-induced perfusion defects in their thallium-201 scintigrams. Coronary spasms might have caused myocardial ischemia in these patients. (author).

  20. Enhanced regional washout of technetium-99m-sestamibi in patients with coronary spastic angina

    International Nuclear Information System (INIS)

    Ono, Souichi; Yamaguchi, Hiroyuki; Abe, Shigeru; Tachibana, Hidetada; Sato, Takayuki; Takeishi, Yasuchika; Kubota, Isao

    2003-01-01

    Reverse redistribution and rapid washout of 99m Tc-sestamibi are observed in patients with acute myocardial infarction and may indicate viable myocardium. However, the clinical significance of this phenomenon has not been rigorously examined in other cardiac diseases. Thus, we investigated whether reverse redistribution and washout of 99m Tc-sestamibi could be used in the diagnosis and follow-up of patients with coronary spastic angina. Thirty patients diagnosed as coronary spastic angina were examined. During coronary arteriography, spasm was induced by provocation test with ergonovine, and only total or subtotal occlusion was considered positive. Myocardial perfusion tomography was obtained 45 min (early) and 3 hr (delayed) after 99m Tc-sestamibi injection. Segmental defect score was visually graded from 0 (normal) to 4 (defect), and a total defect score was determined as the sum of defect scores for all segments. Washout rate of 99m Tc-sestamibi from the myocardium was calculated for each segment. After medical treatment with calcium antagonists and nitrates for 3 months, 99m Tc-sestamibi imaging was repeated. Out of 30 patients, on the early images 17 (57%) patients demonstrated decreased 99m Tc-sestamibi uptake in spastic segments; on the other hand, 24 (80%) patients did decreased 99m Tc-sestamibi uptake in spastic segments on delayed images. Total defect scores in delayed images were higher than those in early images (6.9±0.3 vs. 3.6±0.4, p 99m Tc-sestamibi was observed in 17 out of 30 patients (57%) with coronary spastic angina. Washout rate of 99m Tc-sestamibi from spastic segments was higher than that from non-spastic segments (16±2% vs. 11±5%, p 99m Tc-sestamibi was observed in patients with coronary spastic angina and might indicate that the ability of myocyte to retain the tracer was impaired due to repetitive brief ischemia by coronary spasm. The early and delayed 99m Tc-sestamibi imaging provides useful information for the diagnosis and responses

  1. Five year prognosis in patients with angina identified in primary care: incident cohort study.

    LENUS (Irish Health Repository)

    Buckley, Brian S

    2009-01-01

    OBJECTIVE: To ascertain the risk of acute myocardial infarction, invasive cardiac procedures, and mortality among patients with newly diagnosed angina over five years. DESIGN: Incident cohort study of patients with primary care data linked to secondary care and mortality data. SETTING: 40 primary care practices in Scotland. PARTICIPANTS: 1785 patients with a diagnosis of angina as their first manifestation of ischaemic heart disease, 1 January 1998 to 31 December 2001. MAIN OUTCOME MEASURES: Adjusted hazard ratios for acute myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, death from ischaemic heart disease, and all cause mortality, adjusted for demographics, lifestyle risk factors, and comorbidity at cohort entry. RESULTS: Mean age was 62.3 (SD 11.3). Male sex was associated with an increased risk of acute myocardial infarction (hazard ratio 2.01, 95% confidence interval 1.35 to 2.97), death from ischaemic heart disease (2.80, 1.73 to 4.53), and all cause mortality (1.82, 1.33 to 2.49). Increasing age was associated with acute myocardial infarction (1.04, 1.02 to 1.06, per year of age increase), death from ischaemic heart disease (1.09, 1.06 to 1.11, per year of age increase), and all cause mortality (1.09, 1.07 to 1.11, per year of age increase). Smoking was associated with subsequent acute myocardial infarction (1.94, 1.31 to 2.89), death from ischaemic heart disease (2.12, 1.32 to 3.39), and all cause mortality (2.11, 1.52 to 2.95). Obesity was associated with death from ischaemic heart disease (2.01, 1.17 to 3.45) and all cause mortality (2.20, 1.52 to 3.19). Previous stroke was associated with all cause mortality (1.78, 1.13 to 2.80) and chronic kidney disease with death from ischaemic heart disease (5.72, 1.74 to 18.79). Men were more likely than women to have coronary artery bypass grafting or percutaneous transluminal coronary angioplasty after a diagnosis of angina; older people were less likely to

  2. Cost-utility of ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Spain.

    Science.gov (United States)

    Hidalgo-Vega, Alvaro; Ramos-Goñi, Juan Manuel; Villoro, Renata

    2014-12-01

    Ranolazine is an antianginal agent that was approved in the EU in 2008 as an add-on therapy for symptomatic chronic angina pectoris treatment in patients who are inadequately controlled by, or are intolerant to, first-line antianginal therapies. These patients' quality of life is significantly affected by more frequent angina events, which increase the risk of revascularization. To assess the cost-utility of ranolazine versus placebo as an add-on therapy for the symptomatic treatment of patients with chronic angina pectoris in Spain. A decision tree model with 1-year time horizon was designed. Transition probabilities and utility values for different angina frequencies were obtained from the literature. Costs were obtained from Spanish official DRGs for patients with chronic angina pectoris. We calculated the incremental cost-utility ratio of using ranolazine compared with a placebo. Sensitivity analyses, by means of Monte Carlo simulations, were performed. Acceptability curves and expected value of perfect information were calculated. The incremental cost-utility ratio was €8,455 per quality-adjusted life-year (QALY) per patient in Spain. Sensitivity analyses showed that if the decision makers' willingness to pay is €15,000 per QALY, the treatment with ranolazine will be cost effective at a 95 % level of confidence. The incremental cost-utility ratio is particularly sensitive to changes in utility values of those non-hospitalized patients with mild or moderate angina frequency. Ranolazine is a highly efficient add-on therapy for the symptomatic treatment of chronic angina pectoris in patients who are inadequately controlled by, or intolerant to, first-line antianginal therapies in Spain.

  3. Stabilization of switched nonlinear systems with unstable modes

    CERN Document Server

    Yang, Hao; Cocquempot, Vincent

    2014-01-01

    This book provides its reader with a good understanding of the stabilization of switched nonlinear systems (SNS), systems that are of practical use in diverse situations: design of fault-tolerant systems in space- and aircraft; traffic control; and heat propagation control of semiconductor power chips. The practical background is emphasized throughout the book; interesting practical examples frequently illustrate the theoretical results with aircraft and spacecraft given particular prominence. Stabilization of Switched Nonlinear Systems with Unstable Modes treats several different subclasses of SNS according to the characteristics of the individual system (time-varying and distributed parameters, for example), the state composition of individual modes and the degree and distribution of instability in its various modes. Achievement and maintenance of stability across the system as a whole is bolstered by trading off between individual modes which may be either stable or unstable, or by exploiting areas of part...

  4. The unstable modes of a two-component electron plasma

    Science.gov (United States)

    McQuillan, P.; McClements, K. G.

    1988-12-01

    The linear generation of electrostatic waves in a homogeneous, collisionless, unmagnetized plasma with two Maxwellian electron components, one drifting with respect to the other, is investigated. It is shown that such a system may be unstable to a beam mode rather than the well-known Langmuir mode if the drifting electron component is sufficiently dense and has a sufficiently low temperature. The dispersion characteristics of this 'electron-beam instability' and the Langmuir instability at the critical drift velocity for wave growth are determined for a wide range of parameters. The results are applied to electron beams producing hard X-ray emission in solar flares, and it is argued that such beams may be unstable to the generation of electrostatic waves at frequencies below the electron plasma frequency.

  5. A numerical study of unstable Hele-Shaw flow

    DEFF Research Database (Denmark)

    Hansen, Erik Bent; Rasmussen, Henning

    1999-01-01

    A numerical procedure which is based on an integral equation for the normal velocity at the interface is developed for the unstable flow with surface tension in a Hele-Shaw cell. The procedure has been validated by comparing solutions obtained by it with published results. It has also been applie...... to a study of the effect of small changes in the initial data on the later profiles and it was found that even very small differences can lead to large differences in the profiles at later times. (C) 1999 Elsevier Science Ltd. All rights reserved.......A numerical procedure which is based on an integral equation for the normal velocity at the interface is developed for the unstable flow with surface tension in a Hele-Shaw cell. The procedure has been validated by comparing solutions obtained by it with published results. It has also been applied...

  6. Unstable Titan-generated Rayleigh-Taylor Lakes Impact Ice

    Science.gov (United States)

    Umurhan, O. M.; Korycansky, D. G.; Zahnle, K. J.

    2014-12-01

    The evolution of surface morphology on Titan, Triton, and other worlds is strongly influenced by the interplay of various fluid dynamical processes. Specifically, overturning instabilities can easily arise due to the special circumstances of landform evolution that probably occurred on these worlds. On Titan, large impacts that formed basins like Menrva crater (and possibly Hotei Regio) would have generated impact-melt ice lakes unstably arranged over less dense ice. Cantaloupe terrains, for example as seen on Triton, may be the result of condensation of volatiles (methane, nitrogen) leading to unstably stratified layers of different compositions and densities. In each of these cases, Rayleigh-Taylor instabilities leading to large scale diapirism may be at play. In addition to the dynamics of these instabilities, other physical effects (e.g. heat diffusion, freezing/melting, porosity, temperature dependent viscosity) likely play an important role in the evolution of these features. In this ongoing study, we examine the properties of unstably stratified fluids in which the lower less-dense ice has a temperature dependent viscosity. Surprisingly, we find that there exists an optimal disturbance length scale corresponding to the fastest growth of the Rayleigh-Taylor instability. For unstably stratified layers of water (low viscosity heavy liquid lying above an ice whose viscosity increases with depth) the fastest growing mode corresponds to 40-60 km scales with overturn times of approximately 100 days. We present a detailed numerical stability analysis in a corresponding Boussinessq model (in the creeping flow limit) incorporating thermal conduction and latent heat release and we examine the stability properties surveying a variety of parameters. We have also developed a two-dimensional numerical code (a hybrid spectral/compact-differencing scheme) to model the evolution of such systems for which we shall present preliminary numerical results depicting the outcome of

  7. Order parameter model for unstable multilane traffic flow

    OpenAIRE

    Lubashevsky, Ihor A.; Mahnke, Reinhard

    1999-01-01

    We discuss a phenomenological approach to the description of unstable vehicle motion on multilane highways that explains in a simple way the observed sequence of the phase transitions "free flow -> synchronized motion -> jam" as well as the hysteresis in the transition "free flow synchronized motion". We introduce a new variable called order parameter that accounts for possible correlations in the vehicle motion at different lanes. So, it is principally due to the "many-body" effects in the ...

  8. Unstable states produced in collisions among complex nuclei

    International Nuclear Information System (INIS)

    Sepulveda J, D.

    1978-01-01

    A theory about resonant elastic dispersion is formulated and the wave function of unstable states associated with the resonances observed in the differential and total sections is studied. The object of this theory is to extend to the elastic collisions among complex nuclei interesting case, the methods and formalism of the dispersion of particles without structure by an external potential, following an idea originally formulated by H. Feshbach. (author)

  9. ${ \\mathcal P }{ \\mathcal T }$-symmetric interpretation of unstable effective potentials

    CERN Document Server

    Bender, Carl M.; Mavromatos, Nick E.; Sarkar, Sarben

    2016-01-01

    The conventional interpretation of the one-loop effective potentials of the Higgs field in the Standard Model and the gravitino condensate in dynamically broken supergravity is that these theories are unstable at large field values. A ${ \\mathcal P }{ \\mathcal T }$-symmetric reinterpretation of these models at a quantum-mechanical level eliminates these instabilities and suggests that these instabilities may also be tamed at the quantum-field-theory level.

  10. Human muscular and postural responses in unstable load lifting.

    Science.gov (United States)

    Lee, Yung-Hui; Lee, Tzu-Hsien

    2002-09-01

    Most studies of manual material handling have focused on stable (fixed) loads. The muscular response during unstable load handling deserves more investigative attention. To investigate muscular and postural responses during unstable load lifting, and to quantify the threat posed by such loads in the workplace. Accurate assessment of load weight is important for lifters. Unfortunately, this information is not always available to individuals handling containers of liquids or shifting loads, or those encountering impact loading or a sudden unexpected load. In this study, 12 subjects were subjected to time-variant loads, in which a box weighing 18 kg was used to generate a sudden 12 (kg. m)/second load impact internally during the lifting process. Responses were investigated as a function of different load-shift conditions (anterior-to-posterior and posterior-to-anterior rolling loads and stable load), two foot placements (wide and narrow stance), and two lifting techniques (stoop and squat). Normalized electromyography signals, joint angles, and total linear length for center of pressure (COP-length) were investigated. Lifting an unstable load significantly increases total lifting time, COP-length, and muscular contraction levels. When responding to impact momentum, subjects attempted to lift with greater elbow extension and shoulder and trunk flexion. A more flexed knee joint (approximately an additional 5 degrees ) was observed during preparation for load impact in the anterior-to-posterior rolling task, allowing the formation of a more stable platform to compensate for the load variation. The largest erector spinae contraction for unstable lifting was approximately 12% to 25% greater maximal voluntary contraction than for the stable analog. The normalized electromyography data demonstrate that the central nervous system detects and responds to the need to stabilize the joints closest to the location of load-shift perturbation.

  11. Regularity and chaos in Vlasov evolution of unstable nuclear matter

    International Nuclear Information System (INIS)

    Jacquot, B.; Chomaz, Ph.; Guarnera, A.; Colonna, M.

    1996-01-01

    An analysis of the onset of chaos in mean-field dynamics in presence of volume instabilities is performed. As a main finding, it is shown that the mean-field evolution presents two different regimes: a first one dominated by the almost decoupled amplification of several collective unstable modes, leading to the early condensation of the system into clusters, which is followed by a second stage dominated by a coalescence mechanism among the large-density domains. (K.A.)

  12. The monitoring of unstable rock masses applied to risk management

    OpenAIRE

    POTHERAT, Pierre; DURANTHON, Jean Paul

    2010-01-01

    Rock mass fall case studies presented in this paper show that rupture occur after a more or less long preparation stage which is link to different parameters such as the rate of displacement or the volume and the morphology of the unstable mass. In all sites efficient safety decision could have been taken early enough, with an appropriate monitoring system, even in the case of cliff collapses that are generally considered as sudden movements impossible to anticipate. Kinematics criteria that ...

  13. CP Violation in Correlated Production and Decay of Unstable Particles

    CERN Document Server

    Kittel, Olaf

    2012-01-01

    We study resonant CP-violating Einstein--Podolsky--Rosen correlations that may take place in the production and decay of unstable scalar particles at high-energy colliders. We show that as a consequence of unitarity and CPT invariance of the S-matrix, in 2 --> 2 scatterings mediated by mixed scalar particles, at least three linearly independent decay matrices associated with the unstable scalar states are needed to obtain non-zero CP-odd observables that are also odd under C-conjugation. Instead, for the correlated production and decay of two unstable particle systems in 2 --> 4 processes, we find that only two independent decay matrices are sufficient to induce a net non-vanishing CP-violating phenomenon. As an application of this theorem, we present numerical estimates of CP asymmetries for the correlated production and decay of supersymmetric scalar top--anti-top pairs at the LHC, and demonstrate that these could reach values of order one. As a byproduct of our analysis, we develop a novel spinorial trace ...

  14. Oxygen Consumption While Standing with Unstable Shoe Design

    Directory of Open Access Journals (Sweden)

    Gasser Benedikt A.

    2014-09-01

    Full Text Available Purpose. This study explored the effects of unstable shoe design on oxygen consumption. Methods. Oxygen consumption (VO2 and heart rate (HR were measured in 16 individuals while barefoot, wearing unstable shoes (Masai Barefoot Technology and wearing conventional sport shoes while standing and walking on a treadmill and for 5 individuals while walking around a 400 m track. Results. When wearing the MBT shoes, a significant (p < 0.01 increase of 9.3 ± 5.2% in VO2 was measured while standing quietly for 6 min. No differences in VO2 and HR were observed between the MBT shoes or weight-adjusted conventional shoes (to match the weight of the MBT shoes while walking on a treadmill. However, significant increases (p < 0.01 in VO2 (4.4 ± 8.2% and HR (3.6 ± 7.3% were observed for the MBT shoes compared with being barefoot. No significant differences in VO2 and HR were recorded while walking around a 400 m track either with MBT shoes, weight-adjusted conventional shoes or barefoot. Nonetheless, a comparison of the MBT shoes with barefoot revealed a tendency for VO2 to be higher when wearing the MBT shoes (7.1 ± 6.5%, p < 0.1 although HR was not significantly affected. Conclusions. The unstable shoe design predominantly effects oxygen consumption while standing, most likely due to increased muscle activity of the lower extremities.

  15. Metastability in plyometric training on unstable surfaces: a pilot study

    Science.gov (United States)

    2014-01-01

    Background In the past, plyometric training (PT) has been predominantly performed on stable surfaces. The purpose of this pilot study was to examine effects of a 7-week lower body PT on stable vs. unstable surfaces. This type of exercise condition may be denoted as metastable equilibrium. Methods Thirty-three physically active male sport science students (age: 24.1 ± 3.8 years) were randomly assigned to a PT group (n = 13) exercising on stable (STAB) and a PT group (n = 20) on unstable surfaces (INST). Both groups trained countermovement jumps, drop jumps, and practiced a hurdle jump course. In addition, high bar squats were performed. Physical fitness tests on stable surfaces (hexagonal obstacle test, countermovement jump, hurdle drop jump, left-right hop, dynamic and static balance tests, and leg extension strength) were used to examine the training effects. Results Significant main effects of time (ANOVA) were found for the countermovement jump, hurdle drop jump, hexagonal test, dynamic balance, and leg extension strength. A significant interaction of time and training mode was detected for the countermovement jump in favor of the INST group. No significant improvements were evident for either group in the left-right hop and in the static balance test. Conclusions These results show that lower body PT on unstable surfaces is a safe and efficient way to improve physical performance on stable surfaces. PMID:25089202

  16. Trunk muscle electromyographic activity with unstable and unilateral exercises.

    Science.gov (United States)

    Behm, David G; Leonard, Allison M; Young, Warren B; Bonsey, W Andrew C; MacKinnon, Scott N

    2005-02-01

    The purpose of this cross-sectional study was to evaluate the effect of unstable and unilateral resistance exercises on trunk muscle activation. Eleven subjects (6 men and 5 women) between 20 and 45 years of age participated. Six trunk exercises, as well as unilateral and bilateral shoulder and chest presses against resistance, were performed on stable (bench) and unstable (Swiss ball) bases. Electromyographic activity of the upper lumbar, lumbosacral erector spinae, and lower-abdominal muscles were monitored. Instability generated greater activation of the lower-abdominal stabilizer musculature (27.9%) with the trunk exercises and all trunk stabilizers (37.7-54.3%) with the chest press. There was no effect of instability on the shoulder press. Unilateral shoulder press produced greater activation of the back stabilizers, and unilateral chest press resulted in higher activation of all trunk stabilizers, when compared with bilateral presses. Regardless of stability, the superman exercise was the most effective trunk-stabilizer exercise for back-stabilizer activation, whereas the side bridge was the optimal exercise for lower-abdominal muscle activation. Thus, the most effective means for trunk strengthening should involve back or abdominal exercises with unstable bases. Furthermore, trunk strengthening can also occur when performing resistance exercises for the limbs, if the exercises are performed unilaterally.

  17. From stable to unstable anomaly-induced inflation

    Energy Technology Data Exchange (ETDEWEB)

    Paula Netto, Tiberio de [Universidade Federal de Juiz de Fora, Departamento de Fisica, ICE, Juiz de Fora, MG (Brazil); Pelinson, Ana M. [Universidade Federal de Santa Catarina, Departamento de Fisica, CFM, Bairro da Trindade, Florianopolis, SC (Brazil); Shapiro, Ilya L. [Universidade Federal de Juiz de Fora, Departamento de Fisica, ICE, Juiz de Fora, MG (Brazil); Tomsk State Pedagogical University and Tomsk State University, Tomsk (Russian Federation); Starobinsky, Alexei A. [L.D. Landau Institute for Theoretical Physics RAS, Moscow (Russian Federation); Utrecht University, Department of Physics and Astronomy, Institute for Theoretical Physics, Utrecht (Netherlands)

    2016-10-15

    Quantum effects derived through conformal anomaly lead to an inflationary model that can be either stable or unstable. The unstable version requires a large dimensionless coefficient of about 5 x 10{sup 8} in front of the R{sup 2} term that results in the inflationary regime in the R+R{sup 2} (''Starobinsky'') model being a generic intermediate attractor. In this case the non-local terms in the effective action are practically irrelevant, and there is a 'graceful exit' to a low curvature matter-like dominated stage driven by high-frequency oscillations of R - scalarons, which later decay to pairs of all particles and antiparticles, with the amount of primordial scalar (density) perturbations required by observations. The stable version is a genuine generic attractor, so there is no exit from it. We discuss a possible transition from stable to unstable phases of inflation. It is shown that this transition is automatic if the sharp cut-off approximation is assumed for quantum corrections in the period of transition. Furthermore, we describe two different quantum mechanisms that may provide a required large R{sup 2}-term in the transition period. (orig.)

  18. Tratamento de angina mesentérica em pacientes com arterite de Takayasu Treatment of mesenteric angina in patients with Takayasu's arteritis

    Directory of Open Access Journals (Sweden)

    Luana Thayse Barros de Lima

    2011-04-01

    Full Text Available Aarterite de Takayasu (AT é uma doença inflamatória crônica do tecido conectivo, idiopática, que acomete preferencialmente a aorta e seus ramos. A terapêutica utilizada baseia-se sobretudo no uso de corticosteroides e imunossupressores. É relatado o caso de uma paciente, 33 anos, com mal-estar, febre, mialgia, cefaleia intensa, pulsátil, holocraniana, resistente a analgésicos, hipertensão arterial sistêmica de difícil controle, claudicação no membro inferior direito e dor abdominal de forte intensidade, a qual piorava após a alimentação. A angiotomografia revelou aneurisma da aorta ascendente, estenose da artéria ilíaca comum direita, estenose das artérias renais e estenose da artéria mesentérica superior, fato que embasou o diagnóstico de angina mesentérica e a conduta intervencionista através da angioplastia transluminal percutânea múltipla com a colocação de stents.Takayasu's arteritis (TA is an idiopathic chronic inflammatory disease of the connective tissue that affects mainly the aorta and its branches. Treatment is mainly based on corticosteroids and immunosuppressants. We report the case of a 33-year-old female complaining of malaise, fever, myalgia, severe pulsing holocranial headache resistant to analgesics, systemic arterial hypertension hard to control, right lower limb claudication, and severe abdominal pain that worsened after the meals. Angiotomography revealed aneurysm of the ascending aorta, and stenosis of the following vessels: right common iliac artery, renal arteries, and superior mesenteric artery. Those findings supported the diagnosis of mesenteric angina and the interventional approach by use of percutaneous transluminal angioplasty with stent placement.

  19. Mid term results after bone marrow laser revascularization for treating refractory angina

    Directory of Open Access Journals (Sweden)

    Caballero Paloma

    2010-09-01

    Full Text Available Abstract Background To evaluate the midterm results of patients with angina and diffuse coronary artery disease treated with transmyocardial revascularization in combination with autologous stem cell therapy. Methods Nineteen patients with diffuse coronary artery disease and medically refractory class III/IV angina were evaluated between June 2007 and December 2009 for sole therapy TMR combined with intramyocardial injection of concentrated stem cells. At the time of surgery, autologous bone marrow (120cc was aspirated from the iliac crest. A cardiac MRI and an isotopic test were performed before and after the procedure. Follow-up was performed by personal interview. Results There were no perioperative adverse events including no arrhythmias. Mean number of laser channels was 20 and the mean total number of intramyocardially injected cells per milliliter were: total mononuclear cells(83.6 × 106, CD34+ cells(0.6 × 106, and CD133+ cells(0.34 × 106. At 12 months mean follow-up average angina class was significantly improved (3.4 ± 0.5 vs 1.4 ± 0.6; p = 0.004. In addition, monthly cardiovascular medication usage was significantly decreased (348 ± 118 vs. 201 ± 92; p = 0.001. At six months follow up there was a reduction in the number of cardiac hospital readmissions (2.9 ± 2.3 vs. 0.5 ± 0.8; p Conclusions The stem cell isolator efficiently concentrated autologous bone marrow derived stem cells while the TMR/stem cell combination delivery device worked uneventfully. An improvement in clinical status was noticed in the midterm follow-up. Images test showed no morphological alterations in the left ventricle after the procedure.

  20. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2012-01-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  1. Ludwig's angina in children anesthesiologist's nightmare: Case series and review of literature

    Directory of Open Access Journals (Sweden)

    Maitree Pandey

    2017-01-01

    Full Text Available Ludwig's angina is potentially lethal, rapidly spreading cellulitis of the floor of mouth and neck. The anticipated difficult airway becomes even more challenging when it occurs in children. In children, the larynx is positioned relatively higher in the neck, and one does not have the option for blind nasal intubation or awake fiberoptic, which otherwise is the technique of choice in adult patients. We present the clinical course of 16 children and highlight various problems encountered during the anesthetic management of six children who required emergency surgical drainage under general anesthesia.

  2. A Giant Verrucous Carcinoma of the Penis Presenting with Urinary Sepsis and Angina

    Directory of Open Access Journals (Sweden)

    Michael Nomikos

    2014-01-01

    Full Text Available Penile verrucous carcinoma also known as Buschke-Löwenstein tumor in the genital region is an uncommon variant of penile carcinoma exhibiting slow, expansive growth. We present a case of a 63-year-old male who presented with a giant purulent penile mass causing urinary sepsis and angina. Regional lymph nodes were clinically negative and staging with CT scans of thorax and abdomen did not show any signs of lymph node or distant metastases. After resuscitation, radical penectomy was performed and a perineal urethrostomy was created. Histological examination revealed a Buschke-Löwenstein tumor of the penis with no invasion of corpus cavernosum and urethra.

  3. Economic evaluation of trimetazidine in the management of chronic stable angina in Greece

    OpenAIRE

    Kourlaba, Georgia; Gourzoulidis, George; Andrikopoulos, George; Tsioufis, Konstantinos; Beletsi, Alexandra; Maniadakis, Nikos

    2016-01-01

    Background To evaluate the cost-effectiveness of trimetazidine (TMZ) as add-on therapy to standard-of-care (SoC) compared to SoC alone in patients with chronic stable angina who did not respond adequately to first line therapy with b-blockers, nitrates or calcium channel antagonists in Greece. Methods A Markov model with 3-month cycles and 1-year time horizon was developed to assess the comparators. The analysis was conducted from a third-party payer perspective. The clinical inputs and utili...

  4. A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures

    Directory of Open Access Journals (Sweden)

    Daniele Massera

    2015-01-01

    Full Text Available A 60-year-old man presented with typical angina and had a positive stress test. He declined both drug therapy and invasive testing. Instead, he chose to adopt a whole-food plant-based diet, which consisted primarily of vegetables, fruits, whole grains, potatoes, beans, legumes, and nuts. His symptoms improved rapidly, as well as his weight, blood pressure, and cholesterol levels. Plant-based diets have been associated with improved plasma lipids, diabetes control, coronary artery disease and with a reduction in mortality. Adoption of this form of lifestyle therapy should be among the first recommendations for patients with atherosclerosis.

  5. Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris

    DEFF Research Database (Denmark)

    Ong, Peter; Aziz, Ahmed; Hansen, Henrik Steen

    2015-01-01

    Coronary spasm is involved in many clinical scenarios, such as stable angina, acute coronary syndrome, sudden cardiac death, non-ischemic cardiomyopathy, arrhythmia and syncope. In recent years, imaging tools such as computerized tomographic angiography, intravascular ultrasound or optical...... of vascular smooth muscle hyperreactivity leading to spasm caused by various factors that may also overlap. Focal coronary spasm is related to epicardial atherosclerosis and in the presence of obstructive coronary artery disease it may be useful to treat the lesion to prevent further spasm. The aim...

  6. Ludwig's angina in children anesthesiologist's nightmare: Case series and review of literature.

    Science.gov (United States)

    Pandey, Maitree; Kaur, Manpreet; Sanwal, Manoj; Jain, Aruna; Sinha, Sunil K

    2017-01-01

    Ludwig's angina is potentially lethal, rapidly spreading cellulitis of the floor of mouth and neck. The anticipated difficult airway becomes even more challenging when it occurs in children. In children, the larynx is positioned relatively higher in the neck, and one does not have the option for blind nasal intubation or awake fiberoptic, which otherwise is the technique of choice in adult patients. We present the clinical course of 16 children and highlight various problems encountered during the anesthetic management of six children who required emergency surgical drainage under general anesthesia.

  7. Management of Ludwig's Angina in Pregnancy: A Review of 10 Cases.

    Science.gov (United States)

    Osunde, Od; Bassey, Go; Ver-Or, N

    2014-05-01

    Ludwig's angina is a rapidly spreading cellulitis that may produce upper airway obstruction often leading to death. The present paper reviews the management of Ludwig's angina in the third trimester of pregnancy. The inherent dangers to the mother and her unborn child are highlighted. The case files of pregnant patients who had emergent incision and drainage for life-threatening facial cellulitis at the maxillofacial unit of the Murtala Mohammed Specialist Hospital in Kano, Nigeria, over a 2 year period were retrieved and demographic and clinical characteristics were retrospectively obtained and analyzed descriptively using the statistical package for social sciences (SPSS version 13.0, for Windows, September 2004, Chicago, Illinois). Comparative statistics were determined using Pearson's Chi-square, Fisher's exact tests and independent t tests as appropriate. A P value of less than 0.05 was considered significant. A total of 10 patients were seen within the study period, age ranges from 23 to 40 years, mean 29.5 (5.3) years. Majority of the women were in their third decade [60% (6/10)] while the remaining 40% (4/10) were in their fourth decade of life. Two of the patients presented within the period of less than 1 week of onset of symptoms while those who presented within the periods of 1-2 weeks and periods of over 2 weeks accounted for 50% (5/10) and 30% (3/10) respectively. All the patients presented during the third trimester of their pregnancy and odontogenic infections were responsible for 80% (8/10) of the Ludwig's angina. There were 20% mortality among the patients and this was significant for those with underlying systemic conditions (P = 0.02). The time of presentation was not significant for the survival rate of the gravid patient (P = 0.36) but was significant for survival of the fetus (P = 0.01). During a life-threatening infectious situation such as Ludwig's angina, risks of maternal and fetal morbidity include both septicemia and asphyxia. Attending

  8. Problemas de adaptación fisiológica en personas con angina

    OpenAIRE

    Nóbrega Fortes, Allyne; Martins da Silva, Viviane; Lopes, Marcos Venícios de Oliveira

    2006-01-01

    En este artículo fueron identificados los problemas comunes de adaptación fisiológica presentados por pacientes con angina inestable teniendo como base el Modelo de la Adaptación de Callista Roy. Estudio descriptivo desarrollado en un hospital de servicio especializado en enfermedades cardíacas. La muestra para el estudio fue de 20 pacientes. Para caracterización y discusión, utilizamos las definiciones presentadas por Roy para cada problema de adaptación fisiológic...

  9. Mesenchymal stromal cell derived endothelial progenitor treatment in patients with refractory angina

    DEFF Research Database (Denmark)

    Friis, Tina; Haack-Sørensen, Mandana; Mathiasen, Anders B

    2011-01-01

    Abstract Aims. We evaluated the feasibility, safety and efficacy of intra-myocardial injection of autologous mesenchymal stromal cells derived endothelial progenitor cell (MSC) in patients with stable coronary artery disease (CAD) and refractory angina in this first in man trial. Methods......-myocardial injection of MSC. After six months follow-up myocardial perfusion was unaltered, but the patients increased exercise capacity (p ... patients with stable CAD with autologous culture expanded MSC. Moreover, MSC treated patients had significant improvement in left ventricular function and exercise capacity, in addition to an improvement in clinical symptoms and SAQ evaluations....

  10. Manejo de la angina refractaria con estimulación eléctrica espinal: revisión de la literatura Treatment of refractory chest angina with spinal electrical stimulator: literature review

    Directory of Open Access Journals (Sweden)

    Omar F Gomezese

    2008-06-01

    Full Text Available Justificación: existe un grupo de pacientes con angina de pecho crónica refractaria, que no son candidatos a revascularización quirúrgica o percutánea y que a pesar de recibir un manejo médico óptimo, aún experimentan severos episodios de angina. El estimulador eléctrico espinal es un neuromodulador que se emplea como alternativa de manejo en estos pacientes. Objetivos: se realizó una revisión sobre estimulación eléctrica espinal en el manejo de la angina, su mecanismo de acción, sus beneficios y su costo-efectividad. Materiales y métodos: se llevó a cabo una búsqueda en MedLine, según la metodología Cochrane, de artículos publicados desde enero de 1980 a enero de 2007, mediante los términos «spinal cord stimulation» de ésta se seleccionaron los manuscritos que los autores consideraron relevantes. Conclusiones: el efecto anti-isquémico del estimulador espinal eléctrico reduce los episodios de angina de pecho, mejora la calidad de vida y la tolerancia al ejercicio, disminuye la estancia hospitalaria y retarda la aparición de signos de isquemia.Justification: there is a group of patients with chronic refractory chest angina, who are not ideal candidates for surgical or percutaneous revascularization and who although having a good medical handling continue to experience severe episodes of angina. The spinal electrical stimulator is a neuromodulator used as an alternative to treat these patients. Objectives: to realize a review of scientific literature regarding the spinal electric stimulation in the treatment of chest angina, its mechanism of action, benefits and its cost effectiveness. Materials and methods: using the Cochrane methodology, a search of articles published from January 1980 to January 2007 in Medline using the terms «spinal cord stimulation», was realized. The papers considered most pertinent were selected. Conclusions: the anti-ischemic effect of the electrical spinal stimulator reduces the episodes of

  11. Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events

    DEFF Research Database (Denmark)

    Jespersen, L.; Hvelplund, A.; Abildstrom, S. Z.

    2012-01-01

    Aims Patients with chest pain and no obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce. We investigated the prognostic implications of stable angina pectoris in relation to the presence and degree of CAD with no o...... with stable angina and normal coronary arteries or diffuse non-obstructive CAD have elevated risks of MACE and all-cause mortality compared with a reference population without ischaemic heart disease.......Aims Patients with chest pain and no obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce. We investigated the prognostic implications of stable angina pectoris in relation to the presence and degree of CAD...... (MACE), defined as cardiovascular death, myocardial infarction, stroke or heart failure, and all-cause mortality. Significantly more women (65%) than men (32%) had no obstructive CAD (P

  12. Accelerated collagen turnover in women with angina pectoris without obstructive coronary artery disease: An iPOWER substudy

    DEFF Research Database (Denmark)

    Nielsen, Signe H; Mygind, Naja D; Michelsen, Marie M

    2018-01-01

    , but without significant obstructive coronary artery disease, showed an imbalanced collagen turnover compared to asymptomatic controls. The examined biomarkers are tools to monitor active collagen remodelling in patients with angina pectoris, in risk of developing myocardial fibrosis........ Cardiac magnetic resonance T1 mapping was performed to determine extracellular volume fraction and thus diffuse myocardial fibrosis. A significant association was identified between C5M and extracellular volume fraction by cardiac magnetic resonance (p = 0.01). Conclusion: Women with angina pectoris...... patients with diffuse myocardial fibrosis from asymptomatic controls. Methods and results: Seventy-one women with angina pectoris without significant coronary artery disease assessed by invasive coronary angiogram were included. Competitive enzyme-linked immunosorbent assays (ELISAs) measuring circulating...

  13. A Series of Unfortunate Events: Prinzmetal Angina Culminating in Transmural Infarction in the Setting of Acute Gastrointestinal Hemorrhage

    Science.gov (United States)

    Ruisi, Phillip; Rosero, Hugo; Schweitzer, Paul

    2013-01-01

    Prinzmetal angina or vasospastic angina is a clinical phenomenon that is often transient and self-resolving. Clinically it is associated with ST elevations on the electrocardiogram, and initially it may be difficult to differentiate from an acute myocardial infarction. The vasospasm induced in this setting occurs in normal or mildly to moderately diseased vessels and can be triggered by a number of etiologies including smoking, changes in autonomic activity, or drug ingestion. While the ischemia induced is usually transient, myocardial infarction and life-threatening arrhythmias can occur in 25% of cases. We present the case of a 65-year-old female where repetitive intermittent coronary vasospasm culminated in transmural infarction in the setting of gastrointestinal bleeding. This case highlights the mortality associated with prinzmetal angina and the importance of recognizing the underlying etiology. PMID:24826293

  14. Unstable Roche-Lobe Overflow of Gaseous Planets

    Science.gov (United States)

    Jackson, Brian

    The discoveries of more than 100 roughly Earth-sized bodies with orbital periods less than 1 day, ultra-short-period planets or candidates (USPs), have challenged planet formation theories, and evidence suggests USPs may be the remnants of gaseous planets that shed their atmospheres. Indeed, many hot Jupiters are near Roche-Lobe overflow (RLO), and tidal decay can push them the rest of the way in. Recent work has shown stable RLO (atmospheres lost via a steady outflow and thin accretion disk) probably cannot produce USPs on its own but suggested unstable RLO (atmospheres quickly shed on dynamical timescales) may. In fact, stable RLO may drive overflowing hot Jupiters into unstable RLO, and by analogy with the common-envelope binaries, the core that remains can drive off the gaseous envelope at the cost of its orbital energy. Wellestablished mass-radius relations for gaseous planets, coupled to simple energy and angular momentum considerations, provide a connection between the observed masses and periods for USPs and their putative progenitor gaseous planets, with few free parameters. We propose to investigate the hypothesis that USPs originate through tidal decay and a combination of stable and unstable Roche-lobe overflow of short-period gaseous planets through the following studies: -We will explore the planetary masses, orbital periods, etc. that produce unstable RLO using the Modules for Experiments in Stellar Astrophysics (MESA) suite. -We will relate the observed periods and masses of USPs to their putative progenitor masses and periods to see whether they are consistent with the unstable RLO hypothesis. This proposal is directly relevant to the Exoplanets Research Program since it seeks to "understand the ... physical processes of exoplanets" and "improve understanding of [their] origins" through "theoretical studies ... and modeling'". We also expect that it will have broad impacts on a variety of astrophysical topics: -Ultra-short period planets could

  15. Angina Bullosa Hemorrhagica with a Possible Relation to Dental Treatment, Diabetes Mellitus, Steroid Inhaler and Local Trauma: Report of 3 Cases

    Directory of Open Access Journals (Sweden)

    S M Ravi Prakash

    2010-01-01

    Full Text Available Angina bullosa hemorrhagica is a rare condition characterized by one or more blood filled blisters or bullae predominantly in the soft palate region caused either by local mucosal trauma, dental treatment, underlying systemic conditions or use of steroid inhalers. We report three cases of angina bullosa hemorrhagica with different etiological factors.

  16. Study protocol: a randomised controlled trial investigating the effect of exercise training on peripheral blood gene expression in patients with stable angina

    Directory of Open Access Journals (Sweden)

    Crossman David C

    2010-10-01

    Full Text Available Abstract Background Exercise training has been shown to reduce angina and promote collateral vessel development in patients with coronary artery disease. However, the mechanism whereby exercise exerts these beneficial effects is unclear. There has been increasing interest in the use of whole genome peripheral blood gene expression in a wide range of conditions to attempt to identify both novel mechanisms of disease and transcriptional biomarkers. This protocol describes a study in which we will assess the effect of a structured exercise programme on peripheral blood gene expression in patients with stable angina, and correlate this with changes in angina level, anxiety, depression, and exercise capacity. Methods/Design Sixty patients with stable angina will be recruited and randomised 1:1 to exercise training or conventional care. Patients randomised to exercise training will attend an exercise physiology laboratory up to three times weekly for supervised aerobic interval training sessions of one hour in total duration. Patients will undergo assessments of angina, anxiety, depression, and peripheral blood gene expression at baseline, after six and twelve weeks of training, and twelve weeks after formal exercise training ceases. Discussion This study will provide comprehensive data on the effect of exercise training on peripheral blood gene expression in patients with angina. By correlating this with improvement in angina status we will identify candidate peripheral blood transcriptional markers predictive of improvements in angina level in response to exercise training. Trial Registration Clinicaltrials.gov identifier: NCT01147952

  17. Unstable rarefied gas flow conditions in a channel

    Science.gov (United States)

    Aksenova, Olga A.; Khalidov, Iskander A.

    2016-11-01

    Nonlinear dynamic system corresponding to rarefied gas flow in a channel is investigated. Under certain conditions corresponding iterative equations may have unstable solutions in some regions of the values of gas-surface interaction parameters [1]. Numerical calculations have demonstrated that a negligible change of one of the parameters of scattering function (less than 1%) near the bifurcation points causes the substantial difference in gas flow in a channel. As well non-random solutions as random solutions can be observed on bifurcation diagrams. Some of obtained solutions have a physical meaning of locking the channel, i.e. its conductivity reduces significantly. The scattering function is supposed to be close to ray-diffuse model, where the ray model, as well as the specular model, determines only one velocity of reflected gas atoms by given incident velocity. The ray-diffuse model has better experimental confirmation in comparison with the specular-diffuse model widely applied in practical DSMC calculations. However, the problem of the empirical confirmation of the obtained numerically effect is still difficult, because the scattering conditions of this type are hardly reproducible experimentally. To verify the bifurcations of simulated type experimentally all considered physical values in the flows are to be set exactly to the same values as detected in our calculations. Adding the extra parameter of scattering function allows us extending the region where considered dynamic system (related to rarefied gas flow) is unstable in the parametric space. Simulated unstable states of the system are close to physical situations observed in experiments. Obtained connection between the parameters of nonlinear dynamic system and momentum exchange coefficients (or accommodation coefficients) makes it possible to express analytic evaluations in terms of aerodynamic characteristics including Knudsen and Mach numbers, temperature factor etc.

  18. Strategy switching in the stabilization of unstable dynamics.

    Directory of Open Access Journals (Sweden)

    Jacopo Zenzeri

    Full Text Available In order to understand mechanisms of strategy switching in the stabilization of unstable dynamics, this work investigates how human subjects learn to become skilled users of an underactuated bimanual tool in an unstable environment. The tool, which consists of a mass and two hand-held non-linear springs, is affected by a saddle-like force-field. The non-linearity of the springs allows the users to determine size and orientation of the tool stiffness ellipse, by using different patterns of bimanual coordination: minimal stiffness occurs when the two spring terminals are aligned and stiffness size grows by stretching them apart. Tool parameters were set such that minimal stiffness is insufficient to provide stable equilibrium whereas asymptotic stability can be achieved with sufficient stretching, although at the expense of greater effort. As a consequence, tool users have two possible strategies for stabilizing the mass in different regions of the workspace: 1 high stiffness feedforward strategy, aiming at asymptotic stability and 2 low stiffness positional feedback strategy aiming at bounded stability. The tool was simulated by a bimanual haptic robot with direct torque control of the motors. In a previous study we analyzed the behavior of naïve users and we found that they spontaneously clustered into two groups of approximately equal size. In this study we trained subjects to become expert users of both strategies in a discrete reaching task. Then we tested generalization capabilities and mechanism of strategy-switching by means of stabilization tasks which consist of tracking moving targets in the workspace. The uniqueness of the experimental setup is that it addresses the general problem of strategy-switching in an unstable environment, suggesting that complex behaviors cannot be explained in terms of a global optimization criterion but rather require the ability to switch between different sub-optimal mechanisms.

  19. Health care for homeless and unstably housed: overcoming barriers.

    Science.gov (United States)

    Rabiner, Mark; Weiner, Amy

    2012-01-01

    The causes of homelessness are complex and multifactorial and the solutions equally complex. Though homelessness is not a disease process, it is directly linked to poor health outcomes. It is thus incumbent on health care professionals to know the various definitions of homelessness, the ramifications of unstable housing, and the specific living conditions of each homeless patient. These factors needed to be accounted for when designing treatment plans in a way that will increase access to care and promote adherence. Increasing compliance and addressing barriers to care will improve outcomes and may reduce overall health expenditures. © 2012 Mount Sinai School of Medicine.

  20. Unstable volatility functions: the break preserving local linear estimator

    DEFF Research Database (Denmark)

    Casas, Isabel; Gijbels, Irene

    The objective of this paper is to introduce the break preserving local linear (BPLL) estimator for the estimation of unstable volatility functions. Breaks in the structure of the conditional mean and/or the volatility functions are common in Finance. Markov switching models (Hamilton, 1989......) and threshold models (Lin and Terasvirta, 1994) are amongst the most popular models to describe the behaviour of data with structural breaks. The local linear (LL) estimator is not consistent at points where the volatility function has a break and it may even report negative values for finite samples...

  1. Effects of medium and gain inhomogeneities in unstable optical resonators.

    Science.gov (United States)

    Santana, C; Felsen, L B

    1977-04-01

    A previously formulated waveguide analysis of empty unstable optical resonators with finite mirrors is generalized to accommodate active media with transverse variations of refractive index and gain. The theory is developed for parallel plane mirrors and arbitrary medium inhomogeneities and is then applied to special profiles for which explicit analytical solutions can be obtained. Emphasis is placed on modifications, due to the active medium, of the edge-diffraction-dominated resonant mode behavior. It is found that even slight variations in refractive index can exert a marked influence on the resonant mode characteristics. These conclusions remain applicable also for curved mirror geometries.

  2. Correlations of Decay Times of Entangled Composite Unstable Systems

    Science.gov (United States)

    Durt, Thomas

    2013-01-01

    The role played by time in the quantum theory is still mysterious by many aspects. In particular it is not clear today whether the distribution of decay times of unstable particles could be described by a time operator (TO). As we shall discuss, different approaches to this problem (one could say interpretations) can be found in the literature on the subject. As we shall show, it is possible to conceive crucial experiments aimed at distinguishing the different approaches, by measuring with accuracy the statistical distribution of decay times of entangled particles. Such experiments can be realized in principle with entangled kaon pairs.

  3. On the definition of entropy for quantum unstable states

    International Nuclear Information System (INIS)

    Civitarese, Osvaldo; Gadella, Manuel

    2015-01-01

    The concept of entropy is central to the formulation of the quantum statistical mechanics, and it is linked to the definition of the density operator and the associated probabilities of occupation of quantum states. The extension of this scheme to accommodate for quantum decaying states is conceptually difficult, because of the nature of these states. Here we present a way to treat quantum unstable states in the context of statistical mechanics. We focuss on the definition of the entropy and avoid the use of complex temperatures

  4. Unstable Systems and Quantum Zeno Phenomena in Quantum Field Theory

    Science.gov (United States)

    Facchi, P.; Pascazio, S.

    2003-02-01

    We analyze the Zeno phenomenon in quantum field theory. The decay of an unstable system can be modified by changing the time interval between successive measurements (or by varying the coupling to an external system that plays the role of measuring apparatus). We speak of quantum Zeno effect if the decay is slowed and of inverse quantum Zeno (or Heraclitus) effect if it is accelerated. The analysis of the transition between these two regimes requires close scrutiny of the features of the interaction Hamiltonian. We look in detail at quantum field theoretical models of the Lee type.

  5. Porter-Thomas distribution in unstable many-body systems

    International Nuclear Information System (INIS)

    Volya, Alexander

    2011-01-01

    We use the continuum shell model approach to explore the resonance width distribution in unstable many-body systems. The single-particle nature of a decay, the few-body character of the interaction Hamiltonian, and the collectivity that emerges in nonstationary systems due to the coupling to the continuum of reaction states are discussed. Correlations between the structures of the parent and daughter nuclear systems in the common Fock space are found to result in deviations of decay width statistics from the Porter-Thomas distribution.

  6. Is a Doubly Quantized Vortex Dynamically Unstable in Uniform Superfluids?

    Science.gov (United States)

    Takeuchi, Hiromitsu; Kobayashi, Michikazu; Kasamatsu, Kenichi

    2018-02-01

    We revisit the fundamental problem of the splitting instability of a doubly quantized vortex in uniform single-component superfluids at zero temperature. We analyze the system-size dependence of the excitation frequency of a doubly quantized vortex through large-scale simulations of the Bogoliubov-de Gennes equation, and find that the system remains dynamically unstable even in the infinite-system-size limit. Perturbation and semi-classical theories reveal that the splitting instability radiates a damped oscillatory phonon as an opposite counterpart of a quasi-normal mode.

  7. A randomized double-blind placebo-controlled crossover trial of sodium nitrate in patients with stable angina INAS.

    Science.gov (United States)

    Schwarz, Konstantin; Singh, Satnam; Parasuraman, Satish Kumar; Bruce, Maggie; Shepstone, Lee; Feelisch, Martin; Minnion, Magdalena; Ahmad, Shakil; Horowitz, John; Dawson, Dana K; Frenneaux, Michael P

    2016-11-01

    In an aging western population, a significant number of patients continue to suffer from angina once all revascularization and optimal medical treatment options are exhausted. Under experimental conditions, oral supplementation with inorganic nitrate was shown to exhibit a blood pressure-lowering effect, and has also been shown to promote angiogenesis, improve endothelial dysfunction and mitochondrial efficiency in skeletal muscle. It is unknown whether similar changes occur in cardiac muscle. In the current study, we investigate whether oral sodium nitrate treatment will improve myocardial ischemia in patients with stable angina.

  8. A chaotic system with a single unstable node

    Energy Technology Data Exchange (ETDEWEB)

    Sprott, J.C. [Department of Physics, University of Wisconsin, Madison, WI 53706 (United States); Jafari, Sajad, E-mail: sajadjafari@aut.ac.ir [Biomedical Engineering Department, Amirkabir University of Technology, Tehran 15875-4413 (Iran, Islamic Republic of); Pham, Viet-Thanh [School of Electronics and Telecommunications, Hanoi University of Science and Technology, 01 Dai Co Viet, Hanoi (Viet Nam); Hosseini, Zahra Sadat [Biomedical Engineering Department, Amirkabir University of Technology, Tehran 15875-4413 (Iran, Islamic Republic of)

    2015-09-25

    This paper describes an unusual example of a three-dimensional dissipative chaotic flow with quadratic nonlinearities in which the only equilibrium is an unstable node. The region of parameter space with bounded solutions is relatively small as is the basin of attraction, which accounts for the difficulty of its discovery. Furthermore, for some values of the parameters, the system has an attracting torus, which is uncommon in three-dimensional systems, and this torus can coexist with a strange attractor or with a limit cycle. The limit cycle and strange attractor exhibit symmetry breaking and attractor merging. All the attractors appear to be hidden in that they cannot be found by starting with initial conditions in the vicinity of the equilibrium, and thus they represent a new type of hidden attractor with important and potentially problematic engineering consequences. - Highlights: • An unusual example of a three-dimensional dissipative chaotic flow is introduced. • In this system the only equilibrium is an unstable node. • For some values of the parameters, the system has an attracting torus. • This torus can coexist with a strange attractor or with a limit cycle. • These properties are uncommon in three-dimensional systems.

  9. Anatomical reconstruction of unstable trochanteric fractures through posterior approach

    Directory of Open Access Journals (Sweden)

    Partha Saha

    2015-01-01

    Full Text Available Objective Unstable intertrochanteric fractures continue to be a challenge for orthopedic surgeons due to the functional limitations it results in the postoperative period. Anatomical reconstruction of the posteromedial fragment becomes difficult through conventional lateral approach, leading to excessive fracture collapse and limping. Materials and Methods: prospective, nonrandomized study was done with 40 patients. They were operated in prone position through posterior approach. Cancellous screws or SS-wires were used to fix the greater or lesser trochanteric fragments and dynamic hip screw (DHS or dynamic condylar screw (DCS for the main two fragments. Bone grafts were used to pack cavities at the posterior trochanteric regions. Results: Fracture healing occurred earlier compared to conventional lateral approach without excessive fracture collapse in majority of cases (average time to achieve union was 13.8 weeks; range: 10–18 weeks. Good functional recovery was noted with 75% 'Good' or 'Excellent' Harris Hip Scores at 24 weeks. Conclusion: Anatomical reconstruction of unstable trochanteric fractures becomes easier through posterior approach with earlier and better functional recovery.

  10. Boundary Between Stable and Unstable Regimes of Accretion

    Directory of Open Access Journals (Sweden)

    Blinova A. A.

    2014-01-01

    Full Text Available We investigated the boundary between stable and unstable regimes of accretion and its dependence on different parameters. Simulations were performed using a “cubed sphere" code with high grid resolution (244 grid points in the azimuthal direction, which is twice as high as that used in our earlier studies. We chose a very low viscosity value, with alpha-parameter α=0.02. We observed from the simulations that the boundary strongly depends on the ratio between magnetospheric radius rm (where the magnetic stress in the magnetosphere matches the matter stress in the disk and corotation radius rcor (where the Keplerian velocity in the disk is equal to the angular velocity of the star. For a small misalignment angle of the dipole field, Θ = 5°, accretion is unstable if rcor/rm> 1.35, and is stable otherwise. In cases of a larger misalignment angle of the dipole, Θ = 20°, instability occurs at slightly larger values, rcor/rm> 1.41

  11. Clinical evaluation of efonidipine hydrochloride in angina pectoris. Evaluation in exercise 201Tl myocardial scintigraphy

    International Nuclear Information System (INIS)

    Hori, Masatsugu; Nishimura, Tsunehiko

    1996-01-01

    Clinical usefulness of once-daily administration of 20 to 60 mg of efonidipine hydrochloride and coronary hemodynamics during exercise 201 Tl myocardial scintigraphy were investigated in patients with angina pectoris. Out of 11 patients enrolled in this study, 9 patients were included in the evaluation of patients' impression, in improvement rating in subjective symptoms, in the analysis of the exercise test, in the improvement rating of images on 201 Tl myocardial scintigraphy, and in the global improvement rating, while 10 patients were included in the overall safety rating. Four patients in improvement rating in subjective symptoms, 2 in improving rating in the exercise test, and 5 in the global improvement rating were rated 'improved' or better. In the improvement rating on the exercise 201 Tl myocardial scintigraphy image, reduction of the image was observed in 5 patients, 3 out of which were evaluated as 'improved' or better. A distinctive reduction of ischemic regions was observed in 2 patients out of the 3. A significant decrease in the number of angina pectoris events and a decreasing tendency in consumption of fast-acting nitrates were observed in spite of the low number of the patients studied. An adverse effect was observed in 1 patient and abnormal laboratory values were observed in 2 patients which were improved promptly after withdrawal of the drug. It was in 7 patients evaluated as 'no problem', while in 4 patients it was evaluated as 'useful' or more. (author)

  12. [Angina morbidity in an organized collective with a periodic turnover of its personnel].

    Science.gov (United States)

    Sobolev, V I; Beliakov, V D; Briko, N I

    1993-02-01

    The article studies the average angina morbidity in the military unit during 9 years which resulted in 48.4% (scarlet fever--0.34%). Laboratory diagnostics is needed to make the estimation of streptococcal infection which has an acute respiratory infectious character during its clinical course. Among the whole number of patients 89.2% have come through this illness for one time, 9% twice, and 4.8%--three times. The dynamics of the angina morbidity had a periodical cycle of 2-3 years which was independent from the morbidity cycle of local civilian population. The authors show a statistic dependency between average morbidity index and the quantity of servicemen in one dormitory, its square and volume per one man. Application of "time before illness" index for 24 months made it possible to disclose the phase character in the development of streptococcal infection among personnel of the same call-up period. The general tendency towards reduction of the morbidity index was accompanied with regular upgrades of the infection after each spring or autumn renovation of personnel.

  13. Psychometric properties of a specific quality of life questionnaire in angina pectoris patients.

    Science.gov (United States)

    Marquis, P; Fayol, C; Joire, J E; Leplège, A

    1995-12-01

    This paper describes the psychometric properties of the French version of the APQLQ (Angina Pectoris Quality of Life Questionnaire), that is to say, scaling assumptions, reliability and validity. This disease-specific Swedish questionnaire provides a global score as well as four subscores measuring physical activities, somatic symptoms, emotional distress, and life satisfaction. The French version was produced according to the forward-backward translation methodology. In a cross-sectional study, 183 coronary patients filled out the APQLQ and the MOS (Medical Outcomes Study) SF-36; 170 sent it back; the rate of missing data was low (1.3%). The factorial structure and the high level of inter-scale correlations (> 0.60) suggested that the APQLQ measured one global concept rather than separate domains. The multitrait analysis identified one problematic item correlated strongly with all domains. The internal consistency was good (alpha Cronbach > 0.70). The correlations with the SF-36 scales were consistent with what was expected. The distribution of the scores of the APQLQ according to the clinical severity of Angina Pectoris (AP) was as hypothesized: the more severe the AP, the more impaired the Quality of Life. The score significantly discriminated between symptomatic (n = 110) and asymptomatic patients (n = 60) except for the emotional distress scale (p = 0.14). We recommend to analyze the French APQLQ as an index rather than as a profile. Its reliability, concurrent and clinical validity allowed its use in clinical trials.

  14. Effect of oral aminophylline in patients with angina and normal coronary arteriograms (cardiac syndrome X).

    Science.gov (United States)

    Elliott, P. M.; Krzyzowska-Dickinson, K.; Calvino, R.; Hann, C.; Kaski, J. C.

    1997-01-01

    BACKGROUND: Patients with syndrome X (exertional angina, positive exercise test, normal coronary arteriogram) have an altered perception of cardiac pain. This symptom may arise from increased sensitivity to adenosine. Previous studies suggest that intravenous aminophylline (an adenosine receptor blocker) improves exercise tolerance in patients with this disorder. OBJECTIVE: To examine the efficacy of oral aminophylline in syndrome X. METHODS: 13 patients (11 women and two men, mean (SD) 54 (6) years) with syndrome X were studied. Patients were randomised in a double blind crossover study to receive either oral aminophylline or placebo for three weeks. All patients underwent symptom limited exercise testing and ambulatory electrocardiography at the end of each three week period. RESULTS: 10 patients completed the study. The time to angina during exercise testing in patients who were given aminophylline was longer than for the placebo group (mean (SD) 632 (202) seconds v 522 (264) seconds, P = 0.004). Peak exercise ST depression did not differ significantly between patients who received aminophylline and those administered placebo (mean (SD) -1.9 (0.7) mm v -1.5 (0.8) mm). Six patients taking aminophylline reported a reduction in the total number of episodes of chest pain during the three weeks, but the frequency and duration of ST segment depression during Holter monitoring was unchanged. CONCLUSION: Oral aminophylline has a favourable effect on exercise induced chest pain threshold in patients with syndrome X. The disparate effects on symptoms and ST segment changes are intriguing and further study is warranted. PMID:9227295

  15. Addition of felodipine to metoprolol vs replacement of metoprolol by felodipine in patients with angina pectoris despite adequate beta-blockade - Results of the felodipine ER and metoprolol CR in angina (FEMINA) study

    NARCIS (Netherlands)

    Dunselman, P; Liem, AH; Verdel, G; Kragten, H; Bosma, A; Bernink, P

    1997-01-01

    Aims The study aimed to compare the addition of felodipine to metoprolol, and of the replacement of metoprolol by felodipine, with continuation of metoprolol, in patients with angina pectoris despite optimal beta-blockade. Methods and results The study was double-blind, parallel, randomized and

  16. Stable angina

    Science.gov (United States)

    ... Most occur between 6 a.m. and noon. Exams and Tests Your health care provider will examine you and check your blood pressure. Tests that may be done include: Coronary angiography Blood cholesterol profile ECG Exercise tolerance test (stress test or treadmill test) Nuclear medicine (thallium) stress ...

  17. Epileptic Angina ?

    OpenAIRE

    Sureshbabu, Sachin; Nayak, Dinesh; Peter, Sudhir; Sobhana, Chindripu; Mittal, Gaurav

    2017-01-01

    Purpose: To investigate the probable ictal origin of unexplained episodic chest pain and if possible to lateralize and localize the epileptic focus. Methods: A 14 year old boy presented with episodic short lasting localized chest pain. His cardiac and other systemic work-up were normal. MRI brain did not reveal any structural pathology. Video telemetry was done for characterization of the paroxysms. Results: Interictal record showed left fronto-central epileptiform discharges. A left he...

  18. Percutaneous Device to Narrow the Coronary Sinus : Shifting Paradigm in the Treatment of Refractory Angina? A Review of the Literature

    NARCIS (Netherlands)

    Benedetto, Daniela; Abawi, Masieh; Stella, Pieter R; Nijhoff, Freek; Lakemeier, Maxime D M; Kortlandt, Friso; Doevendans, Pieter A; Agostoni, Pierfrancesco

    2016-01-01

    Refractory angina pectoris is defined as a chronic debilitating condition characterized by the presence of chronic anginal symptoms due to a severe obstructive and/or diffuse coronary artery disease that cannot be controlled by the combination of medical therapy and/or revascularization

  19. Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris

    DEFF Research Database (Denmark)

    Ravkilde, J; Nissen, H; Mickley, H

    1994-01-01

    The incidence of cardiac troponin T (Tn-T) and creatine kinase (CK) isoenzyme MB mass release was studied in 23 patients with stable angina pectoris undergoing visually successful percutaneous transluminal coronary angioplasty (PTCA). Serial blood samples were drawn for measurement of serum Tn...

  20. Creatine kinase and creatine kinase subunit-B in coronary sinus blood in pacing-induced angina pectoris

    DEFF Research Database (Denmark)

    Bagger, J P; Ingerslev, J; Heinsvig, E M

    1982-01-01

    In nine out of 10 patients with angiographic documented coronary artery disease, pacing-induced angina pectoris provoked myocardial production of lactate, whereas no significant release of either creatine kinase or creatine kinase subunit-B to coronary sinus and peripheral venous blood could...

  1. Myocardial Strain Analysis by 2-Dimensional Speckle Tracking Echocardiography Improves Diagnostics of Coronary Artery Stenosis in Stable Angina Pectoris

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Hoffmann, Soren; Mogelvang, Rasmus

    2014-01-01

    BACKGROUND: Two-dimensional strain echocardiography detects early signs of left ventricular dysfunction; however, it is unknown whether myocardial strain analysis at rest in patients with suspected stable angina pectoris predicts the presence of coronary artery disease (CAD). METHODS AND RESULTS:...

  2. Chemical and pharmacological evaluation of the effectiveness of enalapril maleate in exertional angina pectoris in elderly and senile patients

    Directory of Open Access Journals (Sweden)

    I. M. Belay

    2013-06-01

    Full Text Available The long-term administration of enalapril maleate in complex therapy of exertional angina pectoris in elderly persons showed antiischemic, antiarrhythmic effects of angiotensin converting enzyme inhibitors. Using chemical-pharmacological analysis the administration of enalapril against the background of basic therapy in patients with ischemic heart disease was grounded.

  3. Value of the addition of Amlodipine to atenolol in patients with angina pectoris despite adequate beta blockade

    NARCIS (Netherlands)

    Dunselman, PHJM; Bouwens, LHM; Herweijer, AH; Bernink, PJLM

    1998-01-01

    Anginal patients who remain symptomatic despite optimally dosed beta blockade may also be given dihydropyridine calcium antagonists. This treatment regimen was examined in a double-blind parallel, randomized, controlled study in 147 patients with angina and positive bicycle exercise tests despite

  4. EFFICACY OF SPINAL-CORD STIMULATION AS ADJUVANT THERAPY FOR INTRACTABLE ANGINA-PECTORIS - A PROSPECTIVE, RANDOMIZED CLINICAL-STUDY

    NARCIS (Netherlands)

    DEJONGSTE, MJL; HAUTVAST, RWM; HILLEGE, HL; LIE, KI

    Objectives. In a prospective, randomized study with an 8-week follow-up period, we evaluated the efficacy of spinal cord stimulation an exercise capacity and quality of life in patients with intractable angina. Background. Despite important achievements in therapy for ischemic heart disease, there

  5. Antisocial personality disorder--stable and unstable subtypes.

    Science.gov (United States)

    Ullrich, Simone; Coid, Jeremy

    2010-04-01

    There have been criticisms that the criteria for antisocial personality disorder (ASPD) are over-dependent on criminal behavior. This study aimed to identify unrelated criteria of social and behavioral problems and instability, and to investigate their associations in a representative household sample of adults in the UK. Approximately one third of adults with ASPD did not fulfill any of the criteria for instability. They were less aggressive and involved in illegal activities but expressed less remorse for their behaviors. Instability in ASPD was mediated primarily through comorbid anxiety disorders and borderline personality disorder. The concept of Secondary Psychopathy, which has not generally been applied to ASPD, demonstrated many similarities to the unstable subtype.

  6. Small Enterprise Strategies in an Unstable Public Environment

    Directory of Open Access Journals (Sweden)

    Daryl D. Green

    2016-04-01

    Full Text Available Many small business owners in the United States dream about getting a large contract with the federal government, feeling that their lives would be easier if they did. Ironically, there have been numerous occasions where small businesses have gone out of business after being overwhelmed by a government contract. This case study addresses how small businesses can improve their survival and success rate in the public sector with a strategic approach to their operations. It begins by discussing the preparation that goes into federal contracting by small businesses. Case examples of four American companies involved in contracting with the Department of Energy are evaluated. Data collection is achieved through qualitative analysis. The application of these conclusions could increase the survival rate of small businesses operating in an unstable public environment. The study is significant because this research widens contemporary assumptions about strategic thinking for small businesses engaged in government contracting.

  7. Development of an RFQ linac for unstable nuclei

    International Nuclear Information System (INIS)

    Arai, S.; Imanishi, A.; Morimoto, T.; Shibuya, S.; Tojyo, E.; Tokuda, N.

    1990-05-01

    A split coaxial RFQ (SCRFQ) is being developed for accelerating unstable nuclei with a charge-to-mass ratio larger than 1/60 from 1 to 170 keV/u in the JHP heavy-ion linac. The SCRFQ is equipped with modulated vanes to generate ideal quadrupole and accelerating fields. The fundamental problems on the SCRFQ have been clarified and solved through studies on a cold model, and the excellent accelerating performance has been confirmed by using a proton accelerating model working at 50 MHz. A 25.5-MHz prototype for the JHP SCRFQ is now under development. The prototype, 2.1 m in length and 0.9 m in diameter, will accelerate ions with a charge-to-mass ratio larger than 1/30 from 1 to 45 keV/u. Low-power tests conducted so far show that the prototype cavity has good rf characteristics. (author)

  8. [Stabilization of unstable intertrochanteric fractures with the proximal femoral nail].

    Science.gov (United States)

    Sehmisch, S; Rieckenberg, J; Dresing, K

    2013-02-01

    Restoration of function and anatomy of the proximal femur. Possibility of full weightbearing after surgery. Less invasive intramedullary osteosynthesis. Unstable trochanteric fracture (AO classification 31-A2, 31-A3), subtrochanteric fracture (AO classification 32-A1), fracture of the femoral shaft in the proximal region. Ipsilateral coxarthrosis, open growth plate, hip fracture. Closed or open reduction on the extension table. Intramedullary reaming of the proximal femur, insertion of PFNA and blade as proximal locking screw, static or dynamic distal locking screw. Implantion of bone cement via blade, if necessary. Weightbearing as limited by pain. Osteoporosis diagnostics and initiation of treatment, if necessary. The stabilization of trochanteric fractures is usually done with PFNA. Compared to other methods, e.g., DHS, fewer complications were observed with the PFNA. Subtrochanteric fractures were associated with higher complication rates compared to intertrochanteric fractures.

  9. Stable and unstable crack growth in pressure vessel models

    International Nuclear Information System (INIS)

    Smith, G.C.; Canonico, D.A.; Stelzman, W.J.

    1978-01-01

    Three identical steel pressure vessels with 254-mm (10-in.) dia, 38-mm (1.5-in.) wall thicknesses and long, deep machined and sharpened axially oriented flaws were tested at three different temperatures. The vessels were assembled by electron-beam welding cylindrical sections with substantially different toughnesses due to different heat treatments. Crack extension initiated in relatively brittle sections, and the cracks extended both stably and unstably, depending on test temperature, toward the tougher sections where crack arrest did and did not occur. Charpy impact specimens and both slow-bend and dynamic precracked Charpy specimens were used for material characterization. The behavior of the vessels is described and related to the Charpy data

  10. Synthesis of unstable cyclic peroxides for chemiluminescence studies

    Energy Technology Data Exchange (ETDEWEB)

    Bartoloni, Fernando H.; Oliveira, Marcelo A. de; Augusto, Felipe A.; Ciscato, Luiz Francisco M.L.; Bastos, Erick L.; Baader, Wilhelm J., E-mail: wjbaader@iq.usp.br [Universidade de Sao Paulo (USP), SP (Brazil). Inst. de Quimica. Dept. de Quimica Fundamental

    2012-11-15

    Cyclic four-membered ring peroxides are important high-energy intermediates in a variety of chemi and bioluminescence transformations. Specifically, a-peroxy lactones (1,2-dioxetanones) have been considered as model systems for efficient firefly bioluminescence. However, the preparation of such highly unstable compounds is extremely difficult and, therefore, only few research groups have been able to study the properties of these substances. In this study, the synthesis, purification and characterization of three 1,2-dioxetanones are reported and a detailed procedure for the known synthesis of diphenoyl peroxide, another important model compound for the chemical generation of electronically excited states, is provided. For most of these peroxides, the complete spectroscopic characterization is reported here for the first time. (author)

  11. Active Feedback Control of Unstable Wells at the Brage Field

    Directory of Open Access Journals (Sweden)

    Morten Dalsmo

    2005-04-01

    Full Text Available In this paper we will present new results on stabilization of horizontal wells with gas lift. The stabilization is achieved by a novel dynamic feedback control solution using the production choke at the wellhead. The primary input to the dynamic feedback controller is a measurement of the downhole pressure. The field results to be presented are from the Brage field operated by Norsk Hydro in the North sea. Production at Brage began in 1993 and the field went off plateau in 1998. As the production has decreased, the problems related to unstable production from some of the wells have escalated steadily. The results from the extensive field tests on the Brage wells arc very promising. The tests have confirmed the stabilization feature of the control solution. The pressure and flow variations have been dramatically reduced, and it is possible to produce the wells at a lower downhole pressure leading to increased production.

  12. Augmentation of proximal femoral nail in unstable trochanteric fractures

    Directory of Open Access Journals (Sweden)

    Gadegone Wasudeo M.

    2017-01-01

    Full Text Available Introduction: Biomechanically proximal femoral nail (PFN is a better choice of implant, still it is associated with screw breakage, cut out of screw through femoral head, Z effect, reverse Z effect, and lateral migration of screws. The purpose of this study is to evaluate the results of augmented PFN in terms of prevention of postoperative complications and failure rates in unstable trochanteric fractures. Material and methods: We carried out a prospective study of 82 cases with unstable trochanteric femoral fractures from April 2010 to December 2015. Forty-two females and 40 males in the age group between 58 and 81 years were included in this study. There were 45 cases of AO 31 A2 (2.2, 2.3 and 37 cases of AO 31 A3 (3.1, 3.2, 3.3. Fractures were fixed by PFN with augmentation by an additional screw from trochanter to inferior quadrant of femoral head or cerclage wire to strengthen the lateral trochanteric wall. Results: The bone healing is observed in all the cases in the mean period of 14.2 weeks. Nine patients developed complications, including lateral migration of neck screws (n = 5, Z effect (n = 1, infection (n = 2, and breakage of distal interlocking bolt in one case. Removal of screws was required in five cases. Patients were followed up for a mean of 8.4 months. At the end of follow-up the Salvati and Wilson hip function was 32 (out of 40 in 88% of patients. Conclusion: The stabilization of lateral trochanteric wall with additional screw or cerclage wire increases the stability of construct.

  13. Effects of Ranolazine on Angina and Quality of Life After Percutaneous Coronary Intervention With Incomplete Revascularization: Results From the Ranolazine for Incomplete Vessel Revascularization (RIVER-PCI) Trial.

    Science.gov (United States)

    Alexander, Karen P; Weisz, Giora; Prather, Kristi; James, Stefan; Mark, Daniel B; Anstrom, Kevin J; Davidson-Ray, Linda; Witkowski, Adam; Mulkay, Angel J; Osmukhina, Anna; Farzaneh-Far, Ramin; Ben-Yehuda, Ori; Stone, Gregg W; Ohman, E Magnus

    2016-01-05

    Angina often persists or returns in populations following percutaneous coronary intervention (PCI). We hypothesized that ranolazine would be effective in reducing angina and improving quality of life (QOL) in incomplete revascularization (ICR) post-PCI patients. In RIVER-PCI, 2604 patients with a history of chronic angina who had ICR post-PCI were randomized 1:1 to oral ranolazine versus placebo; QOL analyses included 2389 randomized subjects. Angina and QOL questionnaires were collected at baseline and months 1, 6, and 12. Ranolazine patients were more likely than placebo to discontinue study drug by month 6 (20.4% versus 14.1%, Pdiabetics (mean difference 3.3; 95% CI 0.6, 6.1; P=0.02) and those with more angina (baseline SAQ angina frequency ≤60; mean difference 3.4; 95% CI 0.6, 6.2; P=0.02), but was not maintained at month 12. Despite ICR following PCI, there was no incremental benefit in angina or QOL measures by adding ranolazine in this angiographically-identified population. These measures markedly improved within 1 month of PCI and persisted up to 1 year in both treatment arms. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01442038. © 2015 American Heart Association, Inc.

  14. Granulocyte colony stimulating factor in chronic angina to stimulate neovascularisation: a placebo controlled crossover trial.

    Science.gov (United States)

    Chih, Sharon; Macdonald, Peter S; McCrohon, Jane A; Ma, David; Moore, John; Feneley, Michael P; Law, Matthew; Kovacic, Jason C; Graham, Robert M

    2012-02-01

    Experimental studies demonstrate that granulocyte colony stimulating factor (G-CSF) promotes neovascularisation and confers cardioprotection. To assess the efficacy of repeated low dose G-CSF plus exercise on myocardial ischaemia in patients with severe chronic ischaemic heart disease. 18 patients with Canadian Cardiovascular Society class III-IV angina completed a randomised, double blind, crossover study of dose adjusted G-CSF versus placebo. Exercise was commenced 6 weeks prior and continued for the duration of the study. G-CSF or placebo was administered daily for 5 consecutive days at fortnightly intervals for three cycles, followed by crossover after 6 weeks. Primary outcome was myocardial perfusion by cardiac magnetic resonance imaging (MRI). Secondary outcomes were: Seattle Angina and Utility Based Quality of Life Heart Questionnaire (SAQ/UBQ-H), Exercise Stress Test (EST) and quantification of endothelial progenitor cells (EPC) by flow cytometry and angiogenic cytokines by immunoassay. Compared with placebo, G-CSF had no effect on myocardial ischaemia by cardiac MRI, EST or SAQ/UBQ-H, despite effective EPC mobilisation (peak fold increase: CD34+ =19, CD34+ CD133+ = 37, CD34+ vascular endothelial growth factor receptor 2 (VEGFR-2)+ = 5, CD34+ CD133+ VEGFR-2+ = 3; all p<0.05 vs. placebo). Plasma levels of stromal cell derived factor 1, angiopoietin 1, interleukin 8 and tumour necrosis factor α decreased after a symptom limited EST while vascular endothelial growth factor and platelet derived growth factor remained unchanged. All cytokines were unchanged following G-CSF. Seven troponin I positive events occurred with G-CSF compared with three with placebo (p=0.289). High sensitivity C reactive protein and N terminal prohormone brain natriuretic peptide increased with G-CSF (both p<0.01 vs. placebo). In patients with chronic ischaemic heart disease, G-CSF mobilises EPCs but does not improve myocardial perfusion or angina. G-CSF increases plasma levels of

  15. Coronary lumen volume to myocardial mass ratio in primary microvascular angina.

    Science.gov (United States)

    Grover, Rominder; Leipsic, Jonathon A; Mooney, John; Kueh, Shaw-Hua; Ohana, Mickael; Nørgaard, Bjarne L; Eftekhari, Ashkan; Bax, Jeroen J; Murphy, Darra T; Hague, Cameron J; Seidman, Michael A; Blanke, Philipp; Sedlak, Tara; Sellers, Stephanie L

    2017-11-01

    Microvascular angina (MVA) is an incompletely understood clinical entity. Computational analysis of coronary Computed Tomography Angiography (CTA) has shown an association between low coronary lumen volume to myocardial mass (V/M) ratio and lower Fractional Flow Reserve values, independent of plaque measures. We hypothesized that low V/M ratio may be present in patients with MVA. A retrospective case-control analysis was performed using patients fulfilling guideline criteria for MVA with controls matched for age, gender, coronary risk factors and atherosclerotic plaque burden. V/M was extracted off site (Heartflow Inc; Redwood City, CA) employing allometric scaling laws that allow the definition of the coronary circulation beyond the epicardium. FFR CT values were calculated in the major epicardial coronary arteries for each group. A total of 30 patients with MVA and 32 matched controls were included in the study. Mean total coronary lumen volume (2302 mm 3  ± 109 vs 2978 mm 3  ± 134, p < 0.001) and mean myocardial mass (90.4 g ± 13.7 vs 100.4 g ± 20.1, p = 0.029) were lower in MVA patients compared to controls. Mean V/M ratio was significantly lower in MVA compared to controls (25.6 mm 3 /g ± 5.9 vs 30.0 mm 3 /g ± 6.5, p = 0.007; c-statistic 0.69). V/M ratio did not differ significantly between subclasses of angina severity (p = 0.747). No difference in mean nadir FFR CT values was found between MVA and control groups in the LAD (0.86 ± 0.07 vs 0.83 ± 0.07, p = 0.154), LCX (0.90 ± 0.05 vs 0.90 ± 0.06, p = 0.240) and RCA (0.90 ± 0.04 vs 0.90 ± 0.03, p = 0.773) vessels. Patients with microvascular angina demonstrate a significantly lower coronary CTA-derived coronary volume/myocardial mass ratio than asymptomatic controls. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  16. [Six-month xenical (orlistat) therapy of patients with stable angina pectoris concomitant with obesity and hyperlipidemia].

    Science.gov (United States)

    Naumov, V G; Lupanov, V P; Dotsenko, Iu V; Tvorogova, M G

    2002-01-01

    To evaluate the efficiency of 6-month therapy with xenical (gastrointestinal lipase inhibitor) in combination with diet in patients with stable angina pectoris associated with obesity and hyperlipemia. An open comparative randomized study of the efficiency of xenical in combination with diet was carried out in patients with stable angina pectoris concomitant with obesity and hyperlipemia. Thirty coronary patients aged 45-65 years with stable angina of effort (functional class I-II) with body weight index 28.1-45.6 kg/m2 (mean 33.5 kg/m2) were examined. All patients presented with dyslipemia (low density lipoprotein (LDL) cholesterol more than 4.14 mmol/liter, triglycerides (TG) more than 2.2 mmol/liter). Controls (n = 15) were treated with diets alone for 6 months. In the main group diets were supplemented by xenical in a dose of 360 mg/day. Body weight index decreased in both groups (by 9.9% in the main group and by 4.2% in the control). Body weight stabilization during 6 months of treatment and the fact that it was slow and gradual were essential. In patients treated with xenical total cholesterol level decreased by 10.9% and of LDL cholesterol by 12.2% after 6 months (p < 0.05). Changes in the levels of high density lipoprotein cholesterol and TG were insignificant. The drug did not affect the incidence of angina attacks and improved exercise tolerance after 6-month therapy. Blood biochemistry (transaminases, alkaline phosphatase, glucose, and creatinine) changed negligibly. No side effects were observed; all patients received a complete 6-month course. The results confirm that xenical (orlistat) can be used for long therapy of patients with stable angina of effort concomitant with obesity and hyperlipemia.

  17. Ludwig’s Angina: The Importance of Oral Cavity Examination in Patients with a Neck Mass

    Directory of Open Access Journals (Sweden)

    Mohamad I

    2012-12-01

    Full Text Available neck mass is a common condition in primary care. the most common affected area is the cervical lymph node. the neck region is also prone infection as structurally the nodes and spaces are in close contact with the upper respiratory tract and the alimentary tract. oral cavity is one of the most common route for harbouring infection. Poor oral hygeine and periapical dental problems are the main causes. thus, it is important to perform a complete oral cavity examination even when trismus is present. Besides dental caries, floor of the mouth should be inspected for oedema that may impose threat to the upper airway. We report a case of Ludwig’s angina originating from a periapical lesion of the lower molar stressing the importance of oral examination in patient with neck mass.

  18. Insulin-resistant glucose metabolism in patients with microvascular angina--syndrome X

    DEFF Research Database (Denmark)

    Vestergaard, H; Skøtt, P; Steffensen, R

    1995-01-01

    insulin-stimulated glucose disposal to peripheral tissues was lower in patients with MA (13.4 +/- 1.0 v 18.2 +/- 1.4 mg.kg fat-free mass [FFM]-1.min-1, P metabolism (8.4 +/- 0.9 v 12.5 +/- 1.3 mg.kg FFM-1.min-1, P ...Studies in patients with microvascular angina (MA) or the cardiologic syndrome X have shown a hyperinsulinemic response to an oral glucose challenge, suggesting insulin resistance and a role for increased serum insulin in coronary microvascular dysfunction. The aim of the present study...... was to examine whether patients with MA are insulin-resistant. Nine patients with MA and seven control subjects were studied. All were sedentary and glucose-tolerant. Coronary arteriography was normal in all participants, and exercise-induced coronary ischemia was demonstrated in all MA patients. A euglycemic...

  19. Psychophysical rehabilitation aspects of patient with coronary heart disease and Angina.

    Directory of Open Access Journals (Sweden)

    Mohammed Ali Khaleel.

    2012-03-01

    Full Text Available It is analyzed scientific and methodological literature, considered the views of scientists on the link of stress and cardiovascular diseases. It is determined causes of stress, with recommendations for combating stress and its prevention. A program of rehabilitation for patients with coronary artery disease after hospital discharge is shown. The experiment involved 88 patients of coronary heart disease and angina, II and III functional class at the age of 40-65 years. Participants were divided into two groups the main and control. The control group performed a program of physical rehabilitation, including breathing and physical exercises, in the program we have added to the main group autogenic exercises. At the end the experiment revealed that the health indicators of main group better than the control group in 23%.

  20. Utility of the Japan arteriosclerosis longitudinal study score for identifying a high risk for vasospastic angina.

    Science.gov (United States)

    Funayama, Akira; Watanabe, Tetsu; Otaki, Yoichiro; Nishiyama, Satoshi; Arimoto, Takanori; Takahashi, Hiroki; Shishido, Tetsuro; Miyamoto, Takuya; Kubota, Isao

    2015-01-01

    The aim of this study was to investigate whether the Japan Arteriosclerosis Longitudinal Study (JALS) score, which is calculated from the traditional atherosclerotic coronary risk, is associated with the incidence of coronary vasospasms. We performed vasospasm provocation tests with acetylcholine in 109 patients referred to our hospital due to suspected vasospastic angina and subsequently calculated the atherosclerotic risk score according to the JALS score. Consequently, coronary vasospasms were evoked in 51 patients. The patients were divided into three groups according to the tertile of the JALS score: 1st, 42, n=37. The third tertile exhibited the greatest risk for vasospasms. A multivariate logistic regression analysis revealed that the JALS score (odds ratio: 1.686, pJALS score can serve as a useful tool for evaluating patients with suspected coronary vasospasms.

  1. [Relations of regulatory polypeptide and syndrome differentiation of traditional Chinese medicine of angina pectoris patients].

    Science.gov (United States)

    Huang, H Y; Zhu, W F; Li, B X

    1996-08-01

    Ninety cases of angina pectoris patients with the Deficiency of Heart Qi Syndrome (DHQS), Deficiency of Heart-Yin Syndrome (DHYS) and blood stasis in Heart vessels Syndrome (BSHVS) were studied. The number of patients were 30 for each group. Their regulatory polypeptides:atrial natri-uretic polypeptide (ANP), beta-Endorphine (beta-EP), Endothelin (ET), Angiotensin (A-II) were tested. Results showed that in comparing with normal level, P BSHVS > normal group > DHYS. ET and A-II of them: DHYS > BSHVS > normal group > DHQS. And the comparison between groups revealed that P < 0.05 or < 0.01. So ANP, beta-EP, ET and A-II were the principal material basis, and they could be the specific objective parameters of the Syndrome Differentiation.

  2. Ventetid og omkostninger ved diagnostik og behandling af stabil angina pectoris

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Sanchez, Ricardo

    : Separate angiography (AG) and percutaneous coronary intervention (PCI) rather than combined procedures was associated with a significantly prolonged time to treatment, of on average 14 days, and increased costs of DKK 11,338 (95% KI 9,160;13,515). Similarly, re- referral rather than procedures being...... conducted at the centre to which the first referral was addressed was associated with significantly longer time to treatment, of on average 22 days, and increased costs of DKK 9,379 (95% KI 6,477;12,281). Conclusion: There seems to be a potential for optimizing the regimen for diagnosis and treatment...... of stable angina pectoris, which ceteris paribus would be associated with cost savings in the health care sector. However, these potentials should be examined in a larger- scale study....

  3. Ludwig's angina: need for including airways and larynx in ultrasound evaluation.

    Science.gov (United States)

    Narendra, P L; Vishal, N S; Jenkins, Brian

    2014-11-09

    Ludwig's angina is a deep neck space infection. Unlike other abscesses elsewhere in the body, rapid progression of the disease results in serious complications such as airway oedema, distortion, total obstruction with loss of airway and death. Thus, early diagnosis and skilful airway management is necessary. For safe airway management, fibreoptic intubation or tracheostomy under local anaesthesia is recommended.1 We describe a case report where an initial attempt at fibreoptic intubation failed and subsequently bleeding ensued causing difficulty in viewing the larynx by fibreoptic bronchoscopy. Radiological investigations such as ultrasound and computer tomography (CT) are commonly ordered by surgeons and emergency physicians to know the extension of disease, but airways and larynx are seldom included. We discuss the role of ultrasound in airway assessment in such critical cases to ensure safe and uncomplicated airway access.

  4. Transient myocardial ischaemia during ambulatory monitoring out of hospital in patients with chronic stable angina pectoris

    DEFF Research Database (Denmark)

    Egstrup, K

    1988-01-01

    Transient myocardial ischaemia during daily life, detected by ambulatory electrocardiographic monitoring, was investigated in 42 patients with chronic stable angina and documented coronary artery disease. Ambulatory monitoring was initiated for 36 hours after all prophylactic antianginal medication...... monitoring was significantly lower than heart rate at the onset of ST-segment change during exercise testing (100.2 +/- 14.6 vs. 115.8 +/- 19.6 beats/min, p less than 0.01), which may indicate different pathophysiological mechanisms. Transient impairment in coronary oxygen supply seems to be of importance...... with and without symptoms was observed, the highest frequency being in the morning hours. Transient myocardial ischaemia was more frequent in patients with double or triple vessel disease, compared with single vessel disease, but with a great variation. Heart rate at the onset of ischaemia during ambulatory...

  5. INFLUENCE OF MILDRONATE ON EFFICIENCY OF ANTIANGINAL THERAPY IN PATIENTS WITH STABLE BURDEN ANGINA

    Directory of Open Access Journals (Sweden)

    N. P. Kutishenko

    2005-01-01

    Full Text Available Aim. To study influence of mildronate (M on treatment efficiency of patients with ischemic heart disease (IHD, receiving standard antianginal therapy (AATMaterials and methods. Double-blind, randomized, placebo-controlled study was carried out in parallel groups. All patients continued the earlier prescribed AAT without changes. After control period (10-14 days was over, randomization of patients either to the treatment group (M 500mg twice per day, or to the control group (placebo (Pl twice per day was made for 6 weeks therapy. Criterion of treatment efficiency: increase in duration of trial with burden on treadmill (TB, decrease in angina attack frequency (AA and reduction in nitroglycerin taking (NTT. TB was carried out at the beginning (TB-1, at the end of the control period (TB-2, and at the end of the treatment (TB-3.Results. TB-1 and TB-2 had good reproducibility, their duration didn’t differ. At the end of the treatment additionally with M, growth in duration of TB-3 (p=0,002 was registered, while there was no growth of TB duration with the Pl treatment (p=0,07. During the treatment decrease in AA number both with M (p=0,002, and with Pl (p=0,02 was noted. With M treatment decrease in NTT treatment (p=0.02 was observed, while NTT with Pl didn’t change (p=0,7. Number of side effects, registered with M and Pl, didn’t differ.Conclusion. Mildronate provides additional benefits for patients with IHD with stable burden angina, when they do not reach desired effect with the prescribed AAT.

  6. Economic evaluation of trimetazidine in the management of chronic stable angina in Greece.

    Science.gov (United States)

    Kourlaba, Georgia; Gourzoulidis, George; Andrikopoulos, George; Tsioufis, Konstantinos; Beletsi, Alexandra; Maniadakis, Nikos

    2016-09-27

    To evaluate the cost-effectiveness of trimetazidine (TMZ) as add-on therapy to standard-of-care (SoC) compared to SoC alone in patients with chronic stable angina who did not respond adequately to first line therapy with b-blockers, nitrates or calcium channel antagonists in Greece. A Markov model with 3-month cycles and 1-year time horizon was developed to assess the comparators. The analysis was conducted from a third-party payer perspective. The clinical inputs and utility values were extracted from the published literature. Resource consumption data were obtained from local experts, using a questionnaire developed for the purpose of the study and were combined with unit cost data (in €2016) obtained from official sources. Cost effectiveness was assessed by calculating the incremental cost effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) was performed to account for uncertainty and variation in the input parameters of the model. The analysis showed that the cost of TMZ plus SoC was €1755.57 versus €1751.76 of SoC alone. In terms of health outcomes, TMZ plus SoC was associated with 0.6650 QALYs versus 0.6562 QALYs for SoC alone. The incremental analysis resulted in an ICER of €430.67 per QALY gained. PSA revealed that the probability of TMZ plus SoC being cost-effective over SoC was 89 %, at a threshold of €34,000 per QALY gained. The results indicate that TMZ as add -on treatment may be a highly cost-effective option for the symptomatic treatment of patients with chronic stable angina in Greece relative to SoC alone.

  7. Cost of illness for chronic stable angina patients enrolled in a self-management education trial

    Science.gov (United States)

    McGillion, Michael; Croxford, Ruth; Watt-Watson, Judy; LeFort, Sandra; Stevens, Bonnie; Coyte, Peter

    2008-01-01

    BACKGROUND: Chronic stable angina (CSA) is a major debilitating health problem in Canada. A paucity of relevant cardiovascular data sets has precluded a detailed examination of the impact of interventions on CSA-related costs and its broader economic burden. OBJECTIVES: As part of a larger clinical trial, the authors sought to determine the short-term impact of a standardized self-management training program on CSA-related costs. A secondary objective was to estimate the total annualized cost of CSA per patient from a societal perspective. METHODS: Pre- and three-month post-test cost data were collected on 117 participants using the Ambulatory Home Care Record. Mean annualized direct, indirect and system-related CSA costs (2003 to 2005) were estimated; total per-patient CSA costs from a societal perspective were calculated as the sum of these costs. RESULTS: The mean (± SD) age of participants was 68±11 years; 80% were male. The program did not impact costs in the short-term. Direct annual out-of-pocket costs, including money paid for health care, travel to appointments, medication, equipment and home support totaled $3,267. Indirect costs, reflecting the value of all unpaid time spent by those engaged in angina-related care, were $12,963. System costs, including costs paid by public and private insurers, were $2,979. Total estimated annual CSA costs from a societal perspective were $19,209 per patient. CONCLUSIONS: These data suggest that CSA imposes a major economic burden, comparable with other prevalent conditions such as chronic noncancer pain. Advancements in self-management training research are needed to help reduce the economic burden of CSA in Canada. PMID:18841254

  8. Manejo de la angina de pecho en el consultorio del Médico de Familia

    Directory of Open Access Journals (Sweden)

    Héctor Conde Cerdeira

    2000-12-01

    Full Text Available Se realiza una revisión sobre los aspectos clínicos de la angina de pecho haciendo énfasis en el dolor típico que se presenta con los esfuerzos y estrés, con características de ser opresivo, retroesternal, difuso, con irradiación al cuello, mandíbula, hombros y brazo izquierdo, y que se alivia con el reposo y/o la nitroglicerina. Se enuncian los resultados más relevantes del electrocardiograma, el ecocardiograma, la prueba ergométrica y se menciona la utilidad de la angiografía coronaria en estos casos. Por último se brinda la conducta a seguir desde el consultorio del Médico de Familia, referente al tratamiento general y farmacológico, empleando los nitratos, bloqueadores beta, los anticálcicos y los nuevos medicamentos utilizadosA review is made on the clinical aspect of angina pectoris, making emphasis on the typical pain that occurs on effort and stress. This pain is oppressive, retrosternal, diffuse and radiates into the neck, jaw, shoulders and left arm. It relieves by rest and/or nitroglycerine. The most significant results of the electrocardiogram, the echocardiogram and the ergometric test are shown. The usefulness of coronary angiography in these cases is also mentioned. Finally, it is explained the conduct to be followed from the family physician's office in relation to the general and pharmacological treatment by using nitrates, beta blockers, calcium antagonists and new drugs

  9. Influence of prolonged wearing of unstable shoes on upright standing postural control.

    Science.gov (United States)

    Sousa, Andreia S P; Macedo, Rui; Santos, Rubim; Sousa, Filipa; Silva, Andreia; Tavares, João Manuel R S

    2016-02-01

    To study the influence of prolonged wearing of unstable shoes on standing postural control in prolonged standing workers. The participants were divided into two groups: one wore unstable shoes while the other wore conventional shoes for 8weeks. Stabilometry parameters related to centre of pressure (CoP), rambling (RM) and trembling (TR) as well as the total agonist/antagonist muscle activity, antagonist co-activation and reciprocal activation were evaluated during upright standing, before and after the 8weeks period. In both moments, the subjects were evaluated wearing the unstable shoes and in barefoot. The unstable shoe condition presented increased CoP displacement related variables and decreased co-activation command compared to barefoot before and after the intervention. The prolonged wearing of unstable shoes led to: (1) reduction of medial-lateral CoP root mean square and area; (2) decreased anteroposterior RM displacement; (3) increased anteroposterior RM mean velocity and mediolateral RM displacement; (4) decreased anteroposterior TR RMS; and (5) increased thigh antagonist co-activation in the unstable shoe condition. The unstable shoe condition is associated to a higher destabilising effect that leads to a selection of more efficient and accurate postural commands compared to barefoot. Prolonged wearing of unstable shoes provides increased effectiveness and performance of the postural control system, while wearing of unstable shoes in upright standing, that are reflected by changes in CoP related variables and by a reorganisation of postural control commands. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. [Surgical treatment of unstable pelvic fractures combined with acetabular fractures].

    Science.gov (United States)

    Wang, Tao; Wang, Jun; Li, Zong-yuan; Liu, Gang

    2015-05-01

    To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome. Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old (means 38 years old). According to Tile classification of pelvic fracture, 11 cases were type B1, 8 were type B2.1, 7 were type B2.2, 3 were type C1.1, 2 were type C1.2, 1 was type C3. According to Judet-Letournel classification, anterior column fracture was in 1 case, transverse fracture in 8, transverse plus posterior wall fracture in 6, T-type fracture in 1, anterior column plus half transverse fractures in 5, double column fracture in 11. Other combined injuries were treated early, the surgical operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during follow-up. The operative time was from 1.8 to 6.5 hours (averaged 3 hours). Two fat patients' incision occurred in fat liquefaction and healed after dressing, no incision infection happened. Only 1 case was lost to follow-up, 31 patients were followed up with a mean time of 23 months (6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks (averaged in 10.6 weeks). The hip function was evaluated according to the Matta and Tornetta standard postoperatively, the result was excellent in 15 cases, good in 14 cases, fair and poor in 1 case respectively. The Majeed score of the hip function was 83.65? 7.67, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The healing time of acetabular fractures was from 8 to 16 weeks (averaged in 10.2 weeks). The fracture reduction was assessed by Matta standard, the result was excellent in 15 cases, good in 12 cases and fair in 4 cases. The heterotopic ossification was evaluated by Brooker standard, 4 cases were grade I, 1 case was

  11. Angina on the Palm: randomized controlled pilot trial of Palm PDA software for referrals for cardiac testing.

    Science.gov (United States)

    Greiver, Michelle; Drummond, Neil; White, David; Weshler, Jason; Moineddin, Rahim

    2005-03-01

    Personal digital assistants (PDAs) are popular with physicians: in 2003, 33% of Canadian doctors reported using them in their practices. We do not know, however, whether using a PDA changes the behaviour of practising physicians. We studied the effectiveness of a PDA software application to help family physicians diagnose angina among patients with chest pain. Prospective randomized controlled pilot trial using a cluster design. Primary care practices in the Toronto area. Eighteen family physicians belonging to the North Toronto Primary Care Research Network (Nortren) or recruited from a local hospital. We randomized physicians to receive a Palm PDA (which included the angina diagnosis software) or to continue conventional care. Physicians prospectively recorded the process of care for patients aged 30 to 75 presenting with suspected angina, over 7 months. Did the process of care for patients with suspected angina improve when their physicians had PDAs and software? The primary outcomes we looked at were frequency of cardiac stress test orders for suspected angina, and the appropriateness of referral for cardiac stress testing at presentation and for nuclear cardiology testing after cardiac stress testing. Secondary outcome was referrals to cardiologists. The software led to more overall use of cardiac stress testing (81% vs 50%). The absolute increase was 31% (P = .007, 95% confidence interval [CI] 8% to 58%). There was a trend toward more appropriate use of stress testing (48.6% with the PDA vs 28.6% control), an increase of 20% (P = .284, 95% CI -11.54% to 51.4%). There was also a trend toward more appropriate use of nuclear cardiology following cardiac stress testing (63.0% vs 45.5%), an absolute increase of 17.5% (P =.400, 95% CI -13.9% to 48.9%). Referrals to cardiologists did not increase (38.2% with the PDA vs 40.9%, P =.869). A PDA-based software application can lead to improved care for patients with suspected angina seen in family practices; this finding

  12. Ranolazine for the treatment of chronic stable angina: a cost-effectiveness analysis from the UK perspective.

    Science.gov (United States)

    Coleman, Craig I; Freemantle, Nick; Kohn, Christine G

    2015-11-06

    To estimate the cost-effectiveness of ranolazine when added to standard-of-care (SoC) antianginals compared with SoC alone in patients with stable coronary disease experiencing ≥3 attacks/week. An economic model utilising a UK health system perspective, a 1-month cycle-length and a 1-year time horizon. Patients with stable coronary disease experiencing ≥3 attacks/week starting in 1 of 4 angina frequency health states based on Seattle Angina Questionnaire Angina Frequency (SAQAF) scores (100=no; 61-99=monthly; 31-60=weekly; 0-30=daily angina). Ranolazine added to SoC or SoC alone. Patients were allowed to transition between SAQAF states (first cycle only) or death (any cycle) based on probabilities derived from the randomised, controlled Efficacy of Ranolazine in Chronic Angina trial and other studies. Patients not responding to ranolazine in month 1 (not improving ≥1 SAQAF health state) discontinued ranolazine and were assumed to behave like SoC patients. Costs (£2014) and quality-adjusted life-years (QALYs) for patients receiving and not receiving ranolazine. Ranolazine patients lived a mean of 0.701 QALYs at a cost of £5208. Those not receiving ranolazine lived 0.662 QALYs at a cost of £5318. The addition of ranolazine to SoC was therefore a dominant economic strategy. The incremental cost-effectiveness ratio was sensitive to ranolazine cost; exceeding £20,000/QALY when ranolazine's cost was >£203/month. Ranolazine remained a dominant strategy when indirect costs were included and mortality rates were assumed to increase with worsening severity of SAQAF health states. Monte Carlo simulation found ranolazine to be a dominant strategy in ∼71% of 10,000 iterations. Although UK-specific data on ranolazine's efficacy and safety are lacking, our analysis suggest ranolazine added to SoC in patients with weekly or daily angina is likely cost-effective from a UK health system perspective. Published by the BMJ Publishing Group Limited. For permission to use

  13. Unstable femoral neck fractures in children - A new treatment option

    Directory of Open Access Journals (Sweden)

    Pruthi K

    2006-01-01

    Full Text Available Background : Femoral neck fractures in children are an uncommon but difficult situation. The aim of our study was to evaluate clinical results of closed reduction internal fixation and primary valgus osteotomy fixed with a tension band wire loop in high angled pediatric femoral neck fractures. Methods : In a prospective nonrandomized study conducted at 2 centres, sixteen children and adolescents with a Pauwel type 2/3 fracture neck femur were taken as participants. The femoral neck fractures were stabilized using closed reduction and internal fixation (6.5 mm noncannulated screw and a primary valgus osteotomy fixed with a tension band wire loop preferably within 24-36 hours of injury. Patients were evaluated to determine complications, clinical and radiological outcome. Results : At a mean post operative follow up of 5 years, union was achieved in all cases. Three patients had AVN and one developed coxavara. Results were evaluated using IOWA hip scores. Thirteen patients had an excellent result while 3 patients had a good result. Conclusion : Use of this technique holds promise in treating these difficult unstable fractures. Although results from a larger series are still awaited yet the use of this technique can safely be extended to stable fractures also, to minimize the incidence of complications as nonunion and AVN.

  14. Gamma camera intrinsic uniformity in an unstable power supply environment.

    Science.gov (United States)

    Ejeh, John E; Adedapo, Kayode S; Akinlade, Bidemi I; Osifo, Bola O A

    2011-01-01

    The main objective of this work was to show that a gamma camera in a developing country could perform efficiently despite electricity outages using intrinsic flood uniformity tests as an index of performance. A total of 143 intrinsic uniformity test results for a new gamma camera in use in an environment with unstable power supply are presented. The integral uniformity for the central field of view (CFOV) was found to be between 3.43% and 1.49% (3.29% for acceptance test) while the integral uniformity for the useful field of view (UFOV) was between 4.51% and 1.9% (5.21% for acceptance test). The differential uniformity for the CFOV was between 1.99% and 1.04% (2.25% for acceptance test) while that of the UFOV was between 2.84% and 1.23% (2.63% for acceptance test). In conclusion, these results show that the uniformity of the gamma camera under this condition is within an acceptable range for both planar and SPET imaging.

  15. Quantum dynamics of dynamically unstable, integrable few-mode systems

    Science.gov (United States)

    Mathew, Ranchu; Tiesinga, Eite

    2017-04-01

    Recently, quenches in isolated ultra-cold atomic quantum systems have become a subject of intense study. We consider quantum few-mode systems that are integrable in their classical mean-field limit and become dynamically unstable after a quench of a system parameter. Specifically, we study the cases of a Bose-Einstein condensate (BEC) in a double-well potential and of an antiferromagnetic F = 1 spinor BEC constrained to a single spatial mode. First, we study the time dynamics of a coherent state after the quench within the truncated Wigner approximation and find that due to phase-space mixing the systems relax to a steady state. Using action-angle formalism and guided by insights from the related pendulum system, we obtain analytical expressions for the time evolution of expectation values of observables and their long-time values. We also study the full quantum dynamics of the systems. Comparing their results with the TWA results, we find agreement in the long-time expectation value of the observables. The relaxation time scales, however, are different.

  16. Coupling of damped and growing modes in unstable shear flow

    Science.gov (United States)

    Fraser, A. E.; Terry, P. W.; Zweibel, E. G.; Pueschel, M. J.

    2017-06-01

    Analysis of the saturation of the Kelvin-Helmholtz instability is undertaken to determine the extent to which the conjugate linearly stable mode plays a role. For a piecewise-continuous mean flow profile with constant shear in a fixed layer, it is shown that the stable mode is nonlinearly excited, providing an injection-scale sink of the fluctuation energy similar to what has been found for gyroradius-scale drift-wave turbulence. Quantitative evaluation of the contribution of the stable mode to the energy balance at the onset of saturation shows that nonlinear energy transfer to the stable mode is as significant as energy transfer to small scales in balancing energy injected into the spectrum by the instability. The effect of the stable mode on momentum transport is quantified by expressing the Reynolds stress in terms of stable and unstable mode amplitudes at saturation, from which it is found that the stable mode can produce a sizable reduction in the momentum flux.

  17. GRAVITATIONALLY UNSTABLE FLAMES: RAYLEIGH-TAYLOR STRETCHING VERSUS TURBULENT WRINKLING

    International Nuclear Information System (INIS)

    Hicks, E. P.; Rosner, R.

    2013-01-01

    In this paper, we provide support for the Rayleigh-Taylor-(RT)-based subgrid model used in full-star simulations of deflagrations in Type Ia supernovae explosions. We use the results of a parameter study of two-dimensional direct numerical simulations of an RT unstable model flame to distinguish between the two main types of subgrid models (RT or turbulence dominated) in the flamelet regime. First, we give scalings for the turbulent flame speed, the Reynolds number, the viscous scale, and the size of the burning region as the non-dimensional gravity (G) is varied. The flame speed is well predicted by an RT-based flame speed model. Next, the above scalings are used to calculate the Karlovitz number (Ka) and to discuss appropriate combustion regimes. No transition to thin reaction zones is seen at Ka = 1, although such a transition is expected by turbulence-dominated subgrid models. Finally, we confirm a basic physical premise of the RT subgrid model, namely, that the flame is fractal, and thus self-similar. By modeling the turbulent flame speed, we demonstrate that it is affected more by large-scale RT stretching than by small-scale turbulent wrinkling. In this way, the RT instability controls the flame directly from the large scales. Overall, these results support the RT subgrid model.

  18. The Unstable Elbow: Current Concepts in Diagnosis and Treatment.

    Science.gov (United States)

    Tashjian, Robert Z; Wolf, Brian R; van Riet, Roger P; Steinmann, Scott P

    2016-01-01

    Elbow instability is common and may occur after a variety of injuries, including falls or direct blows. Instability can be classified as either acute or chronic. Acute instability is classified as simple (without fracture) or complex (with associated fracture). Chronic instability is classified as a chronically dislocated or recurrently unstable elbow. Recurrent instability commonly presents as isolated medial or lateral collateral ligament insufficiency. A chronically dislocated elbow is often more complex, involving both osseous and ligamentous injuries. The treatment of simple dislocations typically involves closed reduction and nonsurgical management. Chronic recurrent lateral and medial collateral ligament insufficiencies have very different clinical characteristics, but definitive treatment frequently involves ligament reconstruction. Complex instability usually requires surgery, which includes open reduction and internal fixation of coronoid and olecranon fractures, repair or replacement of radial head fractures, and lateral collateral ligament repair. Medial collateral ligament repair and/or external fixation are rarely required to restore stability. It is important for surgeons to understand current concepts in the diagnosis and management of acute and chronic elbow instability as well as the preferred surgical treatments and techniques for the management of these injuries.

  19. Unstable mutations: cause of some neurological hereditary diseases

    International Nuclear Information System (INIS)

    Cuenca Berger, P.; Morales Montero, F.

    1999-01-01

    Unstable mutations or amplification of triplets constitute a kind of genetic alteration discovered during the last decade. They had been found inside or near genes important for the normal neurological function of the human being. In some cases, the presence of the amplification causes the inactivation of the gene or the synthesis of a new product which functions different from the original protein. Some common characteristics of diseases caused by the amplification of triplets are that it affects the nervous system and are degenerative in nature. The expression of the manifestations varies according to age. Most of them show genetic anticipation in which the severity of the manifestations increases with each generation and appear at an earlier age. In most cases, the severity of the symptoms is correlated positively to the size of the amplification. The diagnosis of an affected individual in a family may indicate the presence of an altered gene in other relatives. These relatives may not present evident signs of the illness either because it is of late onset or because they carry premutations. The molecular diagnosis of these mutations is important to estimate the risk of developing the disease and/or of transmitting the illness to the descendants and to eliminate the fears of healthy relatives who have inherited normal copies of the gene. (Author) [es

  20. Crustal fingering: solidification on a viscously unstable interface

    Science.gov (United States)

    Fu, Xiaojing; Jimenez-Martinez, Joaquin; Cueto-Felgueroso, Luis; Porter, Mark; Juanes, Ruben

    2017-11-01

    Motivated by the formation of gas hydrates in seafloor sediments, here we study the volumetric expansion of a less viscous gas pocket into a more viscous liquid when the gas-liquid interfaces readily solidify due to hydrate formation. We first present a high-pressure microfluidic experiment to study the depressurization-controlled expansion of a Xenon gas pocket in a water-filled Hele-Shaw cell. The evolution of the pocket is controlled by three processes: (1) volumetric expansion of the gas; (2) rupturing of existing hydrate films on the gas-liquid interface; and (3) formation of new hydrate films. These result in gas fingering leading to a complex labyrinth pattern. To reproduce these observations, we propose a phase-field model that describes the formation of hydrate shell on viscously unstable interfaces. We design the free energy of the three-phase system to rigorously account for interfacial effects, gas compressibility and phase transitions. We model the hydrate shell as a highly viscous fluid with shear-thinning rheology to reproduce shell-rupturing behavior. We present high-resolution numerical simulations of the model, which illustrate the emergence of complex crustal fingering patterns as a result of gas expansion dynamics modulated by hydrate growth at the interface.