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Sample records for disease angina pectoris

  1. 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....

  2. 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...

  3. 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 ...

  4. 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.

  5. 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

  6. Coronary microvascular function and myocardial fibrosis in women with angina pectoris and no obstructive coronary artery disease

    DEFF Research Database (Denmark)

    Mygind, Naja Dam; Michelsen, Marie Mide; Peña, Adam

    2016-01-01

    BACKGROUND: Even in absence of obstructive coronary artery disease women with angina pectoris have a poor prognosis possibly due to coronary microvascular disease. Coronary microvascular disease can be assessed by transthoracic Doppler echocardiography measuring coronary flow velocity reserve (CFVR......) and by positron emission tomography measuring myocardial blood flow reserve (MBFR). Diffuse myocardial fibrosis can be assessed by cardiovascular magnetic resonance (CMR) T1 mapping. We hypothesized that coronary microvascular disease is associated with diffuse myocardial fibrosis. METHODS: Women with angina...... using a modified Look-Locker pulse sequence measuring T1 and extracellular volume fraction (ECV). RESULTS: CFVR and CMR were performed in 64 women, mean (SD) age 62.5 (8.3) years. MBFR was performed in a subgroup of 54 (84 %) of these women. Mean native T1 was 1023 (86) and ECV (%) was 33.7 (3.5); none...

  7. 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

  8. Accelerated collagen turnover in women with angina pectoris without obstructive coronary artery disease: An iPOWER substudy.

    Science.gov (United States)

    Nielsen, Signe H; Mygind, Naja D; Michelsen, Marie M; Bechsgaard, Daria F; Suhrs, Hannah E; Genovese, Federica; Nielsen, Henning B; Brix, Susanne; Karsdal, Morten; Prescott, Eva; Kastrup, Jens

    2018-01-01

    Aim Collagens are major cardiac extracellular matrix components, known to be actively remodelled and accumulated during diffuse myocardial fibrosis. We evaluated whether accelerated collagen turnover described by neo-epitope biomarkers reflecting collagen formation and degradation separates 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 protein fragments in serum assessed the formation and degradation of collagen type III (Pro-C3, C3M and C3C), IV (P4NP7S and C4M), V (Pro-C5 and C5M) and VI (Pro-C6 and C6M), and degradation of collagen type I (C1M). Serum samples from 32 age-matched asymptomatic women were included as controls. Symptomatic women presented significantly elevated levels of Pro-C6, C3C, C3M, C4M and C8-C ( p < 0.0001-0.0058) and significantly decreased levels of Pro-C3, C5M and C6M ( p < 0.0001-0.041), reflecting accelerated collagen turnover and an imbalanced collagen formation and degradation compared to controls. 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, 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.

  9. 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.

  10. 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...

  11. 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.

  12. 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.

  13. 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 ...

  14. 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...

  15. 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.

  16. 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.

  17. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study

    DEFF Research Database (Denmark)

    Mygind, Naja Dam; Michelsen, Marie Mide; Pena, Adam

    2016-01-01

    Background-The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary...... microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing. Methods and Results-After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary...... testing. Conclusion-Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk...

  18. 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....

  19. The diagnostic value of mean platelet volume in males with premature atherosclerotic coronary artery disease having stable angina pectoris

    Directory of Open Access Journals (Sweden)

    Özgül Malçok Gürel

    2014-09-01

    Full Text Available Objective: In this study, we aimed to investigate whether platelet count and mean platelet volume (MPV could be new biomarkers addition to classical risk factors in premature coronary artery disease (CAD. Methods: Totally 124 male patients (mean age: 45.8±13.0 year; range of age: 27-78 year, with stable angina pectoris, were included. Clinical and laboratory findings (whole blood cell count, glucose, creatinine, lipid profile were recorded. Automatic blood counter was used for hematological parameters. Conventional coronary angiography was performed. Patients having acute coronary syndrome within the last six months, with severe valvular, structural or congenital heart disease, thyroid and hepatic dysfunction or signs of any infection were excluded. Results: The study population were separated into three groups by coronary angiography: 51 with stable CAD aged ≤40 years (premature CAD, 38 with stable CAD older than 40 (mature CAD and 35 with the normal coronary arteries (NCA. No significant difference was found in MPV values between premature CAD and mature CAD and also between premature CAD and NCA (p>0.05. A significant negative correlation was found between MPV and platelet count in premature CAD (r=-0.419, p=0.002. Both in premature CAD and mature CAD groups, higher MPV values was found in critical CAD subgroup than noncritical CAD subgroup, but the difference was not statistically significant (p>0.05. Conclusion: There was no significant difference in MPV between premature and mature male CAD patients compared to NCA group. A positive but non-significant correlation was found between the MPV values and the severity of CAD. J Clin Exp Invest 2014; 5 (3: 381-385

  20. 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.

  1. 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.

  2. 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....

  3. 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.

  4. [Influence of the Potassium Channels Activator Nicorandil to the Quality of Life in Patients With Ishemic Heart Disease and Stable Angina Pectoris].

    Science.gov (United States)

    Sizova, Zh M; Zakharova, V L; Kozlova, N V; Kuchkina, T S

    2016-06-01

    The aim of the study to assess the influence of medicamentous therapy to the quality of life of ischemic heart disease patients with stable angina pectoris by activator potassium channels nicorandil in comparison with traditional therapy by isosorbide dinitrate. The study included 84 ischemic heart disease patients. Authors consider quality of life as an estimated category of state of the subject in an illness situation. The dynamic of physical and psychological components of quality of life are compared in ischemic heart disease patients under the treatment by nicorandil and isosorbide dinitrate. Indicators of quality of life, defined on the basis of a questionnaires of SAQ and GHQ supplementing an illness picture, are an multiple-factor criterion of an assessment of a condition of this category of patients. The benefits of nicorandil in influence on quality of life indicators were revealed in the study.

  5. 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.

  6. 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....

  7. 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...

  8. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease: The iPOWER Study.

    Science.gov (United States)

    Mygind, Naja Dam; Michelsen, Marie Mide; Pena, Adam; Frestad, Daria; Dose, Nynne; Aziz, Ahmed; Faber, Rebekka; Høst, Nis; Gustafsson, Ida; Hansen, Peter Riis; Hansen, Henrik Steen; Bairey Merz, C Noel; Kastrup, Jens; Prescott, Eva

    2016-03-15

    The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing. After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary artery stenosis (<50%) were consecutively included. Mean age (SD) was 62.1 (9.7). Assessment included demographic and clinical data, blood samples, questionnaires, and transthoracic echocardiography during rest and high-dose dipyridamole (0.84 mg/kg) with measurement of coronary flow velocity reserve (CFVR) by Doppler examination of the left anterior descending coronary artery. CFVR was successfully measured in 919 (95%) women. Median (IQR) CFVR was 2.33 (1.98-2.76), and 241 (26%) had markedly impaired CFVR (<2). In multivariable regression analysis, predictors of impaired CFVR were age (P<0.01), hypertension (P=0.02), current smoking (P<0.01), elevated heart rate (P<0.01), and low high-density lipoprotein cholesterol (P=0.02), but these variables explained only a little of the CFVR variation (r(2)=0.09). CFVR was not associated with chest pain characteristics or results from diagnostic stress testing. Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk evaluation of these women. Symptom characteristics and results from stress testing did not identify individuals with impaired CFVR. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley

  9. 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.

  10. 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.

  11. Coronary microvascular function and myocardial fibrosis in women with angina pectoris and no obstructive coronary artery disease: the iPOWER study.

    Science.gov (United States)

    Mygind, Naja Dam; Michelsen, Marie Mide; Pena, Adam; Qayyum, Abbas Ali; Frestad, Daria; Christensen, Thomas Emil; Ghotbi, Adam Ali; Dose, Nynne; Faber, Rebekka; Vejlstrup, Niels; Hasbak, Philip; Kjaer, Andreas; Prescott, Eva; Kastrup, Jens

    2016-11-04

    Even in absence of obstructive coronary artery disease women with angina pectoris have a poor prognosis possibly due to coronary microvascular disease. Coronary microvascular disease can be assessed by transthoracic Doppler echocardiography measuring coronary flow velocity reserve (CFVR) and by positron emission tomography measuring myocardial blood flow reserve (MBFR). Diffuse myocardial fibrosis can be assessed by cardiovascular magnetic resonance (CMR) T1 mapping. We hypothesized that coronary microvascular disease is associated with diffuse myocardial fibrosis. Women with angina, a clinically indicated coronary angiogram with <50 % stenosis and no diabetes were included. CFVR was measured using dipyridamole (0.84 mg/kg) and MBFR using adenosine (0.84 mg/kg). Focal fibrosis was assessed by 1.5 T CMR late gadolinium enhancement (0.1 mmol/kg) and diffuse myocardial fibrosis by T1 mapping using a modified Look-Locker pulse sequence measuring T1 and extracellular volume fraction (ECV). CFVR and CMR were performed in 64 women, mean (SD) age 62.5 (8.3) years. MBFR was performed in a subgroup of 54 (84 %) of these women. Mean native T1 was 1023 (86) and ECV (%) was 33.7 (3.5); none had focal fibrosis. Median (IQR) CFVR was 2.3 (1.9; 2.7), 23 (36 %) had CFVR < 2 indicating coronary microvascular disease, and median MBFR was 2.7 (2.2; 3.0) and 19 (35 %) had a MBFR value below 2.5. No significant correlations were found between CFVR and ECV or native T1 (R 2  = 0.02; p = 0.27 and R 2  = 0.004; p = 0.61, respectively). There were also no correlations between MBFR and ECV or native T1 (R 2  = 0.1; p = 0.13 and R 2  = 0.004, p = 0.64, respectively). CFVR and MBFR were correlated to hypertension and heart rate. In women with angina and no obstructive coronary artery disease we found no association between measures of coronary microvascular disease and myocardial fibrosis, suggesting that myocardial ischemia induced by coronary

  12. Improving diagnosis and treatment of women with angina pectoris and microvascular disease: the iPOWER study design and rationale.

    Science.gov (United States)

    Prescott, Eva; Abildstrøm, Steen Zabell; Aziz, Ahmed; Merz, Noel Bairey; Gustafsson, Ida; Halcox, Julian; Hansen, Henrik Steen; Hansen, Peter Riis; Kastrup, Jens; Michelsen, Marie; Mygind, Naja Dam; Ong, Peter; Pena, Adam; Rosengren, Annika; Sechtem, Udo; Søgaard, Peter

    2014-04-01

    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. All women with angina referred to invasive angiographic assessment in Eastern Denmark are invited to join the study according to in- and exclusion criteria. Assessment includes demographic, clinical and psychosocial data, symptoms, electrocardiogram, blood- and urine samples and transthoracic echocardiography during rest and dipyridamol stress with measurement of coronary flow reserve (CFR) by Doppler of the left anterior descending artery. In substudies CMD will be assessed by positron emission tomography, peripheral endothelial function, magnetic resonance imaging-and computed tomography derived myocardial perfusion scans, angiographic corrected TIMI frame counts, 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. 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%). Among women with suspected ischemic heart disease and no obstructive coronary artery disease, non-invasive Doppler CFR is feasible as a routine assessment. The study will provide information on methods to diagnose CMD and determine the prognostic value of routine non-invasive assessment of microvascular function. Future study will provide women identified with CMD participation in interventional substudies designed to test treatment strategies. Copyright © 2014 Mosby, Inc. All rights reserved.

  13. 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

  14. 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.

  15. Predictive value of the corrected TIMI frame count in patients with suspected angina pectoris but no obstructive coronary artery disease at angiography

    DEFF Research Database (Denmark)

    Jespersen, Lasse; Abildstrøm, Steen Z; Peña, Adam

    2014-01-01

    AIMS: To evaluate whether the corrected thrombolysis in myocardial infarction frame count (CTFC), an index of resting coronary blood flow, is associated with the risk of major adverse cardiovascular events (MACE) in patients with suspected stable angina pectoris (SAP) but no obstructive coronary......, fourth and fifth CTFC quintiles, respectively. Adjustment for cardiac risk factors including diabetes, active smoking, body mass index, and use of lipid-lowering and antihypertensive medication did not significantly change the results. CONCLUSIONS: In patients with SAP symptoms without obstructive CAD...

  16. 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)

  17. 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.

  18. 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.

  19. 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....

  20. 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.

  1. 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...

  2. 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:...

  3. 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.

  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. 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...

  6. 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...

  7. 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...

  8. 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

  9. [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.

  10. 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.

  11. 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 ...

  12. Investigation of the Relationship between Myocardial Infarction, Angina Pectoris, and Venous Thrombosis and Some Risk Factors in the Women Suffering from Cardiovascular Diseases with a History of Contraceptive Pills Consumption

    Directory of Open Access Journals (Sweden)

    Marzieh Akbarzade

    2016-06-01

    Full Text Available Background: Cardiovascular diseases have various etiologies. Previous studies have come to contradictory results regarding the effects of Oral Contraceptive Pills (OCPs on the risk of myocardial infarction, angina pectoris, and venous thrombosis. Thus, further investigation is required in this area. Objectives: This study aimed to determine the relationship between cardiovascular diseases and some risk factors in the women with a history of contraceptive pills consumption. Patients and Methods: The present case-control study was conducted on 317 women with cardiovascular diseases (myocardial infarction, angina pectoris, and deep venous thrombosis selected through simple purposive sampling from CCU, ICU, post-ICU, and neurology departments of Nemazee, Faghihi, and Al-Zahra heart hospitals. Also, 371 controls were selected among 20 – 60 year-old women without cardiac diseases. The data were collected through questionnaires, interviewing the patients and their first-degree relatives, and the patients’ medical records. The main variables studied in both groups included the history of OCPs consumption, weight gain, blood sugar level, and hypertension. Then, the data were analyzed using chi-square test, correlation coefficient, and odds ratio. Besides, P < 0.05 was considered to be statistically significant. Results: The mean age of the study population was 49.2 ± 13.4 years. Besides, 10.6%, 4%, and 2.7% of the women had used OCPs for 6 - 10, 11 - 15, and more than 16 years, respectively. There were no significant differences between the two groups in terms of history of using OCPs (47.3% vs. 51.5%, P = 0.8. In addition, no significant relationship was observed between consumption of OCPs and incidence of myocardial infarction (P = 0.202, angina pectoris (P = 0.260, and thrombosis (P = 0.389. However, a significant difference was found between the two groups regarding the frequency of hyperlipidemia, hyperglycemia, and hypertension (P < 0

  13. 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

  14. 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...

  15. 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.

  16. 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...

  17. 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.

  18. 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...

  19. Eversion Subclavian Endarterectomy and Transposition for Coronary-Subclavian Steal Syndrome in a Patient with Refractory Angina Pectoris.

    Science.gov (United States)

    Hinojosa, Carlos A; Anaya-Ayala, Javier E; Laparra-Escareno, Hugo; Guerrero-Hernandez, Manuel; Galindo-Uribe, Jaime

    2016-01-01

    Late onset of angina pectoris associated with subclavian artery (SA) atherosclerotic occlusive disease is a rare and recognized cause of myocardial ischemia when the lesion is proximal to a left internal mammary artery (LIMA) to coronary bypass. The symptoms typically exacerbate by increasing the flow demand in the extremity; this phenomenon is known as late coronary-subclavian steal syndrome. We describe the case of a 66-year-old woman who underwent coronary artery bypass grafting from the LIMA to the left anterior descending coronary artery in 2000. Years later, she experienced refractory angina pectoris associated to an occlusive lesion in the proximal left SA. SA endarterectomy with eversion technique and subclavian-carotid transposition restored the antegrade flow with resolution of the symptomatology. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. N-acetylcysteine modifies the acute effects of isosorbide-5-mononitrate in angina pectoris patients evaluated by exercise testing

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Klarlund, K; Aldershvile, J

    1989-01-01

    significant coronary artery disease were included. All patients received a baseline therapy with beta blockers. None of the patients had developed nitrate tolerance at inclusion. NAC/5-ISMN treatment significantly prolonged the total exercise time as compared with placebo/5-ISMN (7.7 +/- 2.1 min vs. 6.8 +/- 1......, given together with a single oral dose of the long-acting nitrate, isosorbide-5-mononitrate (5-ISMN, 60 mg), would modify the nitrate effect evaluated by exercise testing before and after additional sublingual doses of nitroglycerin (NTG). Ten patients with angina pectoris and angiographically proven.......7 min, p less than 0.05). This increase was of such magnitude that no further effect was obtained after additional NTG doses. This study demonstrated that increased availability of sulfhydryl groups can increase the exercise capacity in angina pectoris patients treated with 5-ISMN without nitrate...

  1. Relationship between lung-to-heart uptake ratio of technetium-99m-tetrofosmin during exercise myocardial single photon emission computed tomographic imaging and the number of diseased coronary arteries in patients with effort angina pectoris without myocardial infarction

    International Nuclear Information System (INIS)

    Okajima, Toshiya; Ueshima, Kenji; Nishiyama, Osamu; Ogawa, Muneyoshi; Ohuchi, Mami; Saitoh, Masahiko; Hiramori, Katsuhiko

    2004-01-01

    Increased lung uptake of thallium-201 in exercise myocardial perfusion imaging is a reliable marker of multivessel disease in patients with ischemic heart disease. This study investigated whether the lung-to-heart uptake ratio with technetium-99m ( 99m Tc)-tetrofosmin also provides valuable information to detect patients with multivessel disease. Fifty-three consecutive patients (35 men, 18 women, mean age 66±11 years; single-vessel disease: 29, double-vessel disease: 16, triple-vessel disease: 8) with stable effort angina pectoris without prior myocardial infarction and 17 control subjects (12 men, 5 women, mean age 62±9 years) underwent exercise myocardial perfusion imaging with 99m Tc-tetrofosmin and coronary angiography in January 2000 to December 2002. The lung-to-heart uptake ratio was calculated on an anterior projection before reconstruction of the exercise single photon emission computed tomographic images. The mean lung-to-heart uptake ratio was 0.34±0.04, 0.38±0.07, 0.41±0.05, and 0.46±0.09, in patients with normal coronary, single-vessel disease, double-vessel disease, and triple-vessel disease, respectively. Significantly higher lung-to-heart uptake ratio was associated with more diseased vessels (p 99m Tc-tetrofosmin can provide clinically useful information to detect multivessel disease in patients with ischemic heart disease. (author)

  2. 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.

  3. Coronary microvascular dysfunction is not associated with a history of reproductive risk factors in women with angina pectoris-An iPOWER substudy

    DEFF Research Database (Denmark)

    Suhrs, Hannah Elena; Kristensen, Anna Meta; Rask, Anna Bay

    2018-01-01

    BACKGROUND: Reproductive risk factors such as preeclampsia and recurrent miscarriages have been associated with adverse cardiovascular (CV) events. Underlying coronary microvascular dysfunction (CMD) may be a common denominator. PURPOSE: We investigated whether a history of reproductive risk...... factors was associated with CMD in women with angina pectoris and no obstructive coronary artery disease (CAD). METHODS: Participants from the iPOWER study, including women with angina pectoris and no obstructive CAD (... risk factors: recurrent miscarriages, gestational diabetes, preeclampsia, rhesus immunity, polycystic ovary syndrome and menopausal status as well as migraine and Raynaud phenomenon. CMD was assessed by transthoracic Doppler echocardiography with measurement of coronary flow velocity reserve (CFVR...

  4. 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.

  5. 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

  6. 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...

  7. 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.

  8. [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.

  9. 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.

  10. 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.

  11. Is there an indication for coronary angiography in patients under 60 years of age with no or minimal angina pectoris after a first myocardial infarction?

    NARCIS (Netherlands)

    Veenbrink, Th.W.G.; Werf, T. van der; Westerhof, P.W.; Robles de Medina, E.O.; Meijler, F.L.

    1985-01-01

    Coronary angiography and exercise stress tests were performed in 91 consecutive patients under 60 years of age having either no or only mild angina pectoris with or without medication after a first myocardial infarction. Nine (10%) patients had angiographic high risk coronary artery disease defined

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. [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.

  17. The effects of enhanced external counterpulsation on health-related quality of life in patients with angina pectoris

    Science.gov (United States)

    Ziaeirad, Marzieh; Ziaei, Gholam Reza; Sadeghi, Narges; Motaghi, Minoo; Torkan, Behnaz

    2012-01-01

    Background: The complicated concept of quality of life (QOL) has been considered as an important criterion for health outcomes in chronic diseases, such as heart disease, in recent years. The aim of this study was to evaluate the QOL of patients with angina pectoris after treatment with enhanced external counterpulsation (EECP). Materials and Methods: This quasi-experimental study was conducted on 64 patients with angina pectoris undergoing EECP who came to Shahid Chamran and Sina Hospitals in Isfahan. Sampling was performed by the convenient method. Data were collected using a questionnaire containing socio-demographic and clinical data. A standard questionnaire called 36-item Short-Form Health Survey was also used. Questionnaires were completed through interviews and phone calls in three stages (before, immediately and three months after the treatment). The results were analyzed using descriptive statistics (frequency, mean, and standard deviation) and analytical statistics (paired t-test and repeated measures test) in SPSS11.5. Findings: The obtained results demonstrated that the majority of patients were men (59.4%) and aged 56-71 years. In addition, 57.8% had hypertension and 56.3% had hyperlipidemia. A history of myocardial infarction was found in 70.3% of the subjects and the familial history of coronary artery disease was detected in73.4%. Although QOL evaluations showed improvements in all subscales immediately and three months after the treatment, the changes were not statistically significant in case of general health, role limitations due to physical problems and role limitations due to mental problems Conclusions: Similar to previous research, this study showed QOL to improve in patients who undergo EECP. This improvement will remain stable three months after the treatment in all subscales. Therefore, EECP is an efficient noninvasive method in treating patients with angina pectoris and in developing their QOL. PMID:23493242

  18. 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.

  19. Diagnosis of coronary artery disease by thallium-201 myocardial scintigraphy with intravenous infusion of SUNY4001 (adenosine) in effort angina pectoris. The clinical trial report at multi-center. Phase II

    International Nuclear Information System (INIS)

    Sakata, Yasushi; Kodama, Kazuhisa; Nishimura, Tsunehiko; Kajiya, Teishi; Kato, Kazuzo

    2004-01-01

    Forty-four patients with effort angina pectoris were evaluated with SUNY4001 (adenosine) thallium-201 ( 201 Tl) myocardial scintigraphy to detect coronary artery disease. These patients had single-vessel disease (≥American Heart Association (AHA) 90% stenosis) in either right coronary artery (RCA) or left anterior descending (LAD). Adenosine was infused at the rate of 120 or 140 μg/kg/min for six minutes. One hundred eleven MBq of 201 Tl was injected after three minutes of the start of the infusion. The early and delayed images were obtained by SPECT imaging. The sensitivity was 94.7% at 120 μg/kg/min and 84.2% at 140 μg/kg/min. Adenosine 201 Tl myocardial scintigraphy showed high accuracy for detecting significant coronary artery disease. Adverse reactions occurred in 77.3% of the patients. Regarding the rates of the adverse reactions, there was no significant difference between 120 and 140 μg/kg/min. Major adverse reactions were Chest pain/discomfort (52.3%) and Flushing/Feeling of warmth (27.3%). No serious complication was observed at any infusion rate. Most of adverse reactions disappeared shortly. Only two patients required treatment for moderate chest pain, which, however, disappeared in several minutes. One of the treatments was merely the termination of adenosine infusion, and the other was sublingual spray of nitroglycerin. Adenosine infusion caused slight decrease in blood pressure and increase in heart rate. The hemodynamic changes resolved within several minutes after the adenosine infusion. Decrease in systolic blood pressure of more than 20 mmHg from the base level occurred in 26.1% and 52.4% at 120 and 140 μg/kg/min infusion rate respectively. Therefore, the adenosine infusion at 120 μg/kg/min should be considered safe and useful for the diagnosis of coronary artery disease by pharmacologic stress imaging. (author)

  20. 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.

  1. [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.

  2. 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.

  3. [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.

  4. [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.

  5. 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.

  6. 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.

  7. 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

  8. Hemodynamic effects of metoprolol and nifedipine in angina pectoris measured by isotope technique

    Energy Technology Data Exchange (ETDEWEB)

    Bostroem, P.A.

    1988-01-01

    In order to evaluate the therapeutic effects of metoprolol, nifedipine, and their combination, 11 patients with secondary angina pectoris and with thallium tomographic findings indicating coronary artery disease were studied before and after these three treatment regimes in a single-blind cross-over study. The therapeutic effect was measured by standardized working test and isotope angiocardiography, which enabled evaluation of left ventricular ejection fraction, stroke volume, and phase analysis of left ventricular contraction. Treatment with metoprolol and combination therapy increased work performance. Ejection fraction did not differentiate the treatment regimes, whereas stroke volume was significantly lower at work and heart rate higher at rest and at work during nifedipine treatment compared to either metoprolol or combination treatment (p less than 0.05). Cardiac output was significantly reduced during nifedipine and metoprolol treatment during work (p less than 0.05). Phase improved after all therapeutic regimes, but reached significance only during the metoprolol treatment period at rest (p less than 0.05).

  9. 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.

  10. 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)

  11. 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).

  12. 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.

  13. 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

  14. 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...

  15. 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)

  16. Diagnostic and prognostic value of a careful symptom evaluation and high sensitive troponin in patients with suspected stable angina pectoris without prior cardiovascular disease

    DEFF Research Database (Denmark)

    Madsen, Debbie Maria; Diederichsen, Axel C P; Hosbond, Susanne E

    2017-01-01

    -TnI in stable chest pain patients without prior cardiovascular disease. METHODS: During a one-year period, 487 patients with suspected stable AP underwent invasive or CT-coronary angiography (significant stenosis ≥50%). At study inclusion, a careful symptom evaluation was obtained, and patients were classified...

  17. 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.

  18. 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...

  19. 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.

  20. [25-year old patient with angina pectoris during religious fasting].

    Science.gov (United States)

    Huber, C A; Wunderlich, G; Brunn, A; Blau, T; Fink, G R; Lehmann, H C

    2015-02-01

    HISTORY AND PRESENTATION AT ADMISSION: A 25-year-old male patient presented with acute left sided chest pain. The patient reported no physical exercise but daytime fasting (with neither food nor liquid intake) which he had started several days before. ECG, echocardiography and chest X-ray were normal, but blood examination revealed elevated levels for creatine kinase (CK) and lactate dehydrogenase (LDH). Ischemic lactate ammonia test revealed no increase of lactate during exercise. Muscle biopsy confirmed suspected diagnosis of glycogen storage disease type V (McArdle's disease). As causal treatments are unavailable for McArdle's disease, careful counselling regarding adequate exercise and regular, carbohydrate rich nutrition are mandatory to ameliorate symptoms. McArdle's disease represents a rare differential diagnosis of cardiac chest pain and somatoform myalgic complaints. When taking the patient's history, questions regarding the "Second wind"-phenomenon are helpful for initiating the adequate investigations early on. © Georg Thieme Verlag KG Stuttgart · New York.

  1. [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.

  2. Diagnosing coronary artery disease by sound analysis from coronary stenosis induced turbulent blood flow: diagnostic performance in patients with stable angina pectoris.

    Science.gov (United States)

    Winther, Simon; Schmidt, Samuel Emil; Holm, Niels Ramsing; Toft, Egon; Struijk, Johannes Jan; Bøtker, Hans Erik; Bøttcher, Morten

    2016-02-01

    Optimizing risk assessment may reduce use of advanced diagnostic testing in patients with symptoms suggestive of stable coronary artery disease (CAD). Detection of diastolic murmurs from post-stenotic coronary turbulence with an acoustic sensor placed on the chest wall can serve as an easy, safe, and low-cost supplement to assist in the diagnosis of CAD. The aim of this study was to evaluate the diagnostic accuracy of an acoustic test (CAD-score) to detect CAD and compare it to clinical risk stratification and coronary artery calcium score (CACS). We prospectively enrolled patients with symptoms of CAD referred to either coronary computed tomography or invasive coronary angiography (ICA). All patients were tested with the CAD-score system. Obstructive CAD was defined as more than 50 % diameter stenosis diagnosed by quantitative analysis of the ICA. In total, 255 patients were included and obstructive CAD was diagnosed in 63 patients (28 %). Diagnostic accuracy evaluated by receiver operating characteristic curves was 72 % for the CAD-score, which was similar to the Diamond-Forrester clinical risk stratification score, 79 % (p = 0.12), but lower than CACS, 86 % (p < 0.01). Combining the CAD-score and Diamond-Forrester score, AUC increased to 82 %, which was significantly higher than the standalone CAD-score (p < 0.01) and Diamond-Forrester score (p < 0.05). Addition of the CAD-score to the Diamond-Forrester score increased correct reclassification, categorical net-reclassification index = 0.31 (p < 0.01). This study demonstrates the potential use of an acoustic system to identify CAD. The combination of clinical risk scores and an acoustic test seems to optimize patient selection for diagnostic investigation.

  3. 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)

  4. [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.

  5. 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....

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. 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.

  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. 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)

  13. 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.

  14. The potential role of herbal medicines in the treatment of chronic stable angina pectoris: a review of key herbs, and as illustration, exploration of the Chinese herbal medicine approach

    Directory of Open Access Journals (Sweden)

    O'Brien KA

    2012-12-01

    Full Text Available Kylie A O'Brien,1,2 Luis Vitetta31Deakin University, Melbourne, Victoria, Australia; 2Monash Medical School, Prahran, Victoria, Australia; 3The University of Queensland, School of Medicine, Centre for Integrative Clinical and Molecular Medicine at the Princess Alexandra Hospital, Brisbane, Queensland, AustraliaAbstract: Herbal medicines have been used for centuries within different cultures to treat cardiovascular disease, including stable angina pectoris. However, the use of herbs varies within traditions of natural medicine, and how they are understood to work in systems such as Chinese medicine, for example, is vastly different from the pharmaceutical model that seeks to reduce herbs to their active constituents. This review first discusses, individually, key herbs used within Western, Indian, and Chinese herbalism to treat stable angina pectoris and their main active constituents and pharmacological actions. The second part of the paper then specifically explores how angina is treated traditionally with Chinese herbal medicine, a unique approach to the understanding of health and illness underpinned by philosophies and theories that describe the physiological functioning and pathological changes in the body in terms very different from those of biomedicine. A foundational account of the guiding theories of Chinese medicine is followed by a description of the cardiovascular system and the etiology and pathogenesis of angina from the Chinese medical perspective. This forms the basis for understanding the rationale for construction of Chinese herbal medicinal formulae for treating angina pectoris. The scientific evidence of the efficacy of some Chinese herbal formulae is discussed.Keywords: herbs, herbal medicine, Chinese herbal medicine, angina pectoris, cardiovascular

  15. 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

  16. Assessment of economic effectiveness in treatment of neuropathic pain and refractory angina pectoris using spinal cord stimulation.

    Science.gov (United States)

    Harat, Aleksandra; Sokal, Paweł; Zieliński, Piotr; Harat, Marek; Rusicka, Teresa; Herbowski, Leszek

    2012-01-01

    The implementation of new diagnostic and therapeutic technologies is related to expanding financial needs. The escalation of expenses for health protection and simultaneous economic problems has resulted in an interest in the subject of economic assessment. Decision makers in the health sector should have reasonable tools that will allow them to make complex evaluations of the economic suitability of health technologies. Economic analysis should also prove that launching new procedures can save money. Numerous studies indicate that chronic pain and psycho-sociological variables lead to a worse quality of life. Chronic pain issues are a major public health problem, by virtue of the difficulties in efficient therapy and the social costs reflected in incapability of work and disability. Spinal cord stimulation is the most efficacious procedure in the treatment of chronic pain. The aim of the study was to estimate the costs of treatment of 37 patients suffering from refractory angina pectoris and neuropathic pain who underwent SCS surgery between 2002 and 2008 in the Neurosurgery Clinic of the 10th Military Hospital in Bydgoszcz in the period of two years before and two years after spinal cord stimulation. The authors also assessed quality of life, using the SF 36 questionnaire, and degree of pain using VAS. The issue was examined with a cost-benefit analysis. Cost was understood as the expenses made two years before and two years after the SCS procedure. The benefits were health care expenses saved by implementation of the SCS procedure. All the costs included in both alternative treatment techniques in a period of 5 years underwent a discounting procedure. The authors also included the price of the neurostimulator under a sensitivity analysis. To assess the quality of life before and after the SCS procedure, a SF 36 questionnaire was used, and to assess the level of pain before and after the SCS procedure, the VAS scale. The costs of treatment of refractory angina

  17. Comparison of chest pain, electrocardiographic changes and thallium-201 scintigraphy during varying exercise intensities in men with stable angina pectoris

    International Nuclear Information System (INIS)

    Heller, G.V.; Ahmed, I.; Tilkemeier, P.L.; Barbour, M.M.; Garber, C.E.

    1991-01-01

    This study was performed to evaluate the presence of angina pectoris, electrocardiographic changes and reversible thallium-201 defects resulting from 2 different levels of exercise in 19 patients with known coronary artery disease and evidence of exercise-induced ischemia. The exercise protocols consisted of a symptom-limited incremental exercise test (Bruce protocol) followed within 3 to 14 days by a submaximal, steady-state exercise test performed at 70% of the maximal heart rate achieved during the Bruce protocol. The presence and time of onset of angina and electrocardiographic changes (greater than or equal to 0.1 mV ST-segment depression) as well as oxygen uptake, exercise duration and pressure-rate product were recorded. Thallium-201 (2.5 to 3.0 mCi) was injected during the last minute of exercise during both protocols, and the images were analyzed using both computer-assisted quantitation and visual interpretations. Incremental exercise resulted in anginal symptoms in 84% of patients, and electrocardiographic changes and reversible thallium-201 defects in all patients. In contrast, submaximal exercise produced anginal symptoms in only 26% (p less than 0.01) and electrocardiographic changes in only 47% (p less than 0.05), but resulted in thallium-201 defects in 89% of patients (p = not significant). The locations of the thallium-201 defects, when present, were not different between the 2 exercise protocols. These findings confirm the sequence of the ischemic cascade using 2 levels of exercise and demonstrate that the cascade theory is applicable during varying ischemic intensities in the same patient

  18. 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.

  19. 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.

  20. 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.

  1. 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)

  2. 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.

  3. [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.

  4. [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.

  5. 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.

  6. 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.

  7. 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.

  8. Understanding the Role of Autoimmune Disorders on the Initial Presentation of Cardiovascular Disease

    Science.gov (United States)

    2015-04-20

    Myocardial Infarction; Ischemic Stroke; Stroke; Subarachnoid Haemorrhage; Venous Thrombosis; Transient Ischemic Attack; Stable Angina Pectoris; Unstable Angina; Heart Failure; Peripheral Arterial Disease; Abdominal Aortic Aneurysm

  9. "Angina pectoris instável: perfil de clientes de uma instituição privada"

    OpenAIRE

    Silvia Sidnéia da Silva

    2003-01-01

    Trata-se de estudo descritivo com abordagem de análise quantitativa que tem por objetivo identificar o perfil de clientes portadores de angina pectoris instável atendidos numa instituição privada, de um município do interior paulista. O referencial teórico utilizado foi o modelo de “Campo de Saúde” de Lalonde que analisa elementos como a biologia humana, meio ambiente, estilo de vida e organização dos serviços de saúde diante da ocorrência de patologias. A amostra constituiu-se de 58 cl...

  10. 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...

  11. 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

  12. [Epidural spinal stimulation in the treatment of refractory angina pectoris. Its clinical efficacy, complications and long-term mortality. An Italian multicenter retrospective study].

    Science.gov (United States)

    Romanò, M; Auriti, A; Cazzin, R; Chiarandà, G; Circo, A; De Luca, A; Di Pede, F; Fiume, D; Greco, S; Grieco, A; Mangiameli, S; Maritano, M; Mazzarino, F; Pinato, G; Raciti, S; Raviele, A; Santini, M; Zucco, F; Zuin, G

    2000-01-01

    Spinal cord stimulation has been used for many years in the treatment of refractory angina pectoris. Its anti-anginal and anti-ischemic effect has been well documented in several studies, but the long-term efficacy, safety and survival rate are not well known. The aim of this study was to carry out a retrospective analysis of a series of patients from the Italian Multicenter Registry, the data of which were collected in five centers, by means of a questionnaire. One hundred and thirty patients (83 males, 47 females, mean age 74.8 +/- 9.8 years) were submitted to spinal cord stimulator implantation for refractory angina pectoris in the period 1988-1995 and controlled during a mean follow-up of 31.4 +/- 25.9 months. A previous myocardial infarction had already occurred in 69.3% of patients, whereas in 67.6% multivessel coronary artery disease was documented. A left ventricular dysfunction (ejection fraction < 0.40) was present in 34% of patients; bypass surgery and coronary angioplasty were performed in 49.6% and in 27% of patients respectively. In 96.3% of cases revascularization procedures were not advisable. A complete follow-up of 116 patients (89.2%) was available. The spinal cord stimulator induced a significant reduction in NYHA functional class from 2.5 +/- 1.2 to 1.5 +/- 0.9 (p < 0.01). During the follow-up 41 patients (35.3%) died, and in 14.2% a new acute myocardial infarction developed. The total percentage of minor spinal cord stimulation-related complications was 6.8%. No major complications occurred. The annual total mortality rate was 6.5%, whereas the cardiac mortality rate was 5%. Compared to the survivors, patients who died showed a higher incidence of left ventricular dysfunction, previous myocardial infarction and bypass surgery at implantation. In our experience, spinal cord stimulation is an effective therapy in patients affected by refractory angina pectoris and who cannot undergo revascularization procedure. The complication rate is low, with

  13. 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.

  14. 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

  15. 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...

  16. Plasma α1-antitrypsin: A Neglected Predictor of Angiographic Severity in Patients with Stable Angina Pectoris

    Directory of Open Access Journals (Sweden)

    Hui Zhao

    2015-01-01

    Full Text Available Background: As an acute phase protein, α1-antitrypsin (AAT has been extensively studied in acute coronary syndrome, but it is unclear whether a relationship exists between AAT and stable angina pectoris (SAP. The purpose of the present study was to investigate the association between AAT plasma levels and SAP. Methods: Overall, 103 SAP patients diagnosed by coronary angiography and clinical manifestations and 118 control subjects matched for age and gender were enrolled in this case-control study. Plasma levels of AAT, high-sensitivity C-reactive protein (hsCRP, lipid profiles and other clinical parameters were assayed for all participants. The severity of coronary lesions was evaluated based on the Gensini score (GS assessed by coronary angiography. Results: Positively correlated with the GS (r = 0.564, P < 0.001, the plasma AAT level in the SAP group was significantly higher than that in the control group (142.08 ± 19.61 mg/dl vs. 125.50 ± 19.67 mg/dl, P < 0.001. The plasma AAT level was an independent predictor for both SAP (odds ratio [OR] = 1.037, 95% confidence interval [CI]: 1.020-1.054, P < 0.001 and a high GS (OR = 1.087, 95% CI: 1.051-1.124, P < 0.001 in a multivariate logistic regression model. In the receiver operating characteristic curve analysis, plasma AAT level was found to have a larger area under the curve (AUC for predicting a high GS (AUC = 0.858, 95% CI: 0.788-0.929, P < 0.001 than that of hsCRP (AUC = 0.665, 95% CI: 0.557-0.773, P = 0.006; Z = 2.9363, P < 0.001, with an optimal cut-off value of 137.85 mg/dl (sensitivity: 94.3%, specificity: 68.2%. Conclusions: Plasma AAT levels correlate with both the presence and severity of coronary stenosis in patients with SAP, suggesting that it could be a potential predictive marker of severe stenosis in SAP patients.

  17. [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

  18. Effect of spinal cord stimulation on heart rate variability and myocardial ischemia in patients with chronic intractable angina pectoris - A prospective ambulatory electrocardiographic study

    NARCIS (Netherlands)

    Hautvast, RWM; Brouwer, J; DeJongste, MJL; Lie, KI

    Background and hypothesis: Spinal cord stimulation is an effective treatment for chronic refractory angina pectoris. Its efficacy is related to an anti-ischemic action, possibly as a result of modulation of the autonomic nervous system. Therefore, the influence of spinal cord stimulation on the

  19. 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.

  20. 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.

  1. 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...

  2. 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

  3. Coronary microvascular dysfunction is not associated with a history of reproductive risk factors in women with angina pectoris-An iPOWER substudy.

    Science.gov (United States)

    Suhrs, Hannah Elena; Kristensen, Anna Meta; Rask, Anna Bay; Michelsen, Marie Mide; Frestad, Daria; Mygind, Naja Dam; Bové, Kira; Prescott, Eva

    2018-01-01

    Reproductive risk factors such as preeclampsia and recurrent miscarriages have been associated with adverse cardiovascular (CV) events. Underlying coronary microvascular dysfunction (CMD) may be a common denominator. We investigated whether a history of reproductive risk factors was associated with CMD in women with angina pectoris and no obstructive coronary artery disease (CAD). Participants from the iPOWER study, including women with angina pectoris and no obstructive CAD (<50% stenosis), were invited to complete an electronic survey regarding reproductive risk factors: recurrent miscarriages, gestational diabetes, preeclampsia, rhesus immunity, polycystic ovary syndrome and menopausal status as well as migraine and Raynaud phenomenon. CMD was assessed by transthoracic Doppler echocardiography with measurement of coronary flow velocity reserve (CFVR) during high-dose dipyridamole infusion, and analyzed in three categories with cut-off points at 2.0 and 2.5. Associations between CFVR and a history of reproductive risk factors were examined by age-adjusted trend test. The questionnaire was completed by 613 women (73% of those invited), of whom 550 had a successful CFVR measurement. There was no significant difference in baseline characteristics between participants and non-participants. Median (interquartile range (IQR)) age was 62.8 (54.8; 68.7) years, median (IQR) BMI 26.2 (23.2; 29.8) kg/m 2 , and 81.5% were postmenopausal. We did not find any significant associations between any of the reproductive risk factors, Raynaud's phenomenon or migraine and CFVR. The lack of association between coronary microvascular function and a history of reproductive risk factors, migraine and Raynaud's phenomenon suggests that a common vascular pathophysiological mechanism underlying these conditions is unlikely. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. 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.

  5. 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.

  6. 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

  7. 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.

  8. 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.

  9. Evaluation of pharmacokinetics and pharmacodynamics relationships for Salvianolic Acid B micro-porous osmotic pump pellets in angina pectoris rabbit

    Directory of Open Access Journals (Sweden)

    Shu-Ling Kan

    2014-06-01

    Full Text Available The work aims to investigate the in vitro release, pharmacokinetics (PK, pharmacodynamics (PD and PK–PD relationships of Salvianolic Acid B micro-porous osmotic pump pellets (SalB-MPOPs in angina pectoris New Zealand White (NZW rabbits, compared with those of SalB immediate-release pellets (SalB-IRPs. The SalB plasma concentrations and Superoxide dismutase levels (PD index were recorded continuously at predetermined time interval after administration, and the related parameters were calculated by using WinNonlin software. The release profile of MPOPs was more sustained than that of IRPs. PK results indicated that the mean Cmax was significantly lower, the SalB plasma concentrations were steadier, both area under concentration-time curve from 0 to 24 h (AUC0–24 h and from 0 to infinity (AUC0–∞ were presented larger, and both the peak concentration time (Tmax and mean residence time (MRT were prolonged for MPOPs, as compared with those of IRPs. PD results suggested that peak drug effect (Emax was lower and the equilibration rate constant (ke0 between the central compartment and the effect compartment was higher of MPOPs vs. those of IRPs. PK–PD relationships demonstrated that the effect-concentration-time (ECT course of MPOPs was clockwise hysteresis loop, and that of IRPs was counter-clockwise hysteresis loop. Collectively, those results demonstrated that MPOPs were potential formulations in treating angina pectoris induced by atherosclerosis.

  10. 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.

  11. 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

  12. The effects of lidoflazine on exercise performance and thallium stress scintigraphy in patients with stable angina pectoris

    International Nuclear Information System (INIS)

    Shapiro, W.; Narahara, K.A.; Park, J.

    1982-01-01

    Lidoflazine is a synthetic drug with calcium-channel blocking effects. In a 7-month study, 36 patients with stable angina pectoris were tested during a 3-month single-blind placebo phase. Nineteen were then randomized by double-blind methods to lidoflazine and 17 to placebo therapy. The lidoflazine group had a significant (p < 0.01) reduction in anginal attacks; the placebo group did not. Exercise testing demonstrated that lidoflazine therapy was associated with a 34% increase in total work performance and a 15.6% increase in peak calculated oxygen uptake during double-blind treatment (both p < 0.004 compared with the placebo group). Heart rate was significantly reduced at submaximal levels of exercise during lidoflazine therapy (p < 0.04). Nitroglycerin consumption and electrocardiographic changes at the end of exercise did not change during the double-blind phase. In a second study of six similar patients, single-blind administration of lidoflazine was associated with improved myocardial perfusion during exercise as determined by thallium-201 stress scintigraphy. These studies demonstrate that lidoflazine therapy is associated with relief of angina, an increased physical work capacity, and improved regional myocardial perfusion during exercise

  13. The effects of lidoflazine on exercise performance and thallium stress scintigraphy in patients with stable angina pectoris

    International Nuclear Information System (INIS)

    Shapiro, W.; Narahara, K.A.; Park, J.

    1982-01-01

    Lidoflazine is a synthetic drug with calcium-channel blocking effects. In a 7-month study, 36 patients with stable angina pectoris were tested during a 3-month single-blind placebo phase. Nineteen were then randomized by double-blind methods to lidoflazine and 17 to placebo therapy. The lidoflazine group had a significant (p less than 0.01) reduction in anginal attacks; the placebo group did not. Exercise testing demonstrated that lidoflazine therapy was associated with a 34% increase in total work performance and a 15.6% increase in peak calculated oxygen uptake during double-blind treatment (both p less than 0.004 compared with the placebo group). Heart rate was significantly reduced at submaximal levels of exercise during lidoflazine therapy (p less than 0.04). Nitroglycerin consumption and electrocardiographic changes at the end of exercise did not change during the double-blind phase. In a second study of six similar patients, single-blind administration of lidoflazine was associated with improved myocardial perfusion during exercise as determined by thallium-201 stress scintigraphy. These studies demonstrate that lidoflazine therapy is associated with relief of angina, an increased physical work capacity, and improved regional myocardial perfusion during exercise

  14. Clinical course, neurohumoral and hemodynamic disorders in patients with stable angina pectoris on the background of community-acquired pneumonia

    Directory of Open Access Journals (Sweden)

    N. S. Mykhailovska

    2014-08-01

    Full Text Available Introduction: Coronary heart disease is among the most common problems in cardiology. The magnitude of the problem of coronary heart disease is highlighted by estimates that more than 22% of cardiac deaths among women and 20% among men occur every year. The clinical course of coronary heart disease depends on traditional risk factors, coexisting nonspecific respiratory diseases, especially community acquired pneumonia. It is known that within 30 days after community-acquired pneumonia the hospitalizations rate because of exacerbation of coronary heart disease is increased. Objective: to study the clinical course, neurohumoral and hemodynamic changes in patients with coronary heart disease after community acquired pneumonia. Materials and methods: 51 patients with coronary heart disease: stable angina pectoris, 2-3 functional class (22 men and 29 women, from 52 to 78 years old. The patients were examined during the inpatient treatment. The study involved 2 separate groups of patients with coronary heart disease. One group included 31 patients with coronary heart disease and community acquired pneumonia (the principal group. The control group included 20 patients without pneumonia. Within the first 3 days in hospital the levels of total cholesterol, high- and low-density lipoprotein cholesterol, triglyceride (BIOLATEST, company PLIVA-Lachema, high-sensitivity C-reactive protein (by solid-phase chemiluminescence analysis, daily monitoring of ECG («Kardiosens K»,Kharkov and ultrasonography («SONOACE» 8000SE were assessed. The data were processed by methods of variation statistics using application package «Statistica 11.0» by standard requirements. Results: The study showed that in the principal group dyspnea (2.8 times more, p <0.005, cardiac arrhythmia (by 33.39%, p <0.05 were observed frequently; lower levels of HDL-cholesterol by 25.28% (p <0.05, increased level of hs-CRP by 6.54-times (p <0.05 were revealed. The ECG monitoring data in the

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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.

  20. FEATURES OF PLATELET HEMOSTASIS IN PATIENTS WITH VARIOUS SENSITIVITY TO ANTIPLATELET THERAPY IN STABLE ANGINA PECTORIS AFTER PLANNED PERCUTANEOUS CORONARY INTERVENTION

    Directory of Open Access Journals (Sweden)

    Pronko T. P.

    2018-02-01

    Full Text Available Background. One of the significant problems of using double antiplatelet therapy (DATT in patients with ischemic heart disease is the development of resistance to acetylsalicylic acid (ASA and to clopidogrel. Purpose of the study. Evaluation of the features of platelet hemostasis in patients with different sensitivity to DATT with stable angina pectoris (SAP who have undergone scheduled percutaneous coronary intervention (PCI. Material and methods. Sixty patients with stable angina pectoris who underwent planned PCI and received DATT were examined. A blood test and a study of the morphometric parameters of platelets: MPV, PDW, PCT, P-LCR were performed by means of cytoflowing method on the automatic hemo-analyzer Sysmex XS-500i, Japan. Platelet aggregation was evaluated on an impedance 5-channel Multiplateaggregometer (VerumDiagnostica GmbH, Germany with several aggregation inducers. Results. 45% of patients with insufficient response to DAPT were detected – SG2. TRAP-test was 90.62 ± 18.37 U in SG1, 110.7 ± 19.83 U in SG2, p <0.05; MPV was 8.87 ± 1.71 fl in SG1, 9.85 ± 1.42 fl in SG2, p <0.05; P-LCR was 29.74 ± 5.38% in SG1, 33.96 ± 5.70% in SG2, p <0.05. Conclusions. In 45% of patients with SAP, there is an inadequate response to DATT, of which 18 patients (30% to ASA, 15 people to clopidogrel (25%, to two drugs at the same time - 6 people (10%. In patients with an inadequate response to DATT, MPV and P-LCR are significantly higher than those with normal response to DATT. Correlation analysis revealed interrelations between the MPV, PCT, PLC-R indices and aggregation values, which confirm the idea that one of the factors reducing the effectiveness of DATT is the initially high platelet activity and their high heterogeneity in size.

  1. Percutaneous coronary intervention with optimal medical therapy vs. optimal medical therapy alone for patients with stable angina pectoris

    Directory of Open Access Journals (Sweden)

    Gorenoi, Vitali

    2011-01-01

    Full Text Available Scientific background: Stable Angina Pectoris (AP is a main syndrome of chronic coronary artery disease (CAD, a disease with enormous epidemiological and health economic relevance. Medical therapy and percutaneous coronary interventions (PCI are the most important methods used in the treatment of chronic CAD. Research questions: The evaluation addresses questions on medical efficacy, incremental cost-effectiveness as well as ethic, social and legal aspects in the use of PCI in CAD patients in comparison to optimal medical therapy alone. Methods: A systematic literature search was conducted in June 2010 in the electronic databases (MEDLINE, EMBASE etc. and was completed by a hand search. The medical analysis was initially based on systematic reviews of randomized controlled trials (RCT and was followed by the evaluation of RCT with use of current optimal medical therapy. The results of the RCT were combined using meta-analysis. The strength and the applicability of the determined evidence were appraised. The health economic analysis was initially focused on the published studies. Additionally, a health economic modelling was performed with clinical assumptions derived from the conducted meta-analysis and economic assumptions derived from the German Diagnosis Related Groups 2011. Results: Seven systematic reviews (applicability of the evidence low and three RCT with use of optimal medical therapy (applicability of the evidence for the endpoints AP and revascularisations moderate, for further endpoints high were included in the medical analysis. The results from RCT are used as a base of the evaluation. The routine use of the PCI reduces the proportion of patients with AP attacks in the follow-up after one and after three years in comparison with optimal medical therapy alone (evidence strength moderate; however, this effect was not demonstrated in the follow-up after five years (evidence strength low. The difference in effect in the follow

  2. Norepinephrine, ANP, BNP and {sup 123}I-MIBG scintigraphy in patients with cardiomyopathy or angina pectoris

    Energy Technology Data Exchange (ETDEWEB)

    Ochiai, Yukie; Kodama, Makoto; Aizawa, Yoshifusa [Niigata Univ. (Japan). School of Medicine; Watanabe, Kenichi; Kusano, Yoriko; Miyajima, Seiichi; Nagatomo, Takafumi

    1998-06-01

    The relationship of blood concentration of norepinephrine (NE), A-type (atrial) natriuretic peptide (ANP) and B-type (brain) natriuretic peptide (BNP) and {sup 123}I-metaiodobenzyl guanidine ({sup 123}I-MIBG) scintigraphy was examined in patients with heart failure. The patients were grouped as follows; 13 of dilated cardiomyopathy (DCM) group, 13 of hypertrophic cardiomyopathy (HCM) group and the 8 of stable effort angina. The control group was of 18 cases with normal {sup 201}TlCl (Tl) cardiac scintigraphy and chest pain. The blood was collected before the exercise tolerance by the ergometer, and the concentration of ANP, BNP and NE in blood was measured by the RIA method and the HPLC method, respectively. Patients were intravenously administrated 111Mbq of {sup 123}I-MIBG at rest and early images of the {sup 123}I-MIBG scintigraphy were taken after 15 min and late images after 3 hours. Washout rate (WR) and heart-mediastinal uptake rate (H/M) were obtained from late images. Compared with the control group, the DCM group showed the high levels of ANP and BNP (p<0.01) and the low level of NE (p=0.025). The HCM group showed the high level of BNP (p<0.001) and the low level in H/M. There were no differences in ANP, NE, H/M and WR between angina pectoris and the control. The correlations among BNP and H/M or WT were significant in all cases. BNP may be a remarkable index for sympathetic dysfunction. (K.H.)

  3. 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

  4. 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.

  5. 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.

  6. Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

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    Pugliese, Francesca; Krestin, Gabriel P. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Mollet, Nico R.A.; deFeyter, Pim J. [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); Runza, Giuseppe [University of Palermo, Department of Radiology, Palermo (Italy); Azienda Ospedaliera di Parma, Department of Radiology, Parma (Italy); Mieghem, Carlos van; Meijboom, Willem B.; Baks, Timo [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); Malagutti, Patrizia [Erasmus Medical Center, Department of Cardiology, Rotterdam (Netherlands); University of Ferrara, Department of Cardiology, Ferrara (Italy); Cademartiri, Filippo [Erasmus Medical Center, Department of Radiology, Rotterdam (Netherlands); Azienda Ospedaliera di Parma, Department of Radiology, Parma (Italy)

    2006-03-15

    Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT coronary angiography in the detection of significant stenoses (defined as {>=} 50% luminal diameter reduction) versus invasive quantitative coronary angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT coronary angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional coronary angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT coronary angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures. (orig.)

  7. Left ventricular dysfunction during exercise in patients with angina pectoris and angiographically normal coronary arteries (syndrome X)

    International Nuclear Information System (INIS)

    Taki, J.; Nakajima, K.; Muramori, A.; Yoshio, H.

    1994-01-01

    Left ventricular function during exercise and recovery was investigated in patients with angina pectoris, ST segment depression during exercise and angiographically normal coronary arteries (syndrome X) using a continuous left ventricular function monitor with cadmium telluride detector (CdTe-VEST). Fourteen patients with syndrome X and 14 patients with atypical chest pain without ST segment depression during exercise and normal coronary arteries (control group) performed supine ergometric exercise after administration of 740-925 MBq of technetium-99m labelled red blood cells, and left ventricular function was monitored every 20 s using CdTe-VEST. Left ventricular ejection fraction (EF) response was impaired (≤ 5% increase from rest to peak exercise) in 11 or 14 patients with syndrome X but in none of the control patients. Resting EF was similar in the two groups (62.1% ± 6.7% in patients with syndrome X, 61.9% ± 6.2% in controls); however, EF increase from rest to peak exercise was lower in syndrome X (-3.1 ± 9.5% vs 14.7% ± 7.4%). After cessation of exercise, all patients showed rapid EF increase over baseline and this EF overshoot was lower (19.3% ± 8.3% vs 26.4% ± 7.3%) with the time to EF overshoot longer (114 ± 43 s vs 74 ± 43 s, P < 0.05) in patients with syndrome X. (orig./MG)

  8. High resolution heart rate variability analysis in patients with angina pectoris during coronary artery bypass graft surgery

    Science.gov (United States)

    Mironov, V. A.; Mironova, T. F.; Kuvatov, V. A.; Nokhrina, O. Yu.; Kuvatova, E. V.

    2017-12-01

    The purpose of the study is approbation of the capabilities of high-resolution rhythmocardiography (RCG) for the determination of the actual cardiovascular status of operated patients with angina pectoris during coronary artery bypass graft surgery (CABGS) for myocardial revascularization. The research was done by means of a KAP-RK-02-Mikor hardware-software complex with a monitor record and the time- and frequency-domain analyses of heart rate variability (HRV). Monitor records were made at each stage of CABGS in 123 patients. As a result, HRV manifested itself as a fairly adequate and promising method for the determination of the cardiovascular status during CABGS. In addition, the data of the HRV study during CABGS testify to the capability of RCG to determine the high risk of life-threatening cardioarrhythmias before and during operation, to different changes in sinoatrial heart node (SN) dysregulation, and contain the HRV symptoms of a high death risk before, during and after shunting. The loss of the peripheral autonomic sympathetic and parasympathetic control in SN in the form of the autonomic cardioneuropathy syndrome is a predictor of the complications related to CABGS. The obtained data on RCG monitoring of HRV recording are suggestive of wide prospects of the high-resolution RCG method to be used in cardiac surgery as a whole. The actual multivariant dysregulations of SN pacemaker activity testify to its adequacy to the pathophysiology of each period of the cardiac operation, according to the initial ischemic damages and localization of cardiosurgical manipulations during CABGS.

  9. 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.

  10. [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.

  11. Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris

    International Nuclear Information System (INIS)

    Pugliese, Francesca; Krestin, Gabriel P.; Mollet, Nico R.A.; DeFeyter, Pim J.; Runza, Giuseppe; Mieghem, Carlos van; Meijboom, Willem B.; Baks, Timo; Malagutti, Patrizia; Cademartiri, Filippo

    2006-01-01

    Multislice computed tomography (CT) is an emerging technique for the non-invasive detection of coronary stenoses. While the diagnostic accuracy of 4-slice scanners was limited, 16-slice CT imagers showed promising results due to increased temporal and spatial resolution. These technical advances prompted us to evaluate the diagnostic performance of 64-slice CT coronary angiography in the detection of significant stenoses (defined as ≥ 50% luminal diameter reduction) versus invasive quantitative coronary angiography (QCA). Thirty-five patients with stable angina pectoris underwent CT coronary angiography performed with a 64-slice scanner (gantry rotation time 330 ms, individual detector width 0.6 mm) prior to conventional coronary angiography. Patients with heart rates >70 beats/min received 100 mg metoprolol orally. One hundred millilitres of contrast agent with an iodine concentration of 400 mgl/ml were injected at a rate of 5 ml/s into the antecubital vein. The CT scan was triggered with the bolus tracking technique. The sensitivity, specificity and the positive and negative predictive values of 64-slice CT were 99%, 96%, 78% and 99%, respectively, on a per-segment basis. The values obtained on a per-patient basis were 100%, 90%, 96% and 100%, respectively. When referral to catheterisation is questionable, CT coronary angiography may identify subjects with normal angiograms and consistently decrease the number of unnecessary invasive procedures. (orig.)

  12. Role of dongchongxiacao (Cordyceps) in prevention of contrast-induced nephropathy in patients with stable angina pectoris.

    Science.gov (United States)

    Zhao, Kai; Li, Yongjian; Zhang, Hong

    2013-06-01

    To study the preventative effects of Dongchongxiacao (Cordyceps) on contrast-induced nephropathy (CIN) in patients with stable angina pectoris (SAP). One-hundred and three SAP inpatients were divided randomly into two groups: basic treatment (n = 51) and Dongchongxiacao (Cordyceps) treatment (n = 52); corbrin capsules (3 g; t.d.s.) were used 3 days before angioplasty and 3 days after angioplasty). Serum creatinine (Scr) was assessed at the time of hospital admission and 1, 2, and 3 days after angioplasty. Values of kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and interleukin (IL) 18 in the kidney were detected before angioplasty and 1 day after angioplasty in the patients of both groups. The prevalence of CIN between the two groups was then compared. CIN occurred in 9 of 103 patients (8.74%). The prevalence of CIN in the Dongchongxiacao (Cordyceps) treatment group was lower than that of the basic treatment group (5.77% vs 11.76%) but the difference was not significant (P > 0.05). The post-procedure mean peak of Scr, post-procedure increase in Scr levels from baseline, and urine levels of KIM-1, NGAL and IL18 after the procedure in the Dongchongxiacao (Cordyceps) treatment group were significantly lower than those in the basic treatment group (P Cordyceps) in SAP patients who undergo coronary angiography or coronary intervention could prevent contrast-induced renal impairment.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Value of resting echocardiographic findings and dobutamine stress echocardiography for diagnosing myocardial ischemia in patients with suspected angina pectoris.

    Science.gov (United States)

    Utsunomiya, Hiroto; Hidaka, Takayuki; Masada, Kenji; Shimonaga, Takashi; Higaki, Tadanao; Iwasaki, Toshitaka; Mitsuba, Naoya; Ishibashi, Ken; Kurisu, Satoshi; Kihara, Yasuki

    2015-06-01

    We evaluated the diagnostic value of resting echocardiographic findings including total heart calcification (THC) score in combination with dobutamine stress echocardiography (DSE) for detection of myocardial ischemia. Altogether, 110 patients with suspected angina pectoris underwent resting echocardiography and DSE. On the basis of resting echocardiography, we determined the THC score, left anterior descending artery diastole-to-systole velocity ratio (LAD-DSVR), and positive myocardial velocity during isovolumic relaxation phase (VIVR ) detected by color-coded tissue Doppler imaging. Myocardial ischemia was diagnosed by a 25% or greater reduction in the internal diameter of major coronary vessels with impaired fractional flow reserve (FFR ≤0.80). DSE had excellent specificity (89%) but modest sensitivity (52%) for wall-motion abnormality (WMA) analysis. Multivariate analysis showed that THC score ≥2 (odds ratio and 95% confidence interval: 4.49 [2.29-10.6]; P = 0.018), LAD-DSVR ≤1.5 (6.43 [1.39-20.3], P = 0.019), and duration of positive VIVR ≥71 msec (7.93 [3.72-12.1]; P < 0.001) were independent predictors of ischemia. The combination of inducible WMA and THC score yielded significantly higher sensitivity for ischemia detection than the inducible WMA alone (80% vs. 52%, P = 0.0008). Using receiver operating characteristics analyses, adding all three resting echocardiographic findings to clinical variables plus inducible WMA further improved prediction of ischemia (P = 0.028). Integration of DSE and resting echocardiographic findings describing degree of heart calcification, impaired LAD flow, and extent of delayed ejection motion of the myocardium improves detection of coronary angiogram-based FFR-guided ischemia. © 2015, Wiley Periodicals, Inc.

  18. Compliance, clinical outcome, and quality of life of patients with stable angina pectoris receiving once-daily betaxolol versus twice daily metoprolol: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Przemyslaw Kardas

    2007-05-01

    Full Text Available Przemyslaw KardasThe First Department of Family Medicine, Medical University of LodzBackground: A randomized, controlled trial was conducted in an outpatient setting to examine the effect of beta-blocker dosing frequency on patient compliance, clinical outcome, and health-related quality of life in patients with stable angina pectoris.Methods: One hundred and twelve beta-blockers-naive outpatients with stable angina pectoris were randomized to receive betaxolol, 20 mg once daily or metoprolol tartrate, 50 mg twice daily for 8 weeks. The principal outcome measure was overall compliance measured electronically, whereas secondary outcome measures were drug effectiveness and health-related quality of life.Results: The overall compliance was 86.5 ± 21.3% in the betaxolol group versus 76.1 ± 26.3% in the metoprolol group (p < 0.01, and the correct number of doses was taken on 84.4 ± 21.6% and 64.0 ± 31.7% of treatment days, respectively (p < 0.0001. The percentage of missed doses was 14.5 ± 21.5% in the once-daily group and 24.8 ± 26.4% in the twice-daily group (p < 0.01. The percentage of doses taken in the correct time window (58.6% vs 42.0%, p = 0.01, correct interdose intervals (77.4% v 53.1%, p < 0.0001, and therapeutic coverage (85.6% vs 73.7%, p < 0.001 were significantly higher in the once-daily group. Both studied drugs had similar antianginal effectiveness. Health-related quality of life improved in both groups, but this increase was more pronounced in the betaxolol arm in some dimensions.Conclusions: The study demonstrates that patient compliance with once-daily betaxolol is significantly better than with twice daily metoprolol. Similarly, this treatment provides better quality of life. These results demonstrate possible therapeutic advantages of once-daily over twice-daily beta-blockers in the treatment of stable angina pectoris.Keywords: patient compliance, quality of life, stable angina pectoris, randomized controlled trial

  19. Three Vessel Coronary Cameral Fistulae Associated with New Onset Atrial Fibrillation and Angina Pectoris

    Directory of Open Access Journals (Sweden)

    Murat Yuksel

    2014-01-01

    Full Text Available Coronary cameral fistulas are abnormal communications between a coronary artery and a heart chamber or a great vessel which are reported in less than 0.1% of patients undergoing diagnostic coronary angiography. All three major coronary arteries are even less frequently involved in fistula formation as it is the case in our patient. A 68-year-old woman was admitted to cardiology clinic with complaints of exertional dyspnea and angina for two years and a new onset palpitation. Standard 12-lead electrocardiogram revealed atrial fibrillation (AF with a ventricular rate of 114 beat/minute and accompanying T wave abnormalities and minimal ST-depression on lateral derivations. Transthoracic echocardiographic examination was normal except for diastolic dysfunction, minimally mitral regurgitation, and mild to moderate enlargement of the left atrium. Sinus rhythm was achieved by medical cardioversion with amiodarone infusion. Coronary angiography revealed diffuse and multiple coronary-left ventricle fistulas originating from the distal segments of both left and right coronary arterial systems without any stenosis in epicardial coronary arteries. The patient’s symptoms resolved almost completely with medical therapy. High volume shunts via coronary artery to left ventricular microfistulas may lead to increased volume overload and subsequent increase in end-diastolic pressure of the left ventricle and may cause left atrial enlargement.

  20. ST depression and left ventricular haemodynamics during exercise in patients with angina pectoris.

    Science.gov (United States)

    Carlens, P; Holmgren, A; Jonasson, R; Landou, C; Orinius, E

    1983-01-01

    The mechanism of ischaemic ST depression and the cause of its low sensitivity to coronary artery stenosis are not well understood. Of 30 patients with severe stable effort angina, 19 (63%) showed ischaemic ST depressions after exercise (the STAE group) and 11 did not. The highest load during the symptom-limited exercise test and the heart rate on that load did not differ between the two groups. The clinical characteristics and angiographic findings were also similar, but the findings at heart catheterization differed during exercise (in supine). Although the load was similar, the stroke index was significantly lower (38 vs. 53 ml/m2 BSA) and the left ventricular end-diastolic pressure rose to a significantly higher value in the STAE group (40 vs. 32 mmHg). When STAE occurred, they were exclusively or concomitantly present in chest lead 5. These findings suggest that ischaemic STAE may not reflect regional ischaemia but the consequent left ventricular dysfunction. The mechanism may, for example, be that a sufficiently elevated left ventricular diastolic pressure causes a global subendocardial ischaemia.

  1. Vasospastic angina pectoris complicated by acute myocardial infarction and complete atrioventricular block

    Directory of Open Access Journals (Sweden)

    Pavlović Milan

    2011-01-01

    Full Text Available Background. A prolonged coronary artery spasm with interruption of coronary blood flow can lead to myocardial necrosis and increase of cardiospecific enzymes and can be complicated with cardiac rhythm disturbances, syncopc, or even sudden cardiac death. Case report. A 55-year old male felt a severe retrosternal pain when exposing himself to cold weather. The pain lasted for 20 minutes and was followed by the loss of conscience. Electrocardiogram (ECG showed a complete antrioventricular (AV block with nodal rhythm and marked elevation of ST segment in inferior leads. Electrocardiogram was soon normalized, but serum activities of cardiospecific enzymes were increased. Coronarography showed normal findings for the left coronary artery and a narrowing at the middle part of the right coronary artery, which disappeared after intracoronary application of nitroglycerine. The following therapy was prescribed: Diltiazem, Amlodipin, Isosorbid mononitrate, Molisdomin, Atrovastatin, Aspirin and Nitroglycerine spray. After 7 months medicaments were abandoned and the patient experienced again reccurent chest pain episodes at rest. Transitory ST segment elevation was recorded in inferior leads of ECG, but without increase of cardiospecific enzymes serum activities. After restoration of the medicament therapy anginal episodes ceased. Conclusion. Coronary dilators in maximal doses can prevent attacks of vasospastic angina.

  2. 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 ...

  3. 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.

  4. 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)

  5. 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.

  6. Livskvalitet ved psoriasis målt opp mot angina pectoris og kronisk obstruktiv lungesykdom

    OpenAIRE

    Kathirgamanathan, Ajenee

    2013-01-01

    Background: Health-related quality of life is an important issue for a patient with chronic disease and severe illness. And it should be an important priority for health policy decision. Psoriasis is a chronic disease that can affect people of all ages. Studies have shown that those with psoriasis have a reduced quality of life. Skin diseases can often be seen as a less severe disease than heart diseases, cancer or diabetes. How is the quality of life of psoriasis patients compared to pat...

  7. Ethnicity and Onset of Cardiovascular Disease: A CALIBER Study

    Science.gov (United States)

    2017-06-07

    Abdominal Aortic Aneurysm; Coronary Heart Disease; Sudden Cardiac Death; Intracerebral Haemorrhage; Heart Failure; Ischemic Stroke; Myocardial Infarction; Stroke; Peripheral Arterial Disease; Stable Angina Pectoris; Subarachnoid Haemorrhage; Transient Ischemic Attack; Unstable Angina; Cardiac Arrest

  8. 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.

  9. 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...

  10. Transient myocardial ischemia during daily life in rest and exertional angina pectoris and comparison of effectiveness of metoprolol versus nifedipine

    DEFF Research Database (Denmark)

    Ardissino, D; Savonitto, S; Egstrup, K

    1991-01-01

    to the questionnaire, the proportion of effort-induced anginal episodes ranged from 1 to 99%. The ischemic threshold during exercise testing ranged from 110 x 10(2) to 350 x 10(2) mm Hg x beats/min. At least 1 episode of ST-segment depression was observed in 29 of the 65 patients during Holter monitoring. Ischemic......The clinical characteristics of 65 patients with mixed angina were classified by means of (1) a questionnaire investigating the proportion of symptoms occurring at rest and on effort, (2) an exercise stress test, (3) 24-hour ambulatory Holter monitoring, and (4) coronary arteriography. According...... episodes during Holter monitoring were more frequent (p less than 0.05) in patients reporting greater than or equal to 50% of anginal attacks on effort, with moderate to severe limitation of exercise capacity and with multivessel coronary artery disease. The effect on ambulatory ischemia of a 6-week...

  11. 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

  12. 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

  13. 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.

  14. [Effect of L-arginine on platelet aggregation, endothelial function adn exercise tolerance in patients with stable angina pectoris].

    Science.gov (United States)

    Sozykin, A V; Noeva, E A; Balakhonova, T V; Pogorelova, O A; Men'shikov, M Iu

    2000-01-01

    Examination of the action of donor NO (L-arginine) on platelet aggregation, endothelial function and exercise tolerance in patients with stable angina of effort (SAE). 42 patients with SAE (functional class I-II) and 10 healthy volunteers (control group) were assigned to two groups. 22 patients of group 1 were randomized to cross-over. They received cardiket (60 mg/day for 10 days or cardiket (60 mg/day) in combination with L-arginine (15 g/day for 10 days). 20 SAE patients of group 2 and control group received L-arginine (15 g/day for 10 days). In each group blood lipids were examined, and bicycle exercise test (BET) was performed. In addition, platelet aggregation and endothelial function were studied in group 2 and control group before and after the course of L-arginine. Compared to control group, endothelial function significantly improved in group 2 (from 5.0 +/- 2.9 to 7.8 +/- 4.1% vs 7.1 +/- 1.9 to 6.6 +/- 4.8%) (M +/- SD). BET duration increased in all the patients. After ADP addition in concentrations 1.5, 2.0, and 5.0 micromol/l platelet aggregation declined in 17 patients except 3 in whom the aggregation remained unchanged. Positive effect of L-arginine on endothelial function, exercise tolerance and platelet aggregation was observed in patients with stable angina of effort (functional class I-II). Therefore, arginine can be recommended as an adjuvant in the treatment of patients with ischemic heart disease.

  15. 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.

  16. 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.

  17. [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.

  18. 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.)

  19. 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.)

  20. Comparative Effectiveness of Ranolazine Versus Traditional Therapies in Chronic Stable Angina Pectoris and Concomitant Diabetes Mellitus and Impact on Health Care Resource Utilization and Cardiac Interventions.

    Science.gov (United States)

    Page, Robert L; Ghushchyan, Vahram; Read, Richard A; Hartsfield, Cynthia L; Koch, Bruce R; Nair, Kavita V

    2015-11-01

    Comparative studies evaluating traditional versus newer antianginal (AA) medications in chronic stable angina pectoris (CSA) on cardiovascular (CV) outcomes and utilization are limited, particularly in patients with diabetes mellitus (DM). Claims data (2008 to 2012) were analyzed using a commercial database. Patients with CSA receiving a β blocker (BB), calcium channel blocker (CCB), long-acting nitrate (LAN), or ranolazine were identified and followed for 12 months after a change in AA therapy. Patients on traditional AA medications were required to have concurrent sublingual nitroglycerin. Therapy change was defined as adding or switching to another traditional AA medication or ranolazine to identify patients whose angina was inadequately controlled with previous therapy. Four groups were identified (BB, CCB, LAN, or ranolazine users) and matched on relevant characteristics. A DM subset was identified. Logistic regression compared revascularization at 30, 60, 90, 180, and 360 days. Negative binomial regression compared all-cause, CV-, and DM-related (in the DM cohort) health care utilization. A total of 8,008 patients were identified with 2,002 patients in each matched group. Majority were men (mean age 66 years). A subset of 3,724 patients with DM (BB, n = 933; CCB, n = 940; LAN, n = 937; and ranolazine, n = 914) resulted from this cohort. Compared to ranolazine in the overall cohort, traditional AA medication exhibited greater odds for revascularization and higher rates in all-cause outpatient, emergency room visits, inpatient length of stay, and CV-related emergency room visits. In the DM cohort, ranolazine demonstrated similar benefits over traditional AA medication. In conclusion, ranolazine use in patients with inadequately controlled chronic angina is associated with less revascularization and all-cause and CV-related health care utilization compared to traditional AA medication. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. Urban angina in the mountains: effects of carbon monoxide and mild hypoxia on subjects with chronic stable angina; Angine de poitrine dans les villes de montangne: effets du monoxyde de carbone et d'une hypoxie legere chez des patients atteints d'angor stable

    Energy Technology Data Exchange (ETDEWEB)

    Kleinman, M.T.; Leaf, D.A.; Kelly, E.; Caiozzo, V.; Osann, K.; O' Neill, T.

    2001-01-01

    The aim of this study is the effects of a carbon monoxide exposure and the altitude on the coming of pectoris angina during physical exercise and on the cardiopulmonary functions for coronary disease patients. (A.L.B.)

  6. The Time Profile of Pentraxin 3 in Patients with Acute ST-Elevation Myocardial Infarction and Stable Angina Pectoris Undergoing Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Ragnhild Helseth

    2014-01-01

    Full Text Available Background. High levels of Pentraxin 3 (PTX3 are reported in acute myocardial infarction (AMI. Aim. To investigate circulating levels and gene expression of PTX3 in patients with AMI and stable angina pectoris (AP undergoing PCI. Methods. Ten patients with AP and 20 patients with AMI were included. Blood samples were drawn before PCI in the AP group and after 3 and 12 hours and days 1, 3, 5, 7, and 14 in both groups. Results. Circulating PTX3 levels were higher in AMI compared to AP at 3 and 12 hours (P<0.001 and P=0.003. Within the AMI group, reduction from 3 hours to all later time points was observed (all P≤0.001. Within the AP group, increase from baseline to 3 hours (P=0.022, followed by reductions thereafter (all P<0.05, was observed. PTX3 mRNA increased in the AMI group from 3 hours to days 7 and 14 in a relative manner of 62% and 73%, while a relative reduction from baseline to 3 and 12 hours of 29% and 37% was seen in the AP group. Conclusion. High circulating PTX3 levels shortly after PCI in AMI indicate that AMI itself influences PTX3 levels. PTX3 mRNA might be in response to fluctuations in circulating levels.

  7. Comparison of the safety and efficacy of ivabradine and nebivolol mono- and combination therapies in the treatment of stable angina pectoris patients with left ventricular dysfunction

    Directory of Open Access Journals (Sweden)

    Rasim Kutlu

    2013-08-01

    Full Text Available We aimed to investigate the pharmacoeconomic efficacy of ivabradine and nebivolol in treatment of stable angina pectoris patients with left ventricular dysfunction prospectively. Pharmacoeconomic analysis was performed by using cost minimization analysis, and cost effectiveness analysis. After 6 months’ treatment LVEF for the nebivolol group (17 patients, 50% improved by (38 ± 6.5 to (41 ± 3.2, (p>0.05 and for the ivabradine group (17 patients, 50% (37 ± 5.4 to (41 ± 2.3, (p>0.05, mean MET value in the nebivolol group increased from (3.7 ± 1.2 to (5.5 ± 1.6, (p>0.05, versus from (3.6 ± 1.5 to (5.5 ± 1.4, (p>0.05 in the ivabradine group, cost minimization analysis results showed a difference in the total cost of treatment was US$ 5288.7 in favor of nebivolol. The findings suggest that nebivolol is more cost-effective than ivabradine in the treatment of patients with left ventricular dysfunction.

  8. 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 ...

  9. Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study

    OpenAIRE

    Kourlaba, Georgia; Vlachopoulos, Charalambos; Parissis, John; Kanakakis, John; Gourzoulidis, George; Maniadakis, Nikos

    2015-01-01

    Background To conduct an economic evaluation comparing ranolazine as add-on therapy to standard-of-care (SoC) with SoC alone in patients with stable angina who did not respond adequately to first line therapy, in Greece. Methods A decision tree model was locally adapted in the Greek setting to evaluate the cost-utility of ranolazine during a 6-month period. The analysis was conducted from a third-party payer perspective. The clinical inputs were extracted from the published literature. The co...

  10. Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease: The iPOWER Study.

    Science.gov (United States)

    Flintholm Raft, Kristoffer; Frestad, Daria; Michelsen, Marie Mide; Suhrs, Hannah Elena; Rask, Anna Bay; Nilsson, Malin; Hermann, Thomas Steffen; Prescott, Eva

    2017-01-01

    We investigated whether impaired flow-mediated dilation (FMD) and plasma biomarkers reflecting endothelial dysfunction are associated with coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease (CAD). Patients (n = 194) were randomly selected women with angina pectoris and no obstructive CAD (<50% stenosis). A reference population of asymptomatic women without CAD (n = 25) was included. We measured FMD in the brachial artery by high-resolution ultrasound. Coronary flow velocity reserve (CFVR) was assessed by transthoracic Doppler flow echocardiography (TTDE) of the left anterior descending artery during rest and high-dose dipyridamole infusion. CMD was defined as CFVR <2. FMD and CFVR were measured in 128 patients and 21 controls. Mean (SD) age was 64.5 (8.9) years, mean CFVR was 2.3 (2.0-2.7), and mean FMD was 8.4% (4.8%) in angina patients. Angina patients had a higher risk factor burden compared with the reference population. Measures of peripheral endothelial dysfunction and endothelial plasma biomarkers did not differ according to angina or CFVR. CFVR and FMD did not correlate (Spearman ρ = -0.07, p = 0.45). FMD and biomarkers of endothelial dysfunction did not identify individuals with CMD assessed as impaired CFVR by TTDE in women with angina and no obstructive CAD. © 2017 S. Karger AG, Basel.

  11. A literature review to evaluate the economic value of ranolazine for the symptomatic treatment of chronic angina pectoris.

    Science.gov (United States)

    Vellopoulou, Katerina; Kourlaba, Georgia; Maniadakis, Nikos; Vardas, Panagiotis

    2016-05-15

    To conduct a systematic review of the evidence regarding the economic value of ranolazine relative to standard-of-care (SOC) for the treatment of symptomatic chronic stable angina (CSA). Electronic databases were searched using relevant keywords. The identified studies were independently reviewed by two investigators against pre-determined inclusion and exclusion criteria. Their data were extracted using a relevant form and consequently were synthesized. Studies were also evaluated using the Quality of Health Economic Studies scale. The main outcomes considered were the cost and effectiveness for each comparator and the incremental cost per quality-adjusted-life year (QALY) gained. Six studies were included in the review. Five of these assessed the cost-utility of ranolazine added to SOC, compared to SOC alone, using decision trees or Markov models whereas one was a retrospective cost evaluation study. The analysis was conducted from a payer perspective in five studies and from a societal perspective in one study with the time horizon varying between six months and a year. The incremental cost-effectiveness ratio (ICER), ranged from €4000 to €15,000 per QALY gained. Ranolazine appears to be dominant or cost-effective, mainly due to its ability to decrease angina-related hospitalizations and also due to a marginal improvement in quality of life. The acquisition cost of ranolazine was the variable with the greatest impact upon the ICER. The existing evidence, although limited, indicates that ranolazine may be a dominant or cost-effective therapy option, for the treatment of patients with symptomatic CSA. Further research is required to evaluate the cost-effectiveness of ranolazine. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Greece: a cost-utility study.

    Science.gov (United States)

    Kourlaba, Georgia; Vlachopoulos, Charalambos; Parissis, John; Kanakakis, John; Gourzoulidis, George; Maniadakis, Nikos

    2015-12-18

    To conduct an economic evaluation comparing ranolazine as add-on therapy to standard-of-care (SoC) with SoC alone in patients with stable angina who did not respond adequately to first line therapy, in Greece. A decision tree model was locally adapted in the Greek setting to evaluate the cost-utility of ranolazine during a 6-month period. The analysis was conducted from a third-party payer perspective. The clinical inputs were extracted from the published literature. The cost inputs considered in the model reflect drug acquisition, hospitalizations, vascular interventions and monitoring of patients. The resource utilization data were obtained from 3 local experts. All costs refer to the year 2014. Cost-effectiveness was assessed by means of the incremental cost per quality adjusted life year (QALY) gained with the ranolazine as add-on therapy relative to SoC alone (ICER). Probabilistic sensitivity analysis (PSA) was performed. Ranolazine as add-on therapy was more costly compared to SoC alone, as the 6-month total cost per patient was €1170 and € 984, respectively. Patients received ranolazine plus SoC and SoC alone gained 0.3155 QALYs and 0.2752 QALYs, respectively. Ranolazine plus SoC resulted in an ICER equal to €4620 per QALY gained, well below the threshold of €34,000 per QALY gained. The PSA showed that the likelihood of ranolazine plus SoC being cost-effective at the threshold of €34,000 per QALY gained was 100 %. Τhe results suggest that ranolazine as add-on treatment may be a cost-effective alternative for the symptomatic treatment of patients with chronic stable angina in Greece.

  13. 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

  14. 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.

  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. Practice of Comparative Effectiveness Research to Identify Treatment Characteristics of Similar Chinese Patent Medicine for Angina Pectoris

    Directory of Open Access Journals (Sweden)

    Hongbo Cao

    2017-01-01

    Full Text Available Objective. Individualized application of TCM is not easy and may lead to undesirable results, such as poor effect or even adverse reactions. This trial aims to compare two common Chinese patent medicines with similar effects. Background of the Research. Four hospitals carried out the test at the same time in Tianjin city of China. Participants. 144 patients were involved in this study; all patients must meet the diagnostic criteria. Interventions. Qishen Yiqi pills, compound danshen pills, and their placebos; an efficacy analysis was conducted after the first medication and after crossover medication. Primary Outcome Measures. The primary index of end point includes Seattle Angina Questionnaire score-7 and score of 7-point Likert Scale; the curative effect was compared with minimal clinically important differences value. Result. Two drugs have their respective advantages in treating SAP. In practical application, the two drugs shall be discriminated in use based on patients’ specific symptoms. Trial Registration. Chinese clinical trials register is ChiCTR-TTRCC-14004406 (registered 23 March 2014.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. Two-dimentional speckle tracking strain imaging in the assessment of myocardial diastolic function in patients with stable angina pectoris

    Directory of Open Access Journals (Sweden)

    Somaye Farokhnejad

    2015-06-01

    Full Text Available Introduction: Ischemic heart disease is caused mainly by obstruction of coronary arteries. The ischemic assessment through echocardiography is dependent on wall motion abnormality detection during systole. In patients with ischemic heart disease the diastolic function is impaired before systolic function and measurement of regional diastolic dysfunction if possible will be most sensitive for assessment of obstructed coronary artery region. This study was designed to determine whether regional left ventricular delayed relaxation diagnosis could be detected with strain imaging derived from two-dimensional speckle-tracking echocardiography in patients with coronary artery disease.Methods: All the articles reviewed were obtained using MEDLINE & ScienceDirect (up to October 2014. All data extracted by speckle tracking echocardiography. The index which is used is strain imaging diastolic index which is calculated as: (A-B A×100  . A is the amount of strain at the time Aortic value closure and B is the amount of strain in first one-third point of diastolic duration.Result: Four articles were reviewed. Three articles assessed patients with echocardiography at rest and one with stress echocardiography. All articles showed the coronary artery tracking with significant stenosis is possible by regional deformation analysis through two-dimensional strain.Discussion: The usage of strain images obtained through two-dimensional speckle tracking has been validated for the quantitation assessment of regional dysfunction in ischemic heart disease. Regional LV delayed relaxation diagnosis with strain imaging is a reliable method after treadmill stress test.Conclusion:  Strain imaging is reasonable for evaluation of ischemia as a low cost noninvasive test with high accuracy.

  4. The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris

    DEFF Research Database (Denmark)

    Nielsen, Lene H; Ortner, Nino; Nørgaard, Bjarne L

    2014-01-01

    suspected of stable coronary artery disease (CAD). METHODS AND RESULTS: We systematically searched for studies published from January 2002 to February 2013 examining the diagnostic accuracy (defined as at least ≥50% luminal obstruction on invasive coronary angiography) and outcomes of coronary CTA (≥16......AIMS: To systematically review and perform a meta-analysis of the diagnostic accuracy and post-test outcomes of conventional exercise electrocardiography (XECG) and single-photon emission computed tomography (SPECT) compared with coronary computed tomography angiography (coronary CTA) in patients...... slice) in comparison with XECG and SPECT. The search revealed 11 eligible studies (N = 1575) comparing the diagnostic accuracy and 7 studies (N = 216.603) the outcomes of coronary CTA vs. XECG or/and SPECT. The per-patient sensitivity [95% confidence interval (95% CI)] to identify significant CAD was 98...

  5. Living with heart disease and angina

    Science.gov (United States)

    Coronary artery disease - living with; CAD - living with; Chest pain - living with ... Get checked and treated for depression, if needed. Exercise . Get plenty of aerobic exercise, such as walking, ...

  6. 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.

  7. 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...

  8. Valor preditivo da angina em detectar doença coronariana em pacientes com estenose aórtica grave a partir da quinta década de vida Predictive value of angina to detect coronary artery disease in patients with severe aortic stenosis aged 50 years or older

    Directory of Open Access Journals (Sweden)

    Aline Alves Vargas Gonçalves

    2006-12-01

    Full Text Available OBJETIVO: O objetivo deste estudo é verificar o valor de previsão da angina de peito no diagnóstico da DAC em pacientes portadores de EA, a partir da quinta década de vida. MÉTODOS: A população estudada foi constituída por 186 pacientes consecutivos com EA e idade e" 50 anos, referidos para cirurgia de troca valvar aórtica entre junho de 1989 e setembro de 2004. Cinecoronariografia de rotina foi realizada em todos os pacientes. Cento e um eram homens (54,3% e 85, mulheres (45,7%, com idade de 66±8 anos. Angina estava presente em 124 pacientes (66,7%. O gradiente máximo transvalvar aórtico foi de 89,4±27,6 mmHg e a área valvar aórtica de 0,59±0,17 cm2. Calculamos a sensibilidade, a especificidade, o valor de previsão positivo e negativo e a razão de verossimilhança positiva da angina na predição da presença de DAC. RESULTADOS: DAC estava presente em 93 pacientes (50%. Dos 124 pacientes com angina, 68 (54,8% apresentavam DAC; enquanto dos 62 sem angina, 25 apresentavam DAC (40,3%. Portanto, a sensibilidade da angina para DAC foi de 73,1%, a especificidade de 39,7%, valor preditivo positivo de 54,8%, valor preditivo negativo de 59,6% e razão de verossimilhança positiva de 1,6. CONCLUSÃO: A angina de peito não é bom preditor da presença de DAC em pacientes com EA a partir da quinta década de vida.OBJECTIVE: The objective of this study is to evaluate the value of angina pectoris as a predictor of CAD (coronary artery disease in patients with AS (aortic stenosis during and beyond the 5th decade of life. METHODS: The study population consisted of 186 consecutive patients with AS and e" 50 years of age, referred for surgical aortic valve replacement (AVR between June 1989 and September 2004. Routine coronary angiography was performed for all patients. One hundred and one patients were males (54.3% and 85 were females (45.7%, and the mean age was 66±8 years. One hundred and twenty-four patients (66.7% had angina. The maximum

  9. 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.

  10. 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

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. Transient myocardial ischemia during nifedipine therapy in stable angina pectoris, and its relation to coronary collateral flow and comparison with metoprolol

    DEFF Research Database (Denmark)

    Egstrup, K; Andersen, P E

    1993-01-01

    There are conflicting results concerning the anti-ischemic effect of nifedipine in patients with chronic stable angina. Therefore, the purpose of this study was to assess whether the anti-ischemic effect of nifedipine may be related to coronary collateral circulation. Forty-one patients with stable...... of collateral circulation. In 17 patients, angiographically poor or no collateral flow was observed (group 1), and 24 had good collateral flow (group 2). Nifedipine was administered to 20 patients (8 in group 1, and 12 in group 2). In group 1, nifedipine reduced the frequency of total and asymptomatic ischemic...

  17. Are negative aspects of social relations predictive of angina pectoris? A 6-year follow-up study of middle-aged Danish women and men

    DEFF Research Database (Denmark)

    Lund, Rikke; Rod, Naja Hulvej; Christensen, Ulla

    2011-01-01

    after adjustment for age, gender, social class, cohabitation status and depression in a dose-response manner. For example, experiencing excessive demands or worries always/often from different roles in the social relations was associated with an increased risk: partner OR=3.53 (1.68 to 7.43), children...... OR=2.19 (1.04 to 4.61), other family OR=1.91 (1.24 to 2.96). Except for frequent conflicts with the partner and neighbours, conflicts with the social relations was not a risk factor for angina. The authors found no interaction of negative aspects of social relations with gender, age, social class...

  18. 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.

  19. 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

  20. 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

  1. [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.

  2. 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

  3. Clinical usefulness of 123I-labeled 15-iodophenyl 3-methyl pentadecanoic acid (BMIPP) myocardial SPECT in coronary artery disease

    International Nuclear Information System (INIS)

    Ito, Kazuki

    1998-01-01

    123 I-BMIPP (BMIPP) myocardial SPECT was carried out in 22 patients with acute myocardial infarction, in 20 patients with unstable angina pectoris, in 80 patients with effort angina pectoris and in 25 patients with vasospastic angina pectoris. In a study of patients with acute myocardial infarction, BMIPP uptake was less than thallium perfusion in areas of myocardial infarction. Such discordant BMIPP/thallium uptake was often observed in areas with recanalized arteries, and in those with abnormal wall motion. In the areas showing discordant BMIPP/thallium uptake, the wall motion abnormalities improved in the chronic phase after recanalization therapy. Therefore, the discordant BMIPP/thallium uptake might represent asynergic but viable regions, and might be valuable in predicting the improvement of wall motion abnormalities. In a study of patients with unstable angina pectoris, the severity of regional wall motion abnormality was significantly correlated with severity of BMIPP uptake. BMIPP imaging well visualized the culprit regions in patients with unstable angina pectoris. In a study of patients with effort angina pectoris, the abnormal BMIPP images were associated with severe coronary artery stenosis of more than 90% and with multivessel stenosis. BMIPP imaging could detect patients with functionally severe coronary artery disease and help to guide coronary angioplasty in patients with effort angina. In a study of patients with vasospastic angina pectoris, metabolic abnormality assessed by BMIPP was associated with left ventricular asynergy and spastic regions. Those abnormalities also correlated inversely with the period from the last attack, and improved after medical treatment. (K.H.)

  4. 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.

  5. Clinical usefulness of {sup 123}I-labeled 15-iodophenyl 3-methyl pentadecanoic acid (BMIPP) myocardial SPECT in coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Kazuki [Kyoto Prefectural Univ. of Medicine (Japan)

    1998-01-01

    {sup 123}I-BMIPP (BMIPP) myocardial SPECT was carried out in 22 patients with acute myocardial infarction, in 20 patients with unstable angina pectoris, in 80 patients with effort angina pectoris and in 25 patients with vasospastic angina pectoris. In a study of patients with acute myocardial infarction, BMIPP uptake was less than thallium perfusion in areas of myocardial infarction. Such discordant BMIPP/thallium uptake was often observed in areas with recanalized arteries, and in those with abnormal wall motion. In the areas showing discordant BMIPP/thallium uptake, the wall motion abnormalities improved in the chronic phase after recanalization therapy. Therefore, the discordant BMIPP/thallium uptake might represent asynergic but viable regions, and might be valuable in predicting the improvement of wall motion abnormalities. In a study of patients with unstable angina pectoris, the severity of regional wall motion abnormality was significantly correlated with severity of BMIPP uptake. BMIPP imaging well visualized the culprit regions in patients with unstable angina pectoris. In a study of patients with effort angina pectoris, the abnormal BMIPP images were associated with severe coronary artery stenosis of more than 90% and with multivessel stenosis. BMIPP imaging could detect patients with functionally severe coronary artery disease and help to guide coronary angioplasty in patients with effort angina. In a study of patients with vasospastic angina pectoris, metabolic abnormality assessed by BMIPP was associated with left ventricular asynergy and spastic regions. Those abnormalities also correlated inversely with the period from the last attack, and improved after medical treatment. (K.H.)

  6. Assessment of myocardial fatty acid metabolism in patients with angina pectoris and diabetes mellitus using 123I-BMIPP myocardial scintigraphy

    International Nuclear Information System (INIS)

    Ito, Kazuki; Tanabe, Takuji; Yuba, Tatsuya; Doue, Tomoki; Adachi, Yoshihiko; Katoh, Shuuji; Sugihara, Hiroki; Azuma, Akihiro; Nakagawa, Masao

    2001-01-01

    We studied the effect of myocardial ischemia and diabetes mellitus (DM) on the myocardial fatty acid metabolism using 123 I-BMIPP myocardial scintigraphy. We performed 123 I-BMIPP myocardial scintigraphy in 50 patients with myocardial ischemia and without DM (AP), in 30 patients with myocardial ischemia and DM (AP+DM), 12 patients with DM and without myocardial ischemia (DM), and in 10 normal subjects (N). Myocardial uptake rate of 123 I-BMIPP was obtained using the time activity curve. Myocardial washout rate of 123 I-BMIPP was calculated using the polar images of early and delayed SPECT images. Myocardial uptake rate of 123 I-BMIPP (%) were AP: 4.9±0.6, AP+DM: 5.5±0.5, DM 5.7±0.5 and N: 5.0±0.4. 123 I-BMIPP myocardial uptake rate was increased in AP+DM and DM. 123 I-BMIPP myocardial washout rate (%) were AP: 30.2±4.3, AP+DM: 24.5±3.9, DM: 16.1±2.8 and N: 19.4±3.2. 123 I-BMIPP myocardial washout rate was increased in AP and AP+DM. 123 I-BMIPP myocardial washout rate was increased particularly in patients with multi-vessels disease. 123 I-BMIPP myocardial washout rate was decreased in DM. The present study suggested that diabetes mellitus increased myocardial fatty acid uptake and decreased myocardial fatty acid washout, and that myocardial ischemia increased myocardial fatty acid washout. (author)

  7. ANGINA PECTORIS AND NORMAL CORONARY ANGIOGRAPHY*

    African Journals Online (AJOL)

    superadded symptoms of anxiety and hyperventilation. These I3 comprised 6 White females, 3 White males, 3. Coloured females and I Coloured male. Their ages ranged from 26 to 53 years. None of the patients had diabetes or hypertension. The Wassermann reaction when done was negative. The blood cholesterol, when ...

  8. 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.

  9. Vitamin E and cardiovascular disease

    NARCIS (Netherlands)

    Kleijnen, J.; Knipschild, P.; ter Riet, G.

    1989-01-01

    Randomized clinical trials of the effects of Vitamin E on complaints of intermittent claudication and angina pectoris are reviewed, and their methodological shortcomings are considered. Mechanisms by which Vitamin E might act in cardiovascular disease are discussed. The evidence about the possible

  10. 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%.

  11. 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.

  12. Observer variability in the evaluation of dual-isotope Tl-201/Tc-99m sestamibi rest/stress myocardial perfusion SPECT in men and women with known or suspected stable angina pectoris

    DEFF Research Database (Denmark)

    Johansen, Allan; Høilund-Carlsen, Poul Flemming; Christensen, Henrik Wulff

    2004-01-01

    with known or suspected stable angina who were studied before coronary angiography. A 1-day thallium 201/technetium 99m sestamibi rest/stress MPI protocol was used. MPI was interpreted by 2 independent observers without knowledge of clinical data, using a 20-segment scoring model. By consensus, the overall...

  13. 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.

  14. Role of gastroscopy in gastro-oesophageal reflux disease (GORD)

    African Journals Online (AJOL)

    This two-year study is a retrospective analysis of records of patients diagnosed with gastro-oesophageal reflux disease (GORD) at a private medical aid society for the ... diagnosed GORD patients (n = 586) who were on drug therapy were included in the study. These patients were .... thritis and angina pectoris. NSAIDS, cal-.

  15. Risk stratification of patients suspected of coronary artery disease

    DEFF Research Database (Denmark)

    Jensen, Jesper M; Voss, Mette; Hansen, Vibeke Bøgelund

    2012-01-01

    To compare the performance of five risk models (Diamond-Forrester, the updated Diamond-Forrester, Morise, Duke, and a new model designated COronary Risk SCORE (CORSCORE) in predicting significant coronary artery disease (CAD) in patients with chest pain suggestive of stable angina pectoris....

  16. 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 ...

  17. 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.

  18. 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.

  19. Can osteoprotegerin be used to identify the presence and severity of coronary artery disease in different clinical settings?

    DEFF Research Database (Denmark)

    Hosbond, Susanne Elisabeth; Diederichsen, Axel Cosmus Pyndt; Saaby, Lotte

    2014-01-01

    PURPOSE: The biomarker Osteoprotegerin (OPG) is associated with coronary artery disease (CAD). The main purpose of this study was to evaluate the diagnostic value of OPG in healthy subjects and in patients with suspected angina pectoris (AP). METHODS: A total of 1805 persons were enrolled: 1152...

  20. Different effects of calcium antagonist and beta-blocker therapy on left-ventricular diastolic function in ischemic heart disease. A direct comparison of the impact of mibefradil and atenolol

    DEFF Research Database (Denmark)

    Hassager, C; Thygesen, K; Grande, P

    2001-01-01

    OBJECTIVE: To compare the effect of a calcium antagonist and a beta-blocker on left-ventricular diastolic function in patients with ischemic heart disease. METHODS: 138 patients with chronic stable angina pectoris were randomized in a multicenter, double-blind trial to treatment with either......-ventricular diastolic function in patients with chronic stable angina. However, they affect different parameters and thus apparently act through different mechanisms....

  1. 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.

  2. The relation between angina and myocardial ischemia during exercise stress in coronary artery disease

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa

    1988-01-01

    To examine the mechanism of occurrence of anginal chest pain from the aspect of myocardial ischemia, myocardial Tl-201 SPECT scans were obtained immediately and 3 hr after exercise (Ex) in 35 patients with coronary artery disease (CAD). The extent of ischemia was defined as the percentage of ischemic segments to the entire left ventricle. The minimum washout (WO) rate correlated well with the ratio of Tl uptake in the ischemic area to that in the normal area during Ex in the other 9 patients having single vessel CAD without previous history of myocardial infarction. This suggested that the miminum WO rate reflects the severity of Ex-induced ischemia. According to the development of angina during Ex, patients were classified as having either symptomatic ischemia (n = 16) or silent ischemia (n = 19). In regard to age, sex, a history of myocardial infarction, severity of CAD, and the extent of Ex-induced ischemia, there was no difference between the two groups. The minimum WO rate and the incidence of Ex-induced ST depression were significantly lower and higher, respectively, in the group with symptomatic ischemia than that with silent ischemia. The severity of Ex-induced ischemia has important implications for the development of anginal chest pain. (Namekawa, K.)

  3. Retrospective analysis of etiology and comorbid diseases associated with Ludwig's Angina.

    Science.gov (United States)

    Botha, Andrew; Jacobs, Fred; Postma, Corne

    2015-01-01

    Ludwig's angina (LA) still presents regularly at our tertiary academic hospital. Various etiologies and comorbid diseases are documented worldwide, but the South African population has not been studied. To establish whether LA cases presenting to the department are different from international reports regarding etiology and comorbidities. Retrospective analysis of patients presenting with LA to a tertiary hospital. 93 patients were included over a 5-year period. Archived files were analyzed for data including age, gender, comorbid diseases, etiology, airway management, and season on admission. Descriptive statistics with the inclusion of frequency distributions. 93 patients were included; 65 (69.9%) male and 28 (30.1%) female; age - minimum 20 years, maximum 75 years, mean 40.366. 68 (73.1%) odontogenic, 13 (14%) nonodontogenic, and 12 (12.9%) unknown cause. Comorbid diseases: 21 (22.6%) diabetes mellitus (DM), 19 (20.4%) hypertension, and 18 (19.4%) human immunodeficiency virus (HIV). Airway management: 61 (65.6%) tracheostomy and 32 (34.4%) nonsurgical. 11 (11.8%) deaths, 8 (8.60%) descending mediastinitis, and 7 (7.53%) necrotizing fasciitis. Seasonal occurrence: 30 (32.3%) spring, 24 (25.8%) winter, 22 (23.7%) summer, and 17 (18.3%) autumn. A 2.32:1 ratio male: female presentation mirrors previous statistics. DM patients had increased risks of complications, which resulted in multiple deaths. HIV patients showed increased risks for complications with more intense, longer hospital stays, but lower percentages of deaths compared to patients with DM and complications who died. There was no statistically significant finding regarding seasonal tendency.

  4. 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

  5. Different effects of calcium antagonist and beta-blocker therapy on left-ventricular diastolic function in ischemic heart disease. A direct comparison of the impact of mibefradil and atenolol

    DEFF Research Database (Denmark)

    Hassager, C; Thygesen, K; Grande, P

    2001-01-01

    OBJECTIVE: To compare the effect of a calcium antagonist and a beta-blocker on left-ventricular diastolic function in patients with ischemic heart disease. METHODS: 138 patients with chronic stable angina pectoris were randomized in a multicenter, double-blind trial to treatment with either...

  6. 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...

  7. Percutaneous Device to Narrow the Coronary Sinus: Shifting Paradigm in the Treatment of Refractory Angina? A Review of the Literature.

    Science.gov (United States)

    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 (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.

  8. 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.

  9. 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.

  10. Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease

    DEFF Research Database (Denmark)

    Flintholm Raft, Kristoffer; Frestad, Daria; Michelsen, Marie Mide

    2017-01-01

    PURPOSE: We investigated whether impaired flow-mediated dilation (FMD) and plasma biomarkers reflecting endothelial dysfunction are associated with coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease (CAD). METHODS: Patients (n = 194) were...... Doppler flow echocardiography (TTDE) of the left anterior descending artery during rest and high-dose dipyridamole infusion. CMD was defined as CFVR ....45). CONCLUSIONS: FMD and biomarkers of endothelial dysfunction did not identify individuals with CMD assessed as impaired CFVR by TTDE in women with angina and no obstructive CAD....

  11. The effects of implementation of guideline-directed medical therapy on relief of angina in patients with stable coronary artery disease in Serbia

    Directory of Open Access Journals (Sweden)

    Ilić Ivan

    2016-01-01

    Full Text Available Introduction. Adherence to proposed lifestyle changes and prescribed medication in patients with stable coronary artery disease (SCAD is poor. Objective. We sought to investigate the influence of adjusting guideline proposed medications on relief of angina in a large group of patients with SCAD in Serbia. Methods. The study included a total of 3,490 patients from 15 cardiology clinics with symptoms of stable angina and at least one of the following criteria: abnormal electrocardiogram (ECG, history of myocardial infarction (MI, positive stress test, significant coronary artery disease on coronary angiogram or previous revascularization. All the patients underwent comprehensive evaluation at initial visit and after two months. The relief of angina was study end-point defined as any reduction in Canadian Cardiology Society (CCS class, number of angina attacks per week and/or number of tablets of short-acting nitrates per week. Results. Most patients were included based on abnormal ECG (48.4%. At Visit 1, the average number of prescribed classes of medications to a single patient increased from 4.16 ± 1.29 to 4.63 ± 1.57 (p < 0.001. At the follow-up, the patients had significantly lower blood pressure (141 ± 19 / 85 ± 11 vs. 130 ± 12 / 80 ± 8 mmHg; p < 0.001 and most of them reported CCS class I (63.3%. The average weekly number of angina attacks was reduced from 2.82 ± 2.50 at Visit 1 to 1.72 0 ± 1.66 at Visit 2, as well as average weekly use of short-acting nitrates to treat these attacks (2.69 ± 2.53 to 1.74 ± 1.47 tablets; p < 0.001 for all. Conclusion. Adjustment of prescribed medications to guideline recommendations in a large Serbian patient population with prevalent risk factors led to significant relief of angina.

  12. 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.

  13. PEPTIC ULCER IN PATIENTS WITH ISCHEMIC HEART DISEASE ON CHRONIC ANTI-PLATELET THERAPY WITH ASPIRIN

    OpenAIRE

    松倉, 康夫; 上村, 史朗; 川本, 篤彦; 坂口, 泰弘; 山野, 繁; 藤本, 眞一; 橋本, 俊雄; 土肥, 和紘

    1999-01-01

    Recently, many patients with ischemic heart disease (IHD), including myocardial infarction, angina pectoris, and patients with coronary stent implantation, are receiving chronic aspirin therapy in expectation of its anti-platelet effects. It is well known that, in patients with rheumatic disease on chronic aspirin therapy, aspirin-induced peptic ulcer is frequent and limits its clinical usefulness. In this study, we studied 482 IHD patients after coronary intervention to evaluate the incidenc...

  14. CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial.

    Science.gov (United States)

    2015-06-13

    The benefit of CT coronary angiography (CTCA) in patients presenting with stable chest pain has not been systematically studied. We aimed to assess the effect of CTCA on the diagnosis, management, and outcome of patients referred to the cardiology clinic with suspected angina due to coronary heart disease. In this prospective open-label, parallel-group, multicentre trial, we recruited patients aged 18-75 years referred for the assessment of suspected angina due to coronary heart disease from 12 cardiology chest pain clinics across Scotland. We randomly assigned (1:1) participants to standard care plus CTCA or standard care alone. Randomisation was done with a web-based service to ensure allocation concealment. The primary endpoint was certainty of the diagnosis of angina secondary to coronary heart disease at 6 weeks. All analyses were intention to treat, and patients were analysed in the group they were allocated to, irrespective of compliance with scanning. This study is registered with ClinicalTrials.gov, number NCT01149590. Between Nov 18, 2010, and Sept 24, 2014, we randomly assigned 4146 (42%) of 9849 patients who had been referred for assessment of suspected angina due to coronary heart disease. 47% of participants had a baseline clinic diagnosis of coronary heart disease and 36% had angina due to coronary heart disease. At 6 weeks, CTCA reclassified the diagnosis of coronary heart disease in 558 (27%) patients and the diagnosis of angina due to coronary heart disease in 481 (23%) patients (standard care 22 [1%] and 23 [1%]; pcoronary heart disease increased (1·09, 1·02-1·17; p=0·0172), the certainty increased (1·79, 1·62-1·96; pcoronary heart disease. This changed planned investigations (15% vs 1%; pcoronary heart disease, CTCA clarifies the diagnosis, enables targeting of interventions, and might reduce the future risk of myocardial infarction. The Chief Scientist Office of the Scottish Government Health and Social Care Directorates funded the trial

  15. 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.

  16. Correlation between plasma angiopoietin-1, angiopoietin-2 and matrix metalloproteinase-2 in coronary heart disease.

    Science.gov (United States)

    Wu, Haoyu; Shou, Xiling; Liang, Lei; Wang, Congxia; Yao, Xiaowei; Cheng, Gong

    2016-12-01

    Angiopoietin-2 (Ang-2) plays a critical role in inducing tumor cell infiltration, and this invasive phenotype is caused by up-regulation of matrix metalloproteinase (MMP)-2. The relationship between Ang-2 and MMP-2 in atherosclerosis has not been reported yet. The aim is to measure the plasma concentrations of Ang-1, Ang-2 and MMP-2 and assess the correlation between the concentrations of these factors in coronary heart disease (CHD) patients. The testing was done in a cross-sectional study. We prospectively enrolled 42 individuals with acute myocardial infarction, 42 individuals with unstable angina pectoris, 42 individuals with stable angina pectoris and 45 healthy control subjects. Concentrations of Ang-1, Ang-2 and MMP-2 were measured using the enzyme-linked immunosorbent assay (ELISA) method. Spearman's rank correlation was calculated to evaluate the relationships between MMP-2 and Ang-1, and MMP-2 and Ang-2 in patients with CHD. Patients with acute myocardial infarction and unstable angina pectoris had higher Ang-2 and MMP-2 levels compared with stable angina patients and healthy control subjects ( p correlation showed that Ang-2 levels positively correlated with MMP-2 in patients with CHD ( r = 0.679, p correlated weakly with MMP-2, whereas the Ang-2 and MMP-2 correlation was strong in patients with CHD. Ang-2 may play a role in atherosclerosis, and have an interaction with MMP-2.

  17. 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.

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

    African Journals Online (AJOL)

    1974-06-08

    Jun 8, 1974 ... The vemricular extrasystoles reflect the>:e changes-as primary S-T segment and T-wave changes (see below)-- more clearly. The S-T segments are markedly elevated to about 3 mm. The S-T segment configuration is clearly horizontal with a very sharp-angled ST-T junction. The associated T waves are tall ...

  19. Hjertestop induceret af vasospastisk angina pectoris efter vaginalt administreret misoprostol

    DEFF Research Database (Denmark)

    Matthesen, Terese; Olsen, Rasmus Huan; Bosselmann, Helle Skovmand

    2017-01-01

    A 41-year-old woman developed cardiac arrest after administration of misoprostol in order to induce an abortion. She was successfully resuscitated. Coronary angiography revealed coronary artery spasm which responded to nitroglycerine. Misoprostol is first-line treatment for medically induced...

  20. The Effects of Enhanced External Counterpulsation on Cardiac Electrophysiologic Properties of Patients with Ischemic Heart Disease and Refractory Angina at Function Class II-III

    Directory of Open Access Journals (Sweden)

    Fariborz Akbarzadeh

    2011-05-01

    Full Text Available Introduction: Enhanced external counterpulsation (EECP is a noninvasive circulatory assist device that has been recently emerged as a treatment option for refractory angina or left ventricular (LV dysfunction. The aims of this study were to examine the effects of EECP on the elecrocardiographic parameters and the heart rate variability indices of patients with the coronary heart disease and function class II-III angina resistant to medication. Methods: In a descriptive study, the patients who presented with sever angina at function class II-III were studied. Those meeting the inclusion criteria were invited to participate and provided informed consent. The standard enhanced external counterpulsation treatment (35 one-hour procedures 5-6 times a week was done. Thirty minute ambulatory electrocardiographic monitoring and electrocardiogram before starting and at the end of treatment sessions were done. Data entry and analysis of data was done finally. Results: Twenty five patients with mean age 68±9 year including 21(84% men and 4(16% women were enrolled in this study. Electocardiogarphic parameters before and after treatment by EECP were not different statistically. Time domain indices of heart rate variability according to ambulatory monitoring findings were not changed significantly. Conclusion: Results of this study revealed that EECP did not improve the electrocardiographic and heart rate variability parameters of ischemic heart disease patients with refractory angina at function class II or III.

  1. Myocardial thallium scintigraphy after dipyridamole injection. Application to the diagnosis and evaluation of coronary disease

    International Nuclear Information System (INIS)

    Foult, J.M.; Weinmann, P.; Moretti, J.L.; Le Guludec, D.; Faraggi, M.

    1992-01-01

    Myocardial thallium scintigraphy performed after intravenous injection of dipyridamole is a non-invasive method to diagnose and evaluate coronary disease.It be used as an alternative to post-exercise scintigraphy, both methods having similar sensitivity and specificity. The dipyridamole test is contraindicated in patients with a history of bronchospasm and uncontrolled angina pectoris. Close clinical and electrocardiographic monitoring is required. The wide use of tomographic techniques has notably improved this examination

  2. Autotransplantation of mesenchymal stromal cells from bone-marrow to heart in patients with severe stable coronary artery disease and refractory angina — Final 3-year follow-up

    DEFF Research Database (Denmark)

    Mathiasen, Anders Bruun; Haack-Sørensen, Mandana; Jørgensen, Erik

    2013-01-01

    The study assessed long-term safety and efficacy of intramyocardial injection of autologous bone-marrow derived mesenchymal stromal cells (BMMSCs) in patients with severe stable coronary artery disease (CAD) and refractory angina.......The study assessed long-term safety and efficacy of intramyocardial injection of autologous bone-marrow derived mesenchymal stromal cells (BMMSCs) in patients with severe stable coronary artery disease (CAD) and refractory angina....

  3. Management standards for stable coronary artery disease in India

    Directory of Open Access Journals (Sweden)

    Sundeep Mishra

    2016-12-01

    Full Text Available Coronary artery disease (CAD is one of the important causes of cardiovascular morbidity and mortality globally, giving rise to more than 7 million deaths annually. An increasing burden of CAD in India is a major cause of concern with angina being the leading manifestation. Stable coronary artery disease (SCAD is characterised by episodes of transient central chest pain (angina pectoris, often triggered by exercise, emotion or other forms of stress, generally triggered by a reversible mismatch between myocardial oxygen demand and supply resulting in myocardial ischemia or hypoxia. A stabilised, frequently asymptomatic phase following an acute coronary syndrome (ACS is also classified as SCAD. This definition of SCAD also encompasses vasospastic and microvascular angina under the common umbrella.

  4. 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 ...

  5. Comparison of usefulness of exercise testing versus coronary computed tomographic angiography for evaluation of patients suspected of having coronary artery disease

    DEFF Research Database (Denmark)

    Ovrehus, Kristian A; Jensen, Jesper K; Mickley, Hans

    2010-01-01

    In patients suspected of having coronary artery disease (CAD), we compared the diagnostic sensitivity and specificity of exercise testing using ST-segment changes alone and ST-segment changes, angina pectoris, and hemodynamic variables compared to coronary computed tomographic angiography (CTA......). Quantitative invasive coronary angiography was the reference method (>50% coronary lumen reduction). A positive exercise test was defined as the development of significant ST-segment changes (> or =1 mV measured 80 ms from the J-point), and the occurrence of one or more of the following criteria: ST......-segment changes > or =1 mV measured 80 ms from the J-point, angina pectoris, ventricular arrhythmia (the occurrence of > or =3 premature ventricular beats), and > or =20 mm Hg decrease in systolic blood pressure during the test. Positive results on CTA were defined as a coronary lumen reduction of > or =50...

  6. Alcohol flushing and positive ethanol patch test in patients with coronary spastic angina: possible role of aldehyde dehydrogenase 2 polymorphisms.

    Science.gov (United States)

    Mizuno, Yuji; Morita, Sumio; Harada, Eisaku; Shono, Makoto; Morikawa, Yoshinobu; Murohara, Toyoaki; Yasue, Hirofumi

    2013-01-01

    Coronary spasm plays an important role in the pathogenesis of coronary heart disease (CHD) and angina pectoris caused by coronary spasm or coronary spastic angina (CSA) is prevalent in Japan. However, the precise mechanisms underlying coronary spasm are unclear. Alcohol intolerance is prevalent among East Asians, and we previously reported that coronary spasm could be induced by alcohol intake in CSA patients. We herein examined whether CSA is associated with alcohol intolerance in Japanese subjects. The study subjects consisted of 80 CSA patients (57 men/ 23 women, mean age 62 ± 12) and 52 non-CSA patients (25 men/27 women, mean age 63 ± 10). The ethanol patch test (EPT) and questionnaire which evaluates flushing after ethanol intake, along with an examination of clinical features and laboratory chemistry data for CHD risk factors were done. Gender (male) and smoking were higher (p=0.007, and p=0.019, respectively) and plasma HDL cholesterol level was lower (p=0.035) in the CSA patients than in the non-CSA patients. Multivariable logistic regression analysis including age, EPT, smoking, and plasma HDL cholesterol level as independent variables revealed that positive EPT and smoking were significant predictors of CSA (p=0.011 and p=0.016, respectively). Positive EPT and alcohol flushing following alcohol intake, as well as smoking and plasma levels of HDL cholesterol, were significantly associated with CSA in Japanese patients. Therefore, alcohol ingestion as well as smoking is a significant risk factor for CSA in Japanese.

  7. 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.

  8. Heart rate variability and turbulence to determine true coronary artery disease in patients with ST segment depression without angina during exercise stress testing.

    Science.gov (United States)

    Celik, Atac; Ozturk, Ahmet; Ozbek, Kerem; Kadi, Hasan; Koc, Fatih; Ceyhan, Koksal; Erkorkmaz, Unal

    2011-12-01

    ST segment depression without angina during an exercise stress test causes diagnostic problems, particularly in non-diabetic patients. Heart rate variability (HRV) and heart rate turbulence (HRT) are used to evaluate the changes in cardiac autonomic functions and are also both decreased in patients with coronary artery disease. The aim of this study was determine the values of HRV and HRT that discriminate true coronary artery disease from false positive stress test results. Ninety non-diabetic patients who underwent diagnostic coronary angiography (CA) due to suspected coronary artery disease after ST segment depression without angina during an exercise stress test were enrolled in the study. Prior to CA, 24 hour ambulatory electrocardiogram recordings were taken and HRV and HRT parameters were calculated. Patients were divided into three groups according to the severity of their coronary lesions: (group 1 normal, group 2 non-obstructive and group 3 obstructive. There were no differences among the groups with regards to age, sex, medical history, medications, systolic and diastolic blood pressures, body mass index, fasting glucose, anemia and thyroid status, lipid profile and creatinine clearance. HRV parameters and turbulence slope (TS) were significantly lower while turbulence onset (TO) was significantly higher in group 3 than groups 1 and 2. According to the cut-off values calculated using ROC analysis, SDNN≤69.63 msec, TO > 0.14%, and TS≤2.78 msec/RR have high diagnostic accuracy for predicting obstructive coronary artery disease. HRV and HRT parameters may provide additional information for discriminating between patients who do and do not truly need CA.

  9. Haemostatic function in coronary artery disease (CAD).

    Science.gov (United States)

    Gupta, A; Sikka, M; Madan, N; Dwidedi, S; Rusia, U; Sharma, S

    1997-04-01

    Tests to evaluate haemostatic function bleeding time (BT), prothrombin time (PT) partial thromboplastin time with kaolin (PTTK), thrombin time (TT), platelet count, platelet function tests (platelet adhesiveness and microthrombus index) and plasma fibrinogen levels were performed in 30 patients of coronary artery disease (14 myocardial infarction, 16 angina pectoris) and 20 age and sex matched controls. There was no statistically significant difference in platelet adhesiveness and mean microthrombus index in patients and controls. The BT, PT, PTTK and TT were normal in all patients and controls. Stepwise logistic regression analysis showed that plasma fibrinogen was an independent risk factor in the production of CAD.

  10. Isosorbide dinitrate in coronary diseases patients

    International Nuclear Information System (INIS)

    Savioli, R.M.; Federico, W.A.; Britto, F.S. de; Nassif, M.; Alonso, G.; Martins, L.R.F.; Del Nero Junior, E.

    1982-01-01

    Twelve patients with coronary artery disease and stable angina pectoris were studied. The patients were submited to radioisotopic cineventriculographic study with tecnecio-99m during isotonic exercise in supine position using adapted ergometric bycle. The tests were performed after 30 minutes of rest; 30 minutes after sub-lingual admnistration of 2,5 mg of isosorbide dinitrate and after 30 minutes of sub-lingual admnistration of 5 mg of isosorbide dinitrate. The following variables were analysed: a)ST segment variations; b)occurence of pain during exercise; c)wall ventricular motion; d)left ventricular ejection fraction and their variations. (M.A.C.) [pt

  11. Coronary microvascular dysfunction assessed by intracoronary acetylcholine provocation testing is a frequent cause of ischemia and angina in patients with exercise-induced electrocardiographic changes and unobstructed coronary arteries.

    Science.gov (United States)

    Ong, Peter; Athanasiadis, Anastasios; Hill, Stephan; Schäufele, Tim; Mahrholdt, Heiko; Sechtem, Udo

    2014-08-01

    The exercise electrocardiogram (ECG) is a standard examination in patients with suspected coronary artery disease. However, despite a pathologic result, many patients undergoing diagnostic coronary angiography do not have any significant epicardial stenosis. In this study, we assessed the relation between a pathologic exercise ECG and coronary microvascular dysfunction in response to intracoronary acetylcholine (ACh) provocation in patients without any relevant epicardial stenosis. Coronary microvascular dysfunction is significantly more often in patients with angina, unobstructed coronary arteries and a pathologic exercise stress test compared to those without pathologic stress test. This study recruited 137 consecutive patients with exertional angina pectoris who underwent diagnostic coronary angiography between September 2008 and April 2011 (68% women; mean age, 63 ± 10 years). In none of the patients was there a stenosis of >50%. All patients underwent an exercise ECG before angiography and intracoronary ACh provocation testing for assessment of coronary vasomotor responses directly after angiography. The exercise ECG showed an abnormal result in 69 patients (50%; ST-segment depression ≥0.1 mV and/or reproduction of the patient's usual symptoms). The ACh test revealed a coronary vasomotor abnormality (reproduction of the patient's symptoms, ischemic ECG shifts ± diffuse distal vasoconstriction) in 87 patients (64%). Such a result was significantly more often found in patients with a pathologic exercise ECG (50/69 [72%] vs 19/69 [28%], P = 0.034). There were no other statistically significant differences between patients with and those without pathologic exercise ECG. Coronary microvascular dysfunction is frequently found in patients with exertional angina pectoris and unobstructed coronary arteries. Such a finding is found significantly more often in presence of a pathologic exercise ECG. © 2014 Wiley Periodicals, Inc.

  12. 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...

  13. 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

  14. 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.

  15. 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.

  16. [Martin Luther's somatic diseases. A short life-history 450 years after his death].

    Science.gov (United States)

    Iversen, O H

    1996-12-10

    The article contains a short life-history of the religious reformer Martin Luther (1483-1546) with main emphasis on his many somatic diseases. The list comprises varicose ulcer, angina pectoris with anxiety, obesity, hypertension arterialis, Ménière's disease with vertigo, tinnitus and fainting fits, gastralgia, constipation with anal ulcers and haemorrhoids with bleeding, urolithiasis, arthritis urica, Roemheld's syndrome, and cataract in one eye. Mentally he had a manic-depressive cast of personality, and a tendency to emotional lability. In spite of this he had an enormous capacity for work.

  17. Novel cardiovascular risk markers in women with ischaemic heart disease.

    Science.gov (United States)

    Pop, Dana; Dădârlat, Alexandra; Zdrenghea, D

    2014-01-01

    The incidence of coronary heart disease in premenopausal women is lower than in men because of their hormonal protection. Angina pectoris occurs in women about 10 years later than in men. However, mortality from ischaemic heart disease remains higher in women than in men. Current studies are focusing on novel cardiovascular risk biomarkers because it seems that traditional cardiovascular risk factors and their assessment scores underestimate the risk in females. Increased plasma levels of these newly established biomarkers of risk have been found to worsen endothelial dysfunction and inflammation, both of which play a key role in the pathogenesis of microvascular angina, which is very common in women. These novel cardiovascular risk markers can be classified into three categories: inflammatory markers, markers of haemostasis, and other biomarkers.

  18. Jsou elektronická lékařská doporučení pro nestabilní anginu pectoris přínosem?

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Anger, Z.; Aschermann, M.; Buchtela, David; Tomečková, Marie; Veselý, Arnošt; Zvárová, Jana

    2003-01-01

    Roč. 2, Suppl A (2003), s. 17-18 ISSN 1213-807X. [Konference pracovní skupiny akutní kardiologie České kardiologické společnosti /2./. 11.12.2003-13.12.2003, Karlovy Vary] R&D Projects: GA MŠk LN00B107 Keywords : guidelines in cardiology * unstable angina pectoris * electronic medical guidelines Subject RIV: BD - Theory of Information

  19. 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

  20. Tissue Doppler echocardiography reveals distinct patterns of impaired myocardial velocities in different degrees of coronary artery disease

    DEFF Research Database (Denmark)

    Hoffmann, Soren; Mogelvang, Rasmus; Olsen, Niels Thue

    2010-01-01

    Aim To determine how the left ventricular wall motion assessed by echocardiographic Tissue Doppler Imaging (TDI) is affected by increasing severity of coronary artery disease (CAD) among patients with stable angina pectoris and preserved ejection fraction. METHODS AND RESULTS: This study comprises...... global estimates. Each patient with significant coronary disease was matched with a control of the same age, sex, body mass index, and status regarding diabetes and hypertension. Global systolic and diastolic performance by TDI (in terms of global s' and E/e') were negatively correlated to the number...

  1. Conflicts at work are associated with a higher risk of cardiovascular disease

    Science.gov (United States)

    Jacob, Louis; Kostev, Karel

    2017-01-01

    Background: Only few authors have analyzed the impact of workplace conflicts and the resulting stress on the risk of developing cardiovascular disorders. The goal of this study was to analyze the association between workplace conflicts and cardiovascular disorders in patients treated by German general practitioners. Methods: Patients with an initial documentation of a workplace conflict experience between 2005 and 2014 were identified in 699 general practitioner practices (index date). We included only those who were between the ages of 18 and 65 years, had a follow-up time of at least 180 days after the index date, and had not been diagnosed with angina pectoris, myocardial infarction, coronary heart diseases, or stroke prior to the documentation of the workplace mobbing. In total, the study population consisted of 7,374 patients who experienced conflicts and 7,374 controls for analysis. The main outcome measure was the incidence of angina pectoris, myocardial infarction, and stroke correlated with workplace conflict experiences. Results: After a maximum of five years of follow-up, 2.9% of individuals who experienced workplace conflict were affected by cardiovascular diseases, while only 1.4% were affected in the control group (p-value <0.001). Workplace conflict was associated with a 1.63-fold increase in the risk of developing cardiovascular diseases. Finally, the impact of workplace conflict was higher for myocardial infarction (OR=2.03) than for angina pectoris (OR=1.79) and stroke (OR=1.56). Conclusions: Overall, we found a significant association between workplace conflicts and cardiovascular disorders. PMID:28496397

  2. Prior blunt chest trauma may be a cause of single vessel coronary disease; hypothesis and review

    DEFF Research Database (Denmark)

    Bartels, Mette Damkjær; Nielsen, PE; Sleight, P

    2006-01-01

    Prompted by a case where a patient (with no risk factors, and single vessel disease) developed angina pectoris after previous blunt chest trauma, we searched Medline for blunt chest trauma and myocardial ischaemia. We found 77 cases describing AMI after blunt chest trauma, but only one reporting ...... the situation and acute PCI must be considered preferable. It seems likely that lesser damage could lead to longer-term stenosis we suspect that this sequence is grossly under-reported. This could have medico-legal implications....

  3. Association of monthly frequencies of diverse diseases in the calls to the public emergency service of the city of Buenos Aires during 1999-2004 with meteorological variables and seasons

    Science.gov (United States)

    Alexander, P.

    2013-01-01

    This work aims to study associations between monthly averages of meteorological variables and monthly frequencies of diverse diseases in the calls to the public ambulance emergency service of the city of Buenos Aires during the years 1999-2004. Throughout this time period no changes were made in the classification codes of the illnesses. Heart disease, arrhythmia, heart failure, cardiopulmonary arrest, angina pectoris, psychiatric diseases, stroke, transient ischemic attack, syncope and the total number of calls were analyzed against 11 weather variables and the four seasons. All illnesses exhibited some seasonal behavior, except cardiorespiratory arrest and angina pectoris. The largest frequencies of illnesses that exhibited some association with the meteorological variables used to occur in winter, except the psychiatric cases. Heart failure, stroke, psychiatric diseases and the total number of calls showed significant correlations with the 11 meteorological variables considered, and the largest indices (absolute values above 0.6) were found for the former two pathologies. On the other side, cardiorespiratory arrest and angina pectoris revealed no significant correlations and nearly null indices. Variables associated with temperature were the meteorological proxies with the largest correlations against diseases. Pressure and humidity mostly exhibited positive correlations, which is the opposite of variables related to temperature. Contrary to all other diseases, psychiatric pathologies showed a clear predominance of positive correlations. Finally, the association degree of the medical dataset with recurrent patterns was further evaluated through Fourier analysis, to assess the presence of statistically significant behavior. In the Northern Hemisphere high morbidity and mortality rates in December are usually assigned to diverse factors in relation to the holidays, but such an effect is not observed in the present analysis. There seems to be no clearly preferred

  4. 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 ...

  5. [Value of the isometric exercise test in objectively evaluating the effectiveness of hyperbaric oxygenation in ischemic heart disease].

    Science.gov (United States)

    Efuni, S N; Kudriashov, V E; Rodionov, V V; Beletskiĭ, Iu V; Telegin, Iu N

    1984-05-01

    The isometric test was conducted prior to and after a hyperbaric oxygenation (HBO) session in 31 coronary heart disease (CHD) patients. The results were compared with the findings provided by the examination of 138 coronary patients and 23 normal subjects receiving no HBO treatment. It was shown that the isometric test makes it possible to objectively assess the HBO effect in CHD patients. The results of the test reflect reduction in the severity of angina pectoris or cardiac failure following hyperbarotherpy. The results obtained justify the recommendation of the isometric test for the individual evaluation of the hyperbaric treatment in CHD.

  6. Randomised placebo controlled multicentre trial to assess short term clarithromycin for patients with stable coronary heart disease: CLARICOR trial

    DEFF Research Database (Denmark)

    Jespersen, Christian M; Als-Nielsen, Bodil; Damgaard, Morten

    2005-01-01

    OBJECTIVE: To determine if the macrolide clarithromycin affects mortality and cardiovascular morbidity in patients with stable coronary heart disease. DESIGN: Centrally randomised multicentre trial. All parties at all stages were blinded. Analyses were by intention to treat. SETTING: Five...... Copenhagen University cardiology departments and a coordinating centre. PARTICIPANTS: 13,702 patients aged 18 to 85 years who had a discharge diagnosis of myocardial infarction or angina pectoris in 1993-9 and alive in August 1999 were invited by letter; 4373 were randomised. INTERVENTIONS: Two weeks...

  7. Randomised placebo controlled multicentre trial to assess short term clarithromycin for patients with stable coronary heart disease: CLARICOR trial

    DEFF Research Database (Denmark)

    Jespersen, CM; Als-Nielsen, B; Damgaard, M

    2006-01-01

    OBJECTIVE: To determine if the macrolide clarithromycin affects mortality and cardiovascular morbidity in patients with stable coronary heart disease. DESIGN: Centrally randomised multicentre trial. All parties at all stages were blinded. Analyses were by intention to treat. SETTING: Five...... Copenhagen University cardiology departments and a coordinating centre. PARTICIPANTS: 13,702 patients aged 18 to 85 years who had a discharge diagnosis of myocardial infarction or angina pectoris in 1993-9 and alive in August 1999 were invited by letter; 4373 were randomised. INTERVENTIONS: Two weeks...

  8. 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.

  9. Clinical studies on the thallium-201 myocardial scintiphotography in patient with ischemic heart disease

    International Nuclear Information System (INIS)

    Owada, Kenji

    1980-01-01

    Thallium-201 myocardial scintiphotography was performed in 41 patients with myocardial infarction, 13 with angina pectoris and 12 without coronary artery disease. 1) In patients with congestive heart failure, blood clearance of 201 Tl was delayed and radioactivity on the lung area increased compared with normal cases. 2) The scintillation camera image on a globular model containing 0.5 mCi of 201 Tl was recorded in a magnetic disk as 64 * 64 matrix. Myocardial area was estimated as an area where the count showed more than 55% of maximum counts of myocardium. On the myocardial area, cold area due to infarction was defined as an area where the count showed less than 70% of the maximum. 3) The infarct size (%) was calculated as an ratio of the number of matrix in cold area against to myocardial area on the images of ANT, LAO, and LAT view. The mean infarct size (%) was larger in the patient with cardiomegaly (CTR >= 55%) than those without it, and it was larger in the patients with high values of serum CPK or LDH than in those with low values of them. 4) The correlation coefficient between the mean infarct size (%) and direction of QRS vector at the maximum, 20 msec and 40 msec were r = 0.780, 0.672 and 0.766, respectively. 5) Mean values of MBF/CO (%) ratio were showing significant low in myocardial infarction and in angina pectoris. 6) The mean value of Myocardial blood flow (MBF) was showing significant low in myocardial infarction and in angina pectoris. MBF (ml/min/m 2 ) value expressed the states of coronary blood flow better than MBF/CO (%). (J.P.N.)

  10. Fractional flow reserve is not associated with inflammatory markers in patients with stable coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Jan-Willem E M Sels

    Full Text Available BACKGROUND: Atherosclerosis is an inflammatory condition and increased blood levels of inflammatory biomarkers have been observed in acute coronary syndromes. In addition, high expression of inflammatory markers is associated with worse prognosis of coronary artery disease. The presence and extent of inducible ischemia in patients with stable angina has previously been shown to have strong prognostic value. We hypothesized that evidence of inducible myocardial ischemia by local lesions, as measured by fractional flow reserve (FFR, is associated with increased levels of blood based inflammatory biomarkers. METHODS: Whole blood samples of 89 patients with stable angina pectoris and 16 healthy controls were analyzed. The patients with stable angina pectoris underwent coronary angiography and FFR of all coronary lesions. We analyzed plasma levels of cytokines IL-6, IL-8 and TNF-α and membrane expression of Toll-like receptor 2 and 4, CD11b, CD62L and CD14 on monocytes and granulocytes as markers of inflammation. Furthermore, we quantified the severity of hemodynamically significant coronary artery disease by calculating Functional Syntax Score (FSS, an extension of the Syntax Score. RESULTS: For the majority of biomarkers, we observed lower levels in the healthy control group compared with patients with stable angina who underwent coronary catheterization. We found no difference for any of the selected biomarkers between patients with a positive FFR (≤ 0.75 and negative FFR (>0.80. We observed no relationship between the investigated biomarkers and FSS. CONCLUSION: The presence of local atherosclerotic lesions that result in inducible myocardial ischemia as measured by FFR in patients with stable coronary artery disease is not associated with increased plasma levels of IL-6, IL-8 and TNF-α or increased expression of TLR2 and TLR4, CD11b, CD62L and CD14 on circulating leukocytes.

  11. 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...

  12. 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.

  13. Atrial pacing and thallium 201 scintigraphy: combined use for diagnosis of coronary artery disease

    International Nuclear Information System (INIS)

    Stratmann, H.G.; Mark, A.L.; Walter, K.E.; Fletcher, J.W.; Williams, G.A.

    1987-01-01

    To evaluate the presence of coronary artery disease (CAD), atrial pacing and thallium 201 scintigraphy were performed in 36 patients with stable angina pectoris who were unable to perform an adequate exercise stress test. All patients underwent cardiac catheterization. Nine patients had previously undergone coronary artery bypass surgery. Significant CAD (one or more lesions greater than or equal to 50%) was present in 33 patients. Atrial pacing produced ischemic ST segment depression (greater than or equal to 1 mm) in 18 (55%) patients with CAD, and angina in 20 patients (61%). As the number of vessels with CAD increased, there was no significant change in the sensitivities of pacing-induced angina or ST segment depression for detecting CAD. In the 3 patients without CAD, ST segment depression occurred in 1 patient and angina in none. Thallium 201 scintigraphy demonstrated perfusion defects in 27 (82%) patients with CAD, with fixed defects seen in 13 studies (39%) and reversible defects in 15 (45%). In the 3 patients without CAD, no perfusion defects were seen. The thallium 201 scan successfully predicted the presence of CAD in patients with single-vessel disease but usually underestimated the number of vessels involved in patients with multivessel disease. Combined sensitivity of pacing-induced ST segment depression and an abnormal thallium 201 scan finding for detecting CAD was 91%. The authors conclude that combined atrial pacing and thallium 201 scintigraphy is a useful test for detecting CAD in patients unable to perform an adequate exercise stress test

  14. Doubling of serum creatinine and the risk of cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes mellitus: a cohort study

    Directory of Open Access Journals (Sweden)

    Schneider C

    2016-06-01

    Full Text Available Cornelia Schneider,1,2 Blai Coll,3 Susan S Jick,4 Christoph R Meier1,2,4 1Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; 2Hospital Pharmacy, University Hospital Basel, Basel, Switzerland; 3Renal Development, AbbVie, North Chicago, IL, USA; 4Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, MA, USA Background: Doubling of serum creatinine is often used as a marker for worsening kidney function in nephrology trials. Most people with chronic kidney disease die of other causes before reaching end-stage renal disease. We were interested in the association between doubling of serum creatinine and the risk of a first-time diagnosis of angina pectoris, congestive heart failure (CHF, myocardial infarction (MI, stroke, or transient ischemic attack in patients with chronic kidney disease and with diagnosed type 2 diabetes mellitus. Methods: We identified all adult patients registered in the “Clinical Practice Research Datalink” between 2002 and 2011 with incident chronic kidney disease and type 2 diabetes mellitus and did a cohort study with a Cox proportional hazard analysis. Results: We identified in total 27,811 patients, 693 developed angina pectoris, 1,069 CHF, 508 MI, 970 stroke, and 578 transient ischemic attacks. Patients whose serum creatinine doubled during follow-up had increased risks of CHF (hazard ratio [HR] 2.98, 95% confidence interval [CI] 2.27–3.89, MI (HR 2.53, 95% CI 1.62–3.96, and stroke (HR 1.93, 95% CI 1.38–2.69, as compared with patients whose serum creatinine did not double. The relative risks of angina pectoris (HR 1.18, 95% CI 0.66–2.10 or a transient ischemic attack (HR 1.32, 95% CI 0.78–2.22 were similar in both groups. Conclusion: Diabetic patients with a doubling of serum creatinine were at an increased risk of CHF, MI, or stroke, compared with diabetic

  15. Cardioprotective Effects of Pomegranate (Punica granatum) Juice in Patients with Ischemic Heart Disease.

    Science.gov (United States)

    Razani, Zahra; Dastani, Mostafa; Kazerani, Hamid Reza

    2017-11-01

    Ischemic heart disease is the leading cause of mortality worldwide. The purpose of this study was to evaluate the cardioprotective effects of pomegranate juice in patients with ischemic heart disease. One hundred patients, diagnosed with unstable angina or myocardial infarction, were randomly assigned to the test and the control groups (n = 50, each). During 5 days of hospitalization, in addition to the conventional medical therapies, the test groups received 220 mL pomegranate juice, daily. During the hospitalization period, the blood pressure, heart rate, as well as the intensity, occurrence, and duration of the angina were evaluated on a regular basis. At the end of the hospitalization period, the serum levels of malondialdehyde, interleukin-6, and tumor necrosis factor alpha were measured in all patients. The levels of serum troponin and high-sensitive C-reactive protein levels were also assayed in patients diagnosed with myocardial infarction. Pomegranate juice caused significant reductions in the intensity, occurrence, and duration of angina pectoris in patients with unstable angina. Consistently, the test patients had significantly lower levels of serum troponin and malondialdehyde. Other studied parameters did not change significantly. The results of this study suggest protective effects of pomegranate juice against myocardial ischemia and reperfusion injury. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

  16. 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...

  17. Prognostic value of an abnormal response to acetylcholine in patients with angina and non-obstructive coronary artery disease: Long-term follow-up of the Heart Quest cohort.

    Science.gov (United States)

    Schoenenberger, Andreas W; Adler, Eric; Gujer, Samuel; Jamshidi, Peiman; Kobza, Richard; Stuck, Andreas E; Resink, Therese J; Erne, Paul

    2016-10-15

    This study aims to determine whether small vessel disease (SVD) or vasospastic disease (VSD) has an impact on prognosis. The prospective cohort embraced 718 patients with angina equivalent symptoms and no coronary stenosis ≥50% recruited between 1997 and 2008. At baseline, patients were classified as having SVD, VSD, other cardiac disease or non-cardiac problem based on intracoronary acetylcholine application and fast atrial pacing during coronary angiography. Patients underwent follow-up between 2007 and 2015. Prognostic significance of the diagnosis on cardiovascular events (cardiovascular death or non-fatal myocardial infarction) was evaluated using Cox proportional hazards models adjusted for age and sex. The mean follow-up duration was 11.3±2.7years. Only 11 patients (1.5%) were lost to follow-up, resulting in an analyzed population of 707 patients. Patients with SVD (HR: 4.9, 95% CI: 1.1-22.4, P=0.040) and VSD (HR: 4.8, 95% CI: 1.0-23.4, P=0.050) had an increased risk of suffering cardiovascular events compared to patients with non-cardiac problems. Among SVD patients, those with the presence of endothelial dysfunction had a particularly high risk (HR: 7.3, 95% CI: 1.5-35.5, P=0.015). Among patients with SVD or VSD, those having persisting or worsening angina during follow-up had a higher risk than patients in whom angina improved (HR: 4.8, 95% CI: 1.9-12.3, P=0.001). Our study shows that patients with SVD or VSD have an increased risk of cardiovascular events. This particularly applies to SVD patients with endothelial dysfunction. Symptoms should be taken seriously in SVD and VSD patients. ClinicalTrials.gov Identifier: NCT01318629. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Conversion of the Seattle Angina Questionnaire into EQ-5D utilities for ischemic heart disease: a systematic review and catalog of the literature.

    Science.gov (United States)

    Wijeysundera, Harindra C; Farshchi-Zarabi, Sara; Witteman, William; Bennell, Maria C

    2014-01-01

    There is a paucity of preference-based (utility) measures of health-related quality of life for patients with ischemic heart disease (IHD); in contrast, the Seattle Angina Questionnaire (SAQ) is a widely used descriptive measure. Our objective was to perform a systematic review of the literature to identify IHD studies reporting SAQ scores in order to apply a mapping algorithm to convert these to preference-based scores for secondary use in economic evaluations. Relevant articles were identified in MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library (Wiley), HealthStar (Ovid), and PubMed from inception to 2012. We previously developed and validated a mapping algorithm that converts SAQ descriptive scores to European Quality of Life-5 Dimensions (EQ-5D) utility scores. In the current study, this mapping algorithm was used to estimate EQ-5D utility scores from SAQ scores. Thirty-six studies met the inclusion criteria. The studies were categorized into three groups, ie, general IHD (n=13), acute coronary syndromes (n=4), and revascularization (n=19). EQ-5D scores for patients with general IHD were in the range of 0.605-0.843 at baseline, and increased to 0.649-0.877 post follow-up. EQ-5D scores for studies of patients with recent acute coronary syndromes increased from 0.706-0.796 at baseline to 0.795-0.942 post follow-up. The revascularization studies had EQ-5D scores in the range of 0.616-0.790 at baseline, and increased to 0.653-0.928 after treatment; studies that focused only on coronary artery bypass grafting increased from 0.643-0.788 at baseline to 0.653-0.928 after grafting, and studies that focused only on percutaneous coronary intervention increased in score from 0.616-0.790 at baseline to 0.668-0.897 after treatment. In this review, we provide a catalog of estimated health utility scores across a wide range of disease severity and following various interventions in patients with IHD. Our catalog of EQ-5D scores can be used in IHD-related economic evaluations.

  19. 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

  20. 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...

  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. 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.

  3. 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.

  4. Coronary Anomaly and Coronary Artery Fistula as Cause of Angina Pectoris with Literature Review

    Directory of Open Access Journals (Sweden)

    Jayanth Koneru

    2011-01-01

    Full Text Available Coronary artery fistulas are rare anomalies of the coronary arteries that may sometimes cause symptoms by shunting blood flow away from the myocardial capillary network. We report the case of a 46-year old lady which shows the right coronary cusp giving rise to left main coronary artery called anomalous origin of a coronary artery (AOCA, and also a fistula between the left coronary artery and pulmonary artery. We describe our diagnostic approach and review the literature on the epidemiology, pathophysiology, the diagnostic modalities, and treatment options.

  5. Incidentally detected diaphragmatic hernia mimicking angina pectoris with Tc-99m MIBI myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Cınar, Alev; Sadıc, Murat; Demırel, Koray; Korkmaz, Meliha

    2013-01-01

    In recent years 99m Technetium methoxy-isobutyl-isonitrile ( 99m Tc MIBI) is widely used in the evaluation of myocardial perfusion imaging (MPI). In this imaging protocol besides the cardiac evaluation, numerous other organs are included in the field of view. 99m Technetium MIBI is taken up in all metabolically active tissue in the body except for the brain. Extracardiac uptake patterns as benign or serious conditions can be revealed during the MPI. In the imaging protocol, we should be aware of distribution of this radiotracer in order to recognize the abnormal uptake. Here in, we present a large diaphragmatic hernia, seemed as a mirror vision of myocardium that was determined incidentally during the MPI with 99m Tc MIBI

  6. Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in symptomatic subjects.

    Science.gov (United States)

    Shabestari, Abbas Arjmand; Abdi, Seifollah; Akhlaghpoor, Shahram; Azadi, Mitra; Baharjoo, Hamidreza; Pajouh, Mohammad Danesh; Emami, Zyae; Esfahani, Fatemeh; Firouzi, Iraj; Hashemian, Mahmoud; Kouhi, Morad; Mozafari, Mahmoud; Nazeri, Iraj; Roshani, Mahmoud; Salevatipour, Babak; Tavalla, Hedayatollah; Tehrai, Mahmoud; Zarrabi, Ali

    2007-06-15

    The recent development of 64-channel multislice computed tomography (MSCT) has resulted in noninvasive coronary artery imaging improvement. This study was conducted to determine the accuracy of 64-slice MSCT in a relatively unselected group of 143 patients with presentations suggestive of coronary artery disease, including those with unstable angina pectoris, who underwent both coronary computed tomographic angiography and invasive coronary angiography. No arrhythmia was considered an exclusion criterion except for atrial fibrillation or frequent extrasystoles. In patients with fast heart rates, a beta blocker was administered orally. Data were obtained using electrocardiography gated 64-slice MSCT. Computed tomographic angiography and invasive coronary angiography findings of each coronary segment were compared to determine the sensitivity, specificity, positive predictive value, and negative predictive value of MSCT in the detection of their normalcy or insignificant (or=50% diameter decrease) stenosis or total occlusion. In per-patient assessment, the calculated sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 96%, 67%, 91%, and 83%, respectively. These values in per-artery evaluation were 94%, 94%, 87%, and 97%, and corresponding values in per-segment analysis were 92%, 97%, 77%, and 99%, respectively. In conclusion, computed tomographic angiography has high diagnostic performance in the assessment of significant coronary artery disease in most patients in a daily routine practice, including those presenting with unstable angina pectoris symptoms.

  7. Macrophage Migration Inhibitory Factor Polymorphism Is Associated with Susceptibility to Inflammatory Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Kangting Ji

    2015-01-01

    Full Text Available Background. Macrophage migration inhibitory factor (MIF is a proinflammatory cytokine. This study explored the association of 173G/C polymorphism of the MIF gene with coronary heart disease (CHD. Methods. Sequencing was carried out after polymerase chain reaction with DNA specimens from 186 volunteers without CHD and 70 patients with CHD. Plasma MIF levels on admission were measured by ELISA. Patients were classified into either stable angina pectoris (SAP or unstable angina pectoris (UAP. Genotype distribution between cases and controls and the association of patients’ genotypes with MIF level and plaque stability were statistically evaluated (ethical approval number: 2012-01. Results. The frequency of the C genotype was higher in CHD patients than in the control (P=0.014. The frequency of the 173*CC genotype was higher in CHD patients than in the control (P=0.005. The plasma MIF level was higher in MIF173*C carriers than in MIF173*G carriers (P=0.033. CHD patients had higher plasma MIF levels than the control (P=0.000. Patients with UAP had higher plasma MIF levels than patients with SAP (P=0.014. Conclusions. These data suggest that MIF −173G/C polymorphism may be related to the development of CHD in a Chinese population. Plasma MIF level is a predictor of plaque stability. This trial is registered with NCT01750502 .

  8. Correlation analysis of levels of adiponectin and matrix metalloproteinase-9 with stability of coronary heart disease.

    Science.gov (United States)

    Li, Ya

    2015-01-01

    To analyze the changes of adiponection (ANP) and matrix metalloproteinase-9 (MMP-9) in patients with coronary heart diseases (CHD) of different types, to investigate the correlation between these changes and stability of coronary artery plague. Inpatients of our hospital were divided into 56 cases with acute myocardial infarction (AMI), 56 cases with unstable angina pectoris (UA), 54 cases with stable angina pectoris (SA), and 60 cases with CHD excluded by using coronary arteriongraphy as the control group. Changes of ANP and MMP-9 were determined, and the correlation was analyzed. 1. ANP and MMP-9 levels in CHD group were higher than those of control group (P < 0.01). 2. Serum ANP and MMP-9 levels in AMI and UA groups were significantly higher than those in control group and SA group (P < 0.05). 3. MMP-9 level in AMI group was significantly higher than that in UA group (P < 0.01). 1. Increased ANP and MMP-9 levels are the independent risk factors of CHD; 2. Increased levels of ANP and MMP-9 in patients with CHD suggest instability of atherosclerotic plaque.

  9. 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.

  10. 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.

  11. Association of changes in health-related quality of life in coronary heart disease with coronary procedures and sociodemographic characteristics

    Directory of Open Access Journals (Sweden)

    Rollag Arnfinn

    2004-10-01

    Full Text Available Abstract Background Few studies have focused on the association between the sociodemographic characteristics of a patient with the change in health-related quality of life (HRQOL following invasive coronary procedures, and the results remain inconclusive. The objective of the present study was to measure the temporal changes in HRQOL of patients with coronary heart disease, and assess how these changes are associated with invasive coronary procedures and sociodemographic characteristics. Methods This was a prospective study of 254 patients with angina pectoris and 90 patients with acute coronary syndrome. HRQOL was assessed with the multi-item scales and summary components of the SF-36, both 6 weeks and 2 years after baseline hospitalization in 1998. Paired t-tests and multiple regression analyses were used to assess temporal changes in HRQOL and to identify the associated factors. Results Physical components of HRQOL had improved most during the 2 years following invasive coronary procedures. Our findings indicated that patients with angina pectoris who were younger, male, and more educated were most likely to increase their HRQOL following invasive coronary procedures. When adjusting for baseline HRQOL scores, invasive coronary procedures and sociodemographic characteristics did not explain temporal changes in patients with acute coronary syndrome, possibly due to higher comorbidity. Conclusion Sociodemographic characteristics should be taken into account when comparing and interpreting changes in HRQOL scores in patients with and without invasive coronary procedures.

  12. Effects of ranolazine on ischemic threshold, coronary sinus blood flow, and myocardial metabolism in coronary artery disease.

    Science.gov (United States)

    Bagger, J P; Bøtker, H E; Thomassen, A; Nielsen, T T

    1997-07-01

    Cytoprotection or metabolic modulation is a new principle in the treatment of angina pectoris. The effect of ranolazine (a cytoprotective drug) on ischemic threshold, coronary sinus blood flow, and myocardial metabolism was evaluated by means of two pacing sequences in nine male patients with coronary artery disease (CAD) and in eight male controls. Ranolazine was given as an intravenous bolus followed by continuous infusion; the mean total dose was 32.7 mg and 31.7 mg in patients and controls, respectively. Angina pectoris was relieved in two patients after ranolazine but pacing time to pain was unchanged in the remaining patients. Maximal ST depression was lower (p = 0.02), but pacing time to maximal and to 1-mm ST depression remained unchanged after the drug. Ranolazine had no overall influence on coronary sinus blood flow, cardiac oxygen consumption, blood pressure, and heart rate. Cardiac uptake of free fatty acids (FFA) was reduced (p = 0.01), and net uptakes of glucose (p = 0.07) and lactate (p = 0.06) tended to be lower after ranolazine in CAD patients and controls. Ranolazine had no direct influence on cardiac exchange of glutamate, alanine, and citrate or on the arterial concentration of any metabolite. In the present study ranolazine had minimal clinical effects. A decrease in myocardial FFA utilization, however, allows greater myocardial glucose oxidation, which may increase the energy production in relation to oxygen availability.

  13. 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.

  14. 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.

  15. Estrogen receptor alpha polymorphism and risk of cardiovascular disease, cancer, and hip fracture

    DEFF Research Database (Denmark)

    Kjaergaard, AD; Ellervik, C; Tybjaerg-Hansen, A

    2007-01-01

    cross-sectionally 9244 individuals from the Danish general population and followed them up for 23 to 25 years. End points were CVD (ischemic heart disease, myocardial infarction, angina pectoris, ischemic cerebrovascular disease, ischemic stroke, other ischemic cerebrovascular disease, venous...... thromboembolism, deep vein thrombosis, and pulmonary embolism), cancer of reproductive organs (breasts, ovaries, uterus, and prostate), and hip fracture. We also studied patients with ischemic heart disease (n=2495), ischemic cerebrovascular disease (n=856), and breast cancer (n=1256) versus general population...... controls. The CC, CT, and TT genotypes had general population frequencies of 21%, 50%, and 29%, respectively. Cross-sectionally, genotype did not influence high-density lipoprotein cholesterol response to hormone replacement therapy. In the cohort study, there were no differences in risks of CVD, cancer...

  16. Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients

    Directory of Open Access Journals (Sweden)

    Pivatelli Flávio

    2012-10-01

    Full Text Available Abstract Background Decreased heart rate variability (HRV is related to higher morbidity and mortality. In this study we evaluated the linear and nonlinear indices of the HRV in stable angina patients submitted to coronary angiography. Methods We studied 77 unselected patients for elective coronary angiography, which were divided into two groups: coronary artery disease (CAD and non-CAD groups. For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 40 minutes. We analyzed the linear indices in the time (SDNN [standard deviation of normal to normal], NN50 [total number of adjacent RR intervals with a difference of duration greater than 50ms] and RMSSD [root-mean square of differences] and frequency domains ultra-low frequency (ULF ≤ 0,003 Hz, very low frequency (VLF 0,003 – 0,04 Hz, low frequency (LF (0.04–0.15 Hz, and high frequency (HF (0.15–0.40 Hz as well as the ratio between LF and HF components (LF/HF. In relation to the nonlinear indices we evaluated SD1, SD2, SD1/SD2, approximate entropy (−ApEn, α1, α2, Lyapunov Exponent, Hurst Exponent, autocorrelation and dimension correlation. The definition of the cutoff point of the variables for predictive tests was obtained by the Receiver Operating Characteristic curve (ROC. The area under the ROC curve was calculated by the extended trapezoidal rule, assuming as relevant areas under the curve ≥ 0.650. Results Coronary arterial disease patients presented reduced values of SDNN, RMSSD, NN50, HF, SD1, SD2 and -ApEn. HF ≤ 66 ms2, RMSSD ≤ 23.9 ms, ApEn ≤−0.296 and NN50 ≤ 16 presented the best discriminatory power for the presence of significant coronary obstruction. Conclusion We suggest the use of Heart Rate Variability Analysis in linear and nonlinear domains, for prognostic purposes in patients with stable angina pectoris, in view of their overall impairment.

  17. Comparison of cardiovascular response to combined static-dynamic effort, postprandial dynamic effort and dynamic effort alone in patients with chronic ischemic heart disease

    International Nuclear Information System (INIS)

    Hung, J.; McKillip, J.; Savin, W.; Magder, S.; Kraus, R.; Houston, N.; Goris, M.; Haskell, W.; DeBusk, R.

    1982-01-01

    The cardiovascular responses to combined static-dynamic effort, postprandial dynamic effort and dynamic effort alone were evaluated by upright bicycle ergometry during equilibrium-gated blood pool scintigraphy in 24 men, mean age 59 +/- 8 years, with chronic ischemic heart disease. Combined static-dynamic effort and the postprandial state elicited a peak cardiovascular response similar to that of dynamic effort alone. Heart rate, intraarterial systolic and diastolic pressures, rate-pressure product and ejection fraction were similar for the three test conditions at the onset of ischemia and at peak effort. The prevalence and extent of exercise-induced ischemic left ventricular dysfunction, ST-segment depression, angina pectoris and ventricular ectopic activity were also similar during the three test conditions. Direct and indirect measurements of systolic and diastolic blood pressure were highly correlated. The onset of ischemic ST-segment depression and angina pectoris correlated as strongly with heart rate alone as with the rate-pressure product during all three test conditions. The cardiovascular response to combined static-dynamic effort and to postprandial dynamic effort becomes more similar to that of dynamic effort alone as dynamic effort reaches a symptom limit. If significant ischemic and arrhythmic abnormalities are absent during symptom-limited dynamic exercise testing, they are unlikely to appear during combined static-dynamic or postprandial dynamic effort

  18. Small dense LDL particles - a predictor of coronary artery disease evaluated by invasive and CT-based techniques: a case-control study

    Directory of Open Access Journals (Sweden)

    Andreasen Annette

    2011-01-01

    Full Text Available Abstract Background Coronary angiography is the current standard method to evaluate coronary atherosclerosis in patients with suspected angina pectoris, but non-invasive CT scanning of the coronaries are increasingly used for the same purpose. Low-density lipoprotein (LDL cholesterol and other lipid and lipoprotein variables are major risk factors for coronary artery disease. Small dense LDL particles may be of particular importance, but clinical studies evaluating their predictive value for coronary atherosclerosis are few. Methods We performed a study of 194 consecutive patients with chest pain, a priori considered of low to intermediate risk for significant coronary stenosis (>50% lumen obstruction who were referred for elective coronary angiography. Plasma lipids and lipoproteins were measured including the subtype pattern of LDL particles, and all patients were examined by coronary CT scanning before coronary angiography. Results The proportion of small dense LDL was a strong univariate predictor of significant coronary artery stenosis evaluated by both methods. After adjustment for age, gender, smoking, and waist circumference only results obtained by traditional coronary angiography remained statistically significant. Conclusion Small dense LDL particles may add to risk stratification of patients with suspected angina pectoris.

  19. Perceived stress and risk of ischemic heart disease: causation or bias?

    DEFF Research Database (Denmark)

    Nielsen, Naja Rod; Kristensen, Tage S; Prescott, Eva

    2006-01-01

    BACKGROUND: It is unclear whether the commonly recognized link between stress and cardiovascular disease is causal or the result of reporting bias. The objective of this study was to address the association between perceived stress and first incidence of ischemic heart disease and to evaluate.......56-1.15) or for men (1.09; 0.79-1.52). All associations attenuated with prolonged follow-up. CONCLUSIONS: It remains uncertain whether perceived stress affects subdiagnoses of ischemic heart disease differently or whether the strong association with angina pectoris was spuriously created by a tendency for stressed...... the suggested reporting bias by addressing subdiagnoses of ischemic heart disease separately. METHODS: The 11,839 men and women who participated in the Copenhagen City Heart Study were at baseline (1981-1983) asked about their stress level. The participants were followed in nationwide registries until the year...

  20. Plasma renin activity in patients with ischaemic heart disease

    International Nuclear Information System (INIS)

    Urbanek, J.; Hofman, O.; Reisenauer, R.; Slaby, A.

    1977-01-01

    Plasma renin activity (PRA) stimulated by upright posture was measured in 300 men aged 45-64 years using a radioimmunoassay of angiotensin-I. The examined subjects were normotensive or patients with benign essential hypertension and were divided into 6 groups according to the absence of manifest atherosclerosis, the presence of definite angina pectoris or a history of myocardial infarction. Each group contained 50 unselected subjects, with a comparable mean age. Significant differences in mean PRA were found between corresponding groups of hypertensives and normotensives, the values in hypertensives being lower. The percentage of low renin values was higher in hypertensives with ischaemic heart disease than in other groups. It is suggested that this finding might be explained by functional disturbances in the kidneys in hypertensives with ischaemic heart disease. (orig.) [de

  1. Heavy burden of non-communicable diseases at early age and gender disparities in an adult population of Burkina Faso: world health survey

    Directory of Open Access Journals (Sweden)

    Miszkurka Malgorzata

    2012-01-01

    Full Text Available Abstract Background WHO estimates suggest that age-specific death rates from non-communicable diseases are higher in sub-Saharan Africa than in high-income countries. The objectives of this study were to examine, in Burkina Faso, the prevalence of non-communicable disease symptoms by age, gender, socioeconomic group and setting (rural/urban, and to assess gender and socioeconomic inequalities in the prevalence of these symptoms. Methods We obtained data from the Burkina Faso World Health Survey, which was conducted in an adult population (18 years and over with a high response rate (4822/4880 selected individuals. The survey used a multi-stage stratified random cluster sampling strategy to identify participants. The survey collected information on socio-demographic and economic characteristics, as well as data on symptoms of a variety of health conditions. Our study focused on joint disease, back pain, angina pectoris, and asthma. We estimated prevalence correcting for the sampling design. We used multiple Poisson regression to estimate associations between non-communicable disease symptoms, gender, socioeconomic status and setting. Results The overall crude prevalence and 95% confidence intervals (CI were: 16.2% [13.5; 19.2] for joint disease, 24% [21.5; 26.6] for back pain, 17.9% [15.8; 20.2] for angina pectoris, and 11.6% [9.5; 14.2] for asthma. Consistent relationships between age and the prevalence of non-communicable disease symptoms were observed in both men and women from rural and urban settings. There was markedly high prevalence in all conditions studied, starting with young adults. Women presented higher prevalence rates of symptoms than men for all conditions: prevalence ratios and 95% CIs were 1.20 [1.01; 1.43] for joint disease, 1.42 [1.21; 1.66] for back pain, 1.68 [1.39; 2.04] for angina pectoris, and 1.28 [0.99; 1.65] for asthma. Housewives and unemployed women had the highest prevalence rates of non-communicable disease

  2. Heavy burden of non-communicable diseases at early age and gender disparities in an adult population of Burkina Faso: World Health Survey.

    Science.gov (United States)

    Miszkurka, Malgorzata; Haddad, Slim; Langlois, Étienne V; Freeman, Ellen E; Kouanda, Seni; Zunzunegui, Maria Victoria

    2012-01-10

    WHO estimates suggest that age-specific death rates from non-communicable diseases are higher in sub-Saharan Africa than in high-income countries. The objectives of this study were to examine, in Burkina Faso, the prevalence of non-communicable disease symptoms by age, gender, socioeconomic group and setting (rural/urban), and to assess gender and socioeconomic inequalities in the prevalence of these symptoms. We obtained data from the Burkina Faso World Health Survey, which was conducted in an adult population (18 years and over) with a high response rate (4822/4880 selected individuals). The survey used a multi-stage stratified random cluster sampling strategy to identify participants. The survey collected information on socio-demographic and economic characteristics, as well as data on symptoms of a variety of health conditions. Our study focused on joint disease, back pain, angina pectoris, and asthma. We estimated prevalence correcting for the sampling design. We used multiple Poisson regression to estimate associations between non-communicable disease symptoms, gender, socioeconomic status and setting. The overall crude prevalence and 95% confidence intervals (CI) were: 16.2% [13.5; 19.2] for joint disease, 24% [21.5; 26.6] for back pain, 17.9% [15.8; 20.2] for angina pectoris, and 11.6% [9.5; 14.2] for asthma. Consistent relationships between age and the prevalence of non-communicable disease symptoms were observed in both men and women from rural and urban settings. There was markedly high prevalence in all conditions studied, starting with young adults. Women presented higher prevalence rates of symptoms than men for all conditions: prevalence ratios and 95% CIs were 1.20 [1.01; 1.43] for joint disease, 1.42 [1.21; 1.66] for back pain, 1.68 [1.39; 2.04] for angina pectoris, and 1.28 [0.99; 1.65] for asthma. Housewives and unemployed women had the highest prevalence rates of non-communicable disease symptoms. Our work suggests that social inequality extends

  3. Perceived stress and risk of ischemic heart disease: causation or bias?

    Science.gov (United States)

    Nielsen, Naja Rod; Kristensen, Tage S; Prescott, Eva; Larsen, Katrine Strandberg; Schnohr, Peter; Grønbaek, Morten

    2006-07-01

    It is unclear whether the commonly recognized link between stress and cardiovascular disease is causal or the result of reporting bias. The objective of this study was to address the association between perceived stress and first incidence of ischemic heart disease and to evaluate the suggested reporting bias by addressing subdiagnoses of ischemic heart disease separately. The 11,839 men and women who participated in the Copenhagen City Heart Study were at baseline (1981-1983) asked about their stress level. The participants were followed in nationwide registries until the year 2000, and fewer than 0.1% were lost to follow-up. During follow-up, 2316 individuals were diagnosed with ischemic heart disease. High levels of stress were associated with slightly higher risk of incident ischemic heart disease in both women (hazard ratio = 1.23; 95% confidence interval = 1.01-1.51) and men (1.25; 1.00-1.56). When subdiagnoses of ischemic heart disease were analyzed separately, high stress was associated with markedly higher incidence of angina pectoris for women (1.83; 1.15-2.91) and for men (2.14; 1.32-3.47). There was no association with myocardial infarction for women (0.80; 0.56-1.15) or for men (1.09; 0.79-1.52). All associations attenuated with prolonged follow-up. It remains uncertain whether perceived stress affects subdiagnoses of ischemic heart disease differently or whether the strong association with angina pectoris was spuriously created by a tendency for stressed individuals to report more cardiovascular symptoms. Future studies on this issue should address subdiagnoses of ischemic heart disease separately and should carefully consider the impact of reporting bias and prolonged follow-up.

  4. Randomised placebo controlled multicentre trial to assess short term clarithromycin for patients with stable coronary heart disease: CLARICOR trial

    DEFF Research Database (Denmark)

    Jespersen, CM; Als-Nielsen, B; Damgaard, M

    2006-01-01

    ' treatment with clarithromycin 500 mg/day or matching placebo. MAIN OUTCOME MEASURES: Primary outcome: composite of all cause mortality, myocardial infarction, or unstable angina pectoris during three years' follow-up. Secondary outcome: composite of cardiovascular mortality, myocardial infarction......, or unstable angina pectoris. The outcomes were obtained from Danish registers and were blindly assessed by the event committee. RESULTS: 2172 participants were randomised to clarithromycin and 2201 to placebo. We found no significant effects of clarithromycin on the primary outcome (hazard ratio 1.15, 95...... Copenhagen University cardiology departments and a coordinating centre. PARTICIPANTS: 13,702 patients aged 18 to 85 years who had a discharge diagnosis of myocardial infarction or angina pectoris in 1993-9 and alive in August 1999 were invited by letter; 4373 were randomised. INTERVENTIONS: Two weeks...

  5. Prolonged ischemic heart disease and coronary artery bypass - relation to contractile reserve

    DEFF Research Database (Denmark)

    Kofoed, Klaus F; Bangsgaard, Regitze; Carstensen, Steen

    2002-01-01

    OBJECTIVE: A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have...... was correlated to the LV extent of myocardial metabolism--blood flow reverse mismatch. Most of the patients experienced an improvement in their angina pectoris, heart failure symptoms and exercise capacity after CABG; the overall 3-year survival was 77%. CONCLUSIONS: Patients with chronic ischemic heart disease...... indicated a time limit for such a recovery. We therefore investigated the extent of viable myocardium in patients with impaired LV function due to ischemic heart disease after a prolonged strategy of medical treatment and its relation to changes in clinical variables after CABG. METHODS: Forty...

  6. 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.

  7. Evaluation of Various Cardiac Indices and ROC Analysis in Coronary Artery Disease Employing Resting ECG Gated Blood Pool Scan

    International Nuclear Information System (INIS)

    Choi, Chang Woon; Lee, Dong Soo; Kim, Sang Eun; Chung, June Key; Lee, Myung Chul; Park, Young Bae; Seo, Jung Don; Lee, Young Woo; Koh, Chang Soon

    1992-01-01

    Gated blood pool scan is frequently used for evaluating the change in cardiac function in various cardiac diseases. But resting gated blood pool scan using only LVEF as a cardiac index has been consistently shown to have a low sensitivity, which is about 50%, in detecting coronary artery disease. So it is recommended to compare exercise gated blood pool scan to resting gated blood pool scan. Exercise tests, however, are not always possible, especially in patients with musculoskeletal diseases, recent myocardial infarction and in elderly persons. We studied the usefulness of resting gated blood pool scan using multiple indices in evaluating the patients with coronary artery disease. Studied cases were 185 patients with coronary artery disease (angina pectoris 31, myocardial infarction 154) and 25 normals with low likelihood of coronary artery disease. We used 99m Tc-labeled RBC, 740 MBq labeled by in vivo method. The data were evaluated by Micro DELTA computer program. The results were as following: 1) The ejection rates (PER, AER) and filling rates (PFR, AFR) were different in normals and patients with angina pectoris or myocardial infarction. 2) Mean phase angle, ejection rates and filling rates could separate normals from coronary artery disease patients with normal LVEF. 3) Regional ejection fraction was decreased at the site of the infarct in patients with myocardial infarction. 4) Peak filling rate was the most detectable index in evaluation of cardiac function in patients with coronary artery disease. 5) The threshold at 1.5 standard deviation of normal range was considered as the most reliable cut-off value from ROC analysis. These data suggest that the resting gated blood pool scan has an important role in the evaluation of cardiac functional changes using various cardiac indices in patients with coronary artery disease.

  8. 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...

  9. 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

  10. 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 ...

  11. 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

  12. Combined use of 64-slice computed tomography angiography and gated myocardial perfusion SPECT for the detection of functionally relevant coronary artery stenoses. First results in a clinical setting concerning patients with stable angina

    International Nuclear Information System (INIS)

    Hacker, M.; Hack, N.; Tiling, R.; Jakobs, T.; Nikolaou, K.; Becker, C.; Ziegler, F. von; Knez, A.; Koenig, A.; Klauss, V.

    2007-01-01

    Aim: In patients with stable angina pectoris both morphological and functional information about the coronary artery tree should be present before revascularization therapy is performed. High accuracy was shown for spiral computed tomography (MDCT) angiography acquired with a 64-slice CT scanner compared to invasive coronary angiography (ICA) in detecting obstructive'' coronary artery disease (CAD). Gated myocardial SPECT (MPI) is an established method for the noninvasive assessment of functional significance of coronary stenoses. Aim of the study was to evaluate the combination of 64-slice CT angiography plus MPI in comparison to ICA plus MPI in the detection of hemodynamically relevant coronary artery stenoses in a clinical setting. Patients, methods: 30 patients (63 ± 10.8 years, 23 men) with stable angina (21 with suspected, 9 with known CAD) were investigated. MPI, 64-slice CT angiography and ICA were performed, reversible and fixed perfusion defects were allocated to determining lesions separately for MDCT angiography and ICA. The combination of MDCT angiography plus MPI was compared to the results of ICA plus MPI. Results: Sensitivity, specificity, negative and positive predictive value for the combination of MDCT angiography plus MPI was 85%, 97%, 98% and 79%, respectively, on a vessel-based and 93%, 87%, 93% and 88%, respectively, on a patient-based level. 19 coronary arteries with stenoses =50% in both ICA and MDCT angiography showed no ischemia in MPI. Conclusion: The combination of 64-slice CT angiography and gated myocardial SPECT enabled a comprehensive non-invasive view of the anatomical and functional status of the coronary artery tree. (orig.)

  13. STATINES IN PREVENTION AND TREATMENT OF ATHEROSCLEROSIS CONNECTED DISEASES: EFFICIENCY AND SAFETY

    Directory of Open Access Journals (Sweden)

    Y. A. Karpov

    2005-01-01

    Full Text Available Results of large-scale studies carried out during last 10 years and devoted to the assessment of statines efficiency in prevention of ischemic heart disease (IHD, are analyzed. Decrease in risks of myocardial infarction, instable angina pectoris and mortality by 25-40%, ischemic stroke – by 25-30% (CARE, LIPID, WOSCOPS, AFCAPS/TexCAPS, HPS, ASCOT-LLA, CARDS is demonstrated. Recommendations for statines prescription for primary and secondary prevention of cardiovascular diseases, including IHD and ischemic stroke, are significantly expanded. New goals in holesterol of low density lipoproteid (HLDL reduction are discussed, aswell as problems of statin treatment safety. The choice of the drug must be based on clinical research data, considering efficiency and safety at long-term use, as well as possibilities of achieving new goal level of HLDL.

  14. STATINES IN PREVENTION AND TREATMENT OF ATHEROSCLEROSIS CONNECTED DISEASES: EFFICIENCY AND SAFETY

    Directory of Open Access Journals (Sweden)

    Y. A. Karpov

    2015-12-01

    Full Text Available Results of large-scale studies carried out during last 10 years and devoted to the assessment of statines efficiency in prevention of ischemic heart disease (IHD, are analyzed. Decrease in risks of myocardial infarction, instable angina pectoris and mortality by 25-40%, ischemic stroke – by 25-30% (CARE, LIPID, WOSCOPS, AFCAPS/TexCAPS, HPS, ASCOT-LLA, CARDS is demonstrated. Recommendations for statines prescription for primary and secondary prevention of cardiovascular diseases, including IHD and ischemic stroke, are significantly expanded. New goals in holesterol of low density lipoproteid (HLDL reduction are discussed, aswell as problems of statin treatment safety. The choice of the drug must be based on clinical research data, considering efficiency and safety at long-term use, as well as possibilities of achieving new goal level of HLDL.

  15. The association between cardiovascular disease and type 2 diabetes in adults with atopic dermatitis

    DEFF Research Database (Denmark)

    Thyssen, J P; Halling-Overgaard, A-S; Andersen, Y M F

    2017-01-01

    Recent studies examining the association between atopic dermatitis (AD) and cardiovascular disease (CVD) and type 2 diabetes have shown inconsistent results. We compared the risk of CVD and diabetes between adult patients with and without AD by searching the Pubmed, Embase, and Web of Science...... 0.83-1.56), but a positive association was observed with angina pectoris (OR 1.73; 95% CI 1.27-2.37). Meta-analysis on adjusted data gave similar results. While adults with AD in some populations have increased prevalence of cardiovascular risk factors, such as obesity and smoking, it is unlikely...... that AD represents an independent and clinically relevant risk factor for cardiometabolic disease. This article is protected by copyright. All rights reserved....

  16. Clinical evaluation of stress thallium spect in ischemic heart disease

    International Nuclear Information System (INIS)

    Sui, Osamu; Kimura, Nazuna; Soeki; Takeshi; Takeichi, Naoki; Shinohara, Hisanori; Tamura, Yoshiyuki; Fukuda, Nobuo

    1997-01-01

    Thallium SPECT was performed in patients with significant coronary artery stenosis, 67 cases were after maximal exercise and 74 cases were during coronary vasodilation induced by ATP (adenosine triphosphate) infusion. In patients suspected of angina pectoris, the sensitivity, specificity and predictive accuracy for detection of coronary artery disease (CAD) were 88%, 78% and 82% for exercise SPECT, and 100%, 72% and 84% for ATP SPECT studies, respectively. In patients with old myocardial infarction, these were 73%, 100% and 88% for exercise SPECT and 71%, 100% and 81% for ATP SPECT. These were 75%, 49% and 60% for treadmill exercise test in the patient group including both angina and myocardial infarction. For detection of diseased vessels, the diagnostic accuracy for left anterior descending artery and right coronary artery lesions was almost equal for ATP and exercise SPECT study, but ATP SPECT study was more sensitive than exercise SPECT study in detection of left circumflex artery lesions. ATP as well as exercise SPECT studies occasionally gave false positive results in patients with single-vessel disease. ATP as well as exercise SPECT studies underestimated the severity of multi-vessel disease. In general, the results of ATP SPECT imaging were highly concordant with the results of exercise SPECT imaging. ATP stress thallium SPECT imaging provided a safe and highly accurate diagnostic tool for detection of CAD. (author)

  17. Clinical Experience of Laser Angioplasty for the Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    Masayoshi Okada

    1995-01-01

    Full Text Available In recent years, lasers are being utilized in cardiovascular surgery. Since the 1980's we have investigated angioplasty using an Argon laser for patients with obstructive arterial diseases. This technique aims to open the obstructive arterial lumen. Based on the excellent results of experimental studies, the technique has been clinically applied. Laser angioplasty was carried out in 84 patients with stenotic or obstructive lesions occluding more than 75% of peripheral and coronary arteries angiographically. They consisted of 74 cases with intermittent claudication and 10 cases with angina pectoris. Laser angioplasty for the peripheral arterial disease was performed under local anesthesia in the inguinal region under angioscopic guidance. On the other hand, laser coronary angioplasty was simultaneously undertaken at the time of coronary artery bypass grafting for a patient with multiple coronary stenoses. The initial success rate by laser angioplasty for the peripheral artery was 91% in the stenotic lesions and 71% in the obstructive lesions. The cumulative patency rate was 94% in the stenotic lesions and 83% in the occlusive lesions. A follow-up study of 66 months was carried out for patients with clinical success, excluding the cases where an angiogram showed occlusion within 1 week after laser angioplasty. Consequently, excellent long-term results could be clinically obtained. Based on the satisfactory results in the peripheral artery, coronary laser angioplasty was employed in 10 patients with angina pectoris. There were no complications by laser. Thus, the feasibility of laser application was apparently confirmed and laser angioplasty might be recommended for patients with atherosclerotic changes, especially for small arteries.

  18. 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.

  19. 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.

  20. 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...

  1. Clinical characteristics and methods of treatment of patients with stable coronary heart disease in the primary care settings--the results of the Polish, Multicentre Angina Treatment Pattern (ATP) study.

    Science.gov (United States)

    Ruzyllo, W; Ponikowski, P; Wilkins, A

    2004-12-01

    For further improvement of coronary heart disease (CHD) management large epidemiological studies are required to characterise the real population of patients with CHD, treated in the primary care settings, and to evaluate how the guidelines are implemented in the everyday clinical practice. The aim of the Angina Treatment Pattern (ATP) survey was to characterise (i) the population of patients, treated by the primary care physicians for stable CHD, (ii) the methods applied by the primary care physicians to establish diagnosis of CHD and (iii) the pharmacological therapies for CHD. Across Poland, 397 primary care physicians were randomly selected. They recruited 7420 patients (49% men; mean age, 62 +/- 10 years; range: 25-93 years), treated for stable CHD. The duration of CHD was 7.4 +/- 6.6 years (range: 6 months-50 years), 2750 (37%) patients had myocardial infarction. The following risk factors of CHD were present: arterial hypertension in 58%, dyslipidaemia in 52%, smoking in 40%, family history of CHD in 56% and obesity or overweight in 73% of patients. Primary care physicians based a diagnosis of CHD predominantly on a history of anginal pain (in 33% patients), accompanied either by abnormal resting ECG or positive exercise test (in additional 31% patients). Only in 5% of patients, coronary angiography was applied to diagnose CAD. The following groups of drugs have been used: long-acting nitrates in 90%, anti-platelet drugs or anti-coagulants in 71% (aspirin in 65%), angiotensin-converting enzyme inhibitors in 51%, beta-blockers in 48%, calcium antagonists 31%, hypolipaemic drugs in 23% (statins in 10%) and metabolic agents in 16% of patients. Despite an extensive use of classical anti-anginal drugs (including at least one of the following: long-acting nitrates, beta-blockers, calcium antagonists in 95% of patients), 85% of patients still complained of anginal symptoms. Neither prevalence of angina among patients nor nitroglycerin intake depended on the number

  2. Ultrasound assessment of mitral annular displacement in patients with coronary heart disease and its correlation with left heart function and serum indexes

    Directory of Open Access Journals (Sweden)

    Bing-Yan Lai

    2016-10-01

    Full Text Available Objective: To analyze the ultrasound assessment of mitral annular displacement in patients with coronary heart disease and its correlation with left heart function and serum indexes. Methods: A total of 89 patients with coronary heart disease were divided into angina pectoris group 42 cases and myocardial infarction group 47 cases according to the illness, and 58 cases of healthy subjects were included in control group. Values of mitral annular displacement (MAD parameters, left heart function indexes and serum illness-related indexes of three groups were detected, and the correlation between values of MAD parameters and values of cardiac function indexes and serum illness-related indexes were further analyzed. Results: MAD parameters TMAD1, TMAD2 and TMADmid values, heart function LVEF values and serum CysC level of myocardial infarction group and angina pectoris group were lower than those of control group, and cardiac function LVEDD, LVESD and A/E values as well as serum H-FABP, ICTP, Hcy and vWF levels were higher than those of control group (P<0.05; MAD parameters TMAD1, TMAD2 and TMADmid values of patients with coronary heart disease were negatively correlated with LVEDD, LVESD and A/E values as well as H-FABP, ICTP, Hcy and vWF levels, and were positively correlated with LVEF value and CysC level (P<0.05. Conclusions: Ultrasound assessment of mitral annular displacement in patients with coronary heart disease can early diagnose coronary heart disease and judge the disease severity, and it plays a positive role in optimizing disease prognosis.

  3. Value of the 201-Thallium scintigram in the diagnosis of coronary artery disease in patients with and without myocardial infraction

    International Nuclear Information System (INIS)

    Silber, S.; Klein, U.; Rudolph, W.

    1980-01-01

    The usefulness and limitations of the 201-thallium scintigram in the detection of myocardial hypoperfusions is dependent on the sensitivity, specificity and predictive value of the method. The presence of myocardial hypoperfusion can be diagnosed with certainly from a pathologic scintigram only in the absence of false positive scintigrams. Such a high specificity can be achieved only by desginating markedly positive scintigrams as pathologic findings. This, however, necessarily incurs a reduction in sensitivity. In coronary artery disease with previous myocardial infarction, the sensitivity is primarily dependent on the extent of infarction. In coronary arterx desease with no previous myocardial infarction, the sensitivity of the thallium scintigram in patients with 2-vessel disease was found to be less than that of those with 1-vessel disease and 3-vessel disease. As compared with the exercise ECG, the scintigram was more sensitive only in patients with 1-vessel but less sensitive in those patients with 2-vessel and 3-vessel disease. The thallium scintigram is indicated for patients with atypical chest pain, when angina pectoris cannot be ruled out and when the exercise ECG is borderline or non-interpretable. The thallium scintigram is also indicated for asymptomatic patients with a markedly positive exercise ECG. The thallium scintigram yields no additional information relative to the question of presence or absence of myocardial hypoperfusion in patients with typical angina pectoris. In patients with a history of, but with no electrocardiographic criteria for myocardial infarction, the scintigram seems to be of only limited valued. The thallium scintigram is a valuable adjunct in the assessment of the results of coronary artery bypass surgery provided that a pre-operative study is available for comparison. (orig./MG) [de

  4. [Impact of antidiabetic therapy on the risk of cardiovascular diseases and their complications in patients with type 2 diabetes mellitus].

    Science.gov (United States)

    Ametov, A S; P'ianykh, O P; Chernikova, N A

    2010-01-01

    In Russia, diabetes mellitus afflicts 8 million people, 90% of them had type 2 diabetes mellitus (T2DM) and this figure is growing steadily. At the same time there is a rise in the incidence of macrovascular events (unstable angina pectoris, myocardial infarction). Coronary heart disease and its attack are a major cause of death in the developed countries, including Russia. To prevent chronic complications of DM is likely to be the most urgent task of not only modern diabetology, but also medical science as a whole. In this connection, of great value are the results of a few large international randomized controlled studies, the main objective of which was to evaluate the impact of the rate of blood glucose control on the incidence and outcomes of cardiovascular diseases in patients with T2DM

  5. 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

  6. Detection of coronary artery disease by exercise radionuclide ventriculography, (1)

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko; Saito, Muneyasu; Uehara, Toshiisa; Kozuka, Takahiro

    1982-01-01

    In order to assess the detection of coronary artery disease (CAD) and LV functional reserve, exercise radionuclide ventriculography (ERV) were performed in 80 patients who underwent selective cardiac catneterization for evaluation of chest pain syndrome. 70 patients had CAD (30 patients with angina pectoris and 40 patients with myocardial infarction) and 10 did not. In this study, to obtain accurate data by ERV, its practical consideration were metioned. Radionuclide cardioangiography with sup(99m)Tc-invivo RBC labelling were performed using an Anger camera attached with high-sense collimator and on-line minicomputer system. For data aquisition, multi-gated method were used, especially during exercise, list mode collection was suitable for ERV because of variable R-R intervals. Patient stability was performed with an adjustable shoulder support and hand grip, ECG monitoring system by carbon electrolode was used to obtain during exercise. Exercise protocal was graded bicycle ergometer in supine position. As the results, in the patients of CAD, changes of LVEF from rest to exercise were under 5%, while in normal patients, LVEF increased over 5% in all patients. In 30 patients with angina pectoris, the ERV was abnormal in 25 for a sensitivity of 83.3% and specificity of 100%. The ERV were thought to be superior than stress ECG for the detection of CAD. In conclusion, with increasing clinical application, the use of ERV is rapidly becoming wider-spread but the excellent results were thought to depend upon the careful attention to equipment and exercise procedure. (author)

  7. Gender difference in albuminuria and ischemic heart disease in type 2 diabetes.

    Science.gov (United States)

    Nakhjavani, Manouchehr; Morteza, Afsaneh; Jenab, Yaser; Ghaneei, Azam; Esteghamati, Alireza; Karimi, Maryam; Farokhian, Alireza

    2012-05-01

    The value of urinary albumin excretion in the prediction of myocardial ischemia in men and women with type 2 diabetes is not well understood. We questioned whether gender influences the albuminuria-ischemic heart disease relationship in patients with type 2 diabetes. We designed a matched case-control study of 926 patients with albuminuria (cases) and 926 age and body mass index matched patients without albuminuria (controls). Ischemic heart disease was defined as the presence of (1) history of angina pectoris or angina equivalent symptoms and critical care unit admission, (2) myocardial infarction and/or electrocardiographic evidence of Q-wave myocardial infarction, (3) coronary revascularization and/or stenting, (4) positive myocardial single-photon emission computed tomography scan, (5) ischemic ST-segment or T-wave changes, and (6) positive stress testing. Patients with albuminuria had a lower glomerular filtration rate and a longer diabetes duration than patients without albuminuria. In the group of cases, there were a greater number of men with ischemic heart disease (120 of 370; 32.4%) compared to women (97 of 559; 17.4%) (Pischemic heart disease according to the presence or absence of albuminuria was 1.25 [95% CI: 1.01-1.56] (Pischemic heart disease compared to women. This may be related to the role of high-density lipoprotein on the albuminuria-gender relationship.

  8. Stress scintigraphy using single-photon emission computed tomography in the evaluation of coronary artery disease

    International Nuclear Information System (INIS)

    Nohara, R.; Kambara, H.; Suzuki, Y.; Tamaki, S.; Kadota, K.; Kawai, C.; Tamaki, N.; Torizuka, K.

    1984-01-01

    Twenty-seven patients with angina pectoris, 24 with postmyocardial infarction angina and 7 with normal coronary arteries were examined by exercise thallium-201 emission computed tomography (SPECT) and planar scintigraphy. Exercise SPECT was compared with the reperfusion imaging obtained approximately 2 to 3 hours after exercise. The sensitivity and specificity of demonstrating involved coronary arteries by identifying the locations of myocardial perfusion defects were 96 and 87% for right coronary artery, 88 and 89% for left anterior descending artery (LAD) and 78 and 100% for left circumflex artery (LC). These figures are higher than those for planar scintigraphy (85 and 87% for right coronary artery, 73 and 89% for LAD and 39 and 100% for LC arteries). In patients with 3-vessel disease, sensitivity of SPECT (100, 88 and 75% for right coronary artery, LAD and LC, respectively) was higher than planar imaging (88, 63 and 31%, respectively), with a significant difference for LC (p less than 0.05). In 1, 2 and 0-vessel disease the sensitivity and specificity of the 2 techniques were comparable. Multivessel disease was more easily identified as multiple coronary involvement than planar imaging with a significant difference in 3-vessel disease (p less than 0.05). In conclusion, stress SPECT provides useful information for the identification of LC lesions in coronary heart disease, including 3-vessel involvement

  9. [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.

  10. The Intelligent System of Cardiovascular Disease Diagnosis Based on Extension Data Mining

    Science.gov (United States)

    Sun, Baiqing; Li, Yange; Zhang, Lin

    This thesis gives the general definition of the concepts of extension knowledge, extension data mining and extension data mining theorem in high dimension space, and also builds the IDSS integrated system by the rough set, expert system and neural network, develops the relevant computer software. From the diagnosis tests, according to the common diseases of myocardial infarctions, angina pectoris and hypertension, and made the test result with physicians, the results shows that the sensitivity, specific and accuracy diagnosis by the IDSS are all higher than the physicians. It can improve the rate of the accuracy diagnosis of physician with the auxiliary help of this system, which have the obvious meaning in low the mortality, disability rate and high the survival rate, and has strong practical values and further social benefits.

  11. Job strain and ischemic heart disease: a prospective study using a new approach for exposure assessment

    DEFF Research Database (Denmark)

    Bonde, Jens Peter; Munch-Hansen, Torsten; Agerbo, Esben

    2009-01-01

    based on the average exposure level in minor work units. METHODS: Cohort study of 18,258 Danish public service workers in 1106 work units; 79% were women; 108 subjects with history of cardiovascular disease were excluded from the follow-up. The outcome was hospitalization due to IHD (angina pectoris...... or myocardial infarction) during the period 2002 to end of 2007. RESULTS: During 87,428 person-years at risk (mean follow-up = 4.82 years), 101 subjects were admitted to a hospital due to IHD. Neither job strain (synergy of job demands and job control) nor general job dissatisfaction were related to IHD risk....... However, compared with others, subjects who were allocated to the low job control category, had an increased risk of IHD, Hazard Ratio (95% CI) = 2.0 (1.1 to 3.6). CONCLUSIONS: The findings presented do not lend support to the hypothesis that high job strain and job dissatisfaction are important...

  12. Association between periodontal disease and non-communicable diseases: A 12-year longitudinal health-examinee cohort study in South Korea.

    Science.gov (United States)

    Lee, Jae-Hong; Oh, Jin-Young; Youk, Tae-Mi; Jeong, Seong-Nyum; Kim, Young-Taek; Choi, Seong-Ho

    2017-06-01

    The National Health Insurance Service-Health Examinee Cohort during 2002 to 2013 was used to investigate the associations between periodontal disease (PD) and the following non-communicable diseases (NCDs): hypertension, diabetes mellitus, osteoporosis, cerebral infarction, angina pectoris, myocardial infarction, and obesity.Univariate and multivariate logistic regression analyses adjusting for potential confounders during the follow-up period-including age, sex, household income, insurance status, residence area, health status, and comorbidities-were used to estimated odds ratios (ORs) with 95% confidence intervals (CIs) in order to assess the associations between PD and NCDs.We enrolled 200,026 patients with PD and 154,824 subjects with a healthy oral status. Statistically, significant associations were found between PD and the investigated NCDs except for cerebral and myocardial infarction after adjusting for sociodemographic and comorbidity factors (P < .05). In particular, obesity (OR = 1.30, 95% CI = 1.04-1.63, P = .022), osteoporosis (OR = 1.22, 95% CI = 1.18-1.27, P < .001), and angina pectoris (OR = 1.22, 95% CI = 1.17-1.27, P < .001) were significantly and positively associated with PD.This longitudinal cohort study has provided evidence that patients with PD are at increased risk of NCDs. Further studies are required to confirm the reliability of this association and elucidate the role of the inflammatory pathway in periodontitis pathogenesis as a triggering and mediating mechanism.

  13. 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.

  14. 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

  15. 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...

  16. 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

  17. [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.

  18. Expression of platelet-bound stromal cell-derived factor-1 in patients with non-valvular atrial fibrillation and ischemic heart disease.

    Science.gov (United States)

    Stellos, Konstantinos; Rahmann, A; Kilias, A; Ruf, M; Sopova, K; Stamatelopoulos, K; Jorbenadze, R; Weretka, S; Geisler, T; Gawaz, M; Weig, H-J; Bigalke, B

    2012-01-01

    Blood cell infiltration and inflammation are involved in atrial remodelling during atrial fibrillation (AF) although the exact mechanisms of inflammatory cell recruitment remain poorly understood. Platelet-bound stromal cell-derived factor-1 (SDF-1) is increased in cases of ischemic myocardium and regulates recruitment of CXCR4(+) cells on the vascular wall. Whether platelet-bound SDF-1 expression is differentially influenced by non-valvular paroxysmal or permanent atrial fibrillation (AF) in patients with stable angina pectoris (SAP) or acute coronary syndrome (ACS) has not been reported so far. A total of 1291 consecutive patients with coronary artery disease (CAD) undergoing coronary angiography were recruited. Among the patients with SAP, platelet-bound-SDF-1 is increased in patients with paroxysmal AF compared with SR or to persistent/permanent AF (P disease. Further in vivo studies are required to elucidate the role of SDF-1 in atrial remodeling and the atrial fibrillation course.

  19. Increased vital exhaustion among type-D patients with ischemic heart disease

    NARCIS (Netherlands)

    Pedersen, SS; Middel, B

    Objective: To investigate the prevalence of the "distressed personality" (type-D) in cardiac patients and to explore the relationships between type-D, gender, vital exhaustion and angina pectoris. Methods: A questionnaire was completed by 171 patients scheduled for coronary angiography (CAG) at

  20. Vascular effects of calcium antagonists: implications for hypertension and other risk factors for coronary heart disease

    NARCIS (Netherlands)

    van Zwieten, P. A.

    1989-01-01

    All calcium antagonists (CAs) so far developed are vasodilators, and this property is a most important component of their therapeutic potency in hypertension and angina pectoris. At a cellular level, the specific interaction of CAs with transmembranous calcium fluxes involves both potential and

  1. The prevalence and risk factor control associated with noncommunicable diseases in China, Japan, and Korea.

    Science.gov (United States)

    Ma, Defu; Sakai, Hiromichi; Wakabayashi, Chihiro; Kwon, Jong-Sook; Lee, Yoonna; Liu, Shuo; Wan, Qiaoqin; Sasao, Kumiko; Ito, Kanade; Nishihara, Ken; Wang, Peiyu

    2017-12-01

    Noncommunicable disease (NCD) has become the leading cause of mortality and disease burden worldwide. A cross-sectional survey was carried out to investigate the prevalence of NCDs and risk factor control on dietary behaviors and dietary intake in China, Japan, and Korea. There were significant differences among the three countries on the prevalence of hypertension (24.5% in China, 17.6% in Korea, and 15.2% in Japan), diabetes (8.9% in China, 5.7% in Korea, and 4.8% in Japan), hyperlipidemia (13.1% in China, 9.2% in Korea, and 6.9% in Japan), and angina pectoris (3.6% in China, 1.7% in Korea, and 1.5% in Japan). The prevalence rate of hypertension, diabetes, hyperlipidemia, and angina pectoris was highest in China and lowest in Japan. However, 82.2%, 48.4%, and 64.4% of Chinese, Koreans, and Japanese presented good dietary behavior, respectively. Multivariable logistic regression analysis found that sex, age, and marital status were predictors of good dietary behavior. In addition, in comparison with subjects without hypertension, diabetes, or hyperlipidemia, subjects with hypertension, diabetes, or hyperlipidemia significantly improved their dietary behaviors and controlled their intake of salt, sugar, and oil. The prevalence of NCDs and trends in major modifiable risk factor control in China, Korea, and Japan remain troubling. Public efforts to introduce healthy lifestyle changes and systematic NCDs prevention programs are necessary to reduce the epidemic of NCDs in these three Asian countries. Copyright © 2017 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

  2. Plasma proteome changes in cardiovascular disease patients: novel isoforms of apolipoprotein A1

    Directory of Open Access Journals (Sweden)

    Oravec Milan

    2011-06-01

    Full Text Available Abstract Background The aim of this proteomic study was to look for changes taking place in plasma proteomes of patients with acute myocardial infarction (AMI, unstable angina pectoris (UAP, and stable angina pectoris (SAP. Methods Depleted plasma proteins were separated by 2D SDS-PAGE (pI 4-7, and proteomes were compared using Progenesis SameSpots statistical software. Proteins were identified by nanoLC-MS/MS. Proteins were quantified using commercial kits. Apolipoprotein A1 was studied using 1D and 2D SDS-PAGE, together with western blotting. Results Reciprocal comparison revealed 46 unique, significantly different spots; proteins in 34 spots were successfully identified and corresponded to 38 different proteins. Discrete comparisons of patient groups showed 45, 41, and 8 significantly different spots when AMI, UAP, and SAP were compared with the control group. On the basis of our proteomic data, plasma levels of two of them, alpha-1 microglobulin and vitamin D-binding protein, were determined. The data, however, failed to prove the proteins to be suitable markers or risk factors in the studied groups. The plasma level and isoform representation of apolipoprotein A1 were also estimated. Using 1D and 2D SDS-PAGE, together with western blotting, we observed extra high-molecular weight apolipoprotein A1 fractions presented only in the patient groups, indicating that the novel high-molecular weight isoforms of apolipoprotein A1 may be potential new markers or possible risk factors of cardiovascular disease. Conclusion The reported data show plasma proteome changes in patients with AMI, UAP, and SAP. We propose some apolipoprotein A1 fractions as a possible new disease-associated marker of cardiovascular disorders.

  3. The prevalence and risk factor control associated with noncommunicable diseases in China, Japan, and Korea

    Directory of Open Access Journals (Sweden)

    Defu Ma

    2017-12-01

    Full Text Available Background: Noncommunicable disease (NCD has become the leading cause of mortality and disease burden worldwide. Methods: A cross-sectional survey was carried out to investigate the prevalence of NCDs and risk factor control on dietary behaviors and dietary intake in China, Japan, and Korea. Results: There were significant differences among the three countries on the prevalence of hypertension (24.5% in China, 17.6% in Korea, and 15.2% in Japan, diabetes (8.9% in China, 5.7% in Korea, and 4.8% in Japan, hyperlipidemia (13.1% in China, 9.2% in Korea, and 6.9% in Japan, and angina pectoris (3.6% in China, 1.7% in Korea, and 1.5% in Japan. The prevalence rate of hypertension, diabetes, hyperlipidemia, and angina pectoris was highest in China and lowest in Japan. However, 82.2%, 48.4%, and 64.4% of Chinese, Koreans, and Japanese presented good dietary behavior, respectively. Multivariable logistic regression analysis found that sex, age, and marital status were predictors of good dietary behavior. In addition, in comparison with subjects without hypertension, diabetes, or hyperlipidemia, subjects with hypertension, diabetes, or hyperlipidemia significantly improved their dietary behaviors and controlled their intake of salt, sugar, and oil. Conclusions: The prevalence of NCDs and trends in major modifiable risk factor control in China, Korea, and Japan remain troubling. Public efforts to introduce healthy lifestyle changes and systematic NCDs prevention programs are necessary to reduce the epidemic of NCDs in these three Asian countries.

  4. 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.

  5. 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.

  6. Associations of common chronic non-communicable diseases and medical conditions with sleep-related problems in a population-based health examination study

    Directory of Open Access Journals (Sweden)

    Syaron Basnet

    2016-07-01

    Full Text Available A cross-sectional population-based survey, the National FINRISK 2012 Study, designed to monitor chronic diseases and their risk factors in Finland. A random sample of 10,000 adults aged 25–74 years, and of them, 64% (n=6424 participated the study. Participants subjectively reported the total durations for sleep and naps (n=6238, sleep quality (n=5878, bedtimes and wake-up times separately for working days and weekends yielding the amount of sleep debt (n=5878, and the seasonal variation in sleep duration (n=4852. The participants were asked whether they were diagnosed or treated for common chronic diseases in the past 12 months. Logistic regression models were adopted to analysis and adjusted for a range of covariates as potential confounding factors. Total sleep duration and nap duration prolonged in depression and other mental disorder (p<.001 for all. Seasonal variation in sleep duration was associated with depression (p=.014, hypertension (p=.018 and angina pectoris (p=.024. Participants with gallstones, cardiac insufficiency, depression, or degenerative arthritis had poor sleep quality (odds ratios of 1.6–6.3, p=.001 or less for each. Those with degenerative arthritis had sleep debt less (p<.05 and those with angina pectoris more (p<.05 than individuals without these medical conditions. Depression is significantly associated with sleep problems, albeit no sleep debt. Cardiovascular diseases, degenerative arthritis, and gallstones had significant associations with one or more sleep problems. There is therefore a need for more successful management of sleep problems in chronic diseases to improve the quality of life, to reduce treatment relapses, and to increase health and longevity in a population.

  7. Relative clinical and economic impact of exercise echocardiography vs. exercise electrocardiography, as first line investigation in patients without known coronary artery disease and new stable angina: a randomized prospective study.

    Science.gov (United States)

    Zacharias, Konstantinos; Ahmed, Asrar; Shah, Benoy N; Gurunathan, Sothinathan; Young, Grace; Acosta, Dionisio; Senior, Roxy

    2017-02-01

    Exercise electrocardiography (ExECG) is widely used in suspected stable angina (SA) as the initial test for the evaluation of coronary artery disease (CAD). We hypothesized that exercise stress echo (ESE) would be efficacious with cost advantage over ExECG when utilized as the initial test. Consecutive patients with suspected SA, without known CAD were randomized into ExECG or ESE. Patients with positive tests were offered coronary angiography (CA) and with inconclusive tests were referred for further investigations. All patients were followed-up for cardiac events (death, myocardial infarction, and unplanned revascularization). Cost to diagnosis of CAD was calculated by adding the cost of all investigations, up to and including CA. In the 194 and 191 patients in the ExECG vs. ESE groups, respectively, pre-test probability of CAD was similar (34 ± 23 vs. 35 ± 25%, P = 0.6). Results of ExECG were: 108 (55.7%) negative, 14 (7.2%) positive, 72 (37.1%) inconclusive and of ESE were 181 (94.8%) negative, 9 (4.7%) positive, 1 (0.5%) inconclusive, respectively. Patients with obstructive CAD following positive ESE vs. Ex ECG were 9/9 vs. 9/14, respectively (P = 0.04). Cost to diagnosis of CAD was £266 for ESE vs. £327 for ExECG (P = 0.005). Over a mean follow-up period of 21 ± 5 months, event rates were similar between the two groups. In this first randomized study, ESE was more efficacious and demonstrated superior cost-saving, compared with ExECG when used as the initial investigation for the evaluation of CAD in patients with new-onset suspected SA without known CAD. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  8. 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

  9. 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."

  10. 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.

  11. Cost-effectiveness of functional cardiac imaging in the diagnostic work-up of coronary heart disease.

    Science.gov (United States)

    Pletscher, Mark; Walker, Simon; Moschetti, Karine; Pinget, Christophe; Wasserfallen, Jean-Blaise; Greenwood, John P; Schwitter, Juerg; Girardin, François R

    2016-07-01

    The aim of this study was to assess the cost-effectiveness of eight common diagnostic work-up strategies for coronary heart disease (CHD) in patients with stable angina symptoms in Switzerland. A decision analytical model was used to perform a cost-effectiveness comparison of eight common multitest strategies to diagnose CHD using combinations of four diagnostic techniques: exercise treadmill test (ETT), single-photon emission computed tomography (SPECT), cardiac magnetic resonance imaging (CMR), and coronary angiography (CA). We used a Markov state transition model to extrapolate the results over a life-time horizon, from a third-party payer perspective. We used a CHD prevalence rate of 39% in patients and a base-case scenario with 60-year-old male patients with intermediate symptom severity Canadian Cardiovascular Society grading of angina pectoris 2 and at least one cardiovascular (CV) risk factor but without a history of myocardial infarction and without need for revascularization. Among the eight work-up strategies, one strategy was dominant, i.e. least costly and most effective: ETT followed by CMR if the ETT result was inconclusive and then CA if the CMR result was positive or inconclusive. The CMR features a favourable balance between false-negative diagnoses, associated with an elevated risk of CV events, and false-positive diagnoses, leading to unnecessary CA and related mortality. Key parameters guiding the diagnostic strategy are the prevalence of CHD in patients with angina symptoms and the diagnostic costs of CA and CMR. Cardiac magnetic resonance imaging appears to be a cost-effective work-up strategy compared with other regimens using SPECT or direct CA. Cardiac magnetic resonance imaging should be more widely recommended as a diagnostic procedure for patients with suspected angina symptoms.

  12. 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.

  13. 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...

  14. 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.

  15. 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...

  16. Transient myocardial ischemia during daily life in rest and exertional angina pectoris and comparison of effectiveness of metoprolol versus nifedipine

    DEFF Research Database (Denmark)

    Ardissino, D; Savonitto, S; Egstrup, K

    1991-01-01

    treatment with a beta blocker (metoprolol CR, 200 mg once daily) or a dihydropyridine calcium antagonist (nifedipine retard 20 mg twice daily) were then compared according to a double-blind, parallel group design. Metoprolol significantly reduced the number and duration of the ischemic episodes during daily...

  17. Urokinase-type plasminogen activator (u-PA) and the risk of coronary events in patients with angina pectoris (AP)

    NARCIS (Netherlands)

    Dooijewaard, G.D.; Maat Mpm, E.; Meijer, P.; Kluft, C.; Binder, B.R.; Jespersen, J.; Keber, D.; Risberg, B.

    1998-01-01

    Introduction. This study addresses the rote of circulatory u-PA in the prevention and precipitation of arterial thrombosis. u-PA occurs in three forms: the inactive zymogen scu-PA, the active enzyme tcu-PA and u-PA#, the inactive complex of tcu-PA with inhibitors. In apparently healthy individuals

  18. Relative changes in regional cerebral blood flow during spinal cord stimulation in patients with refractory angina pectoris

    NARCIS (Netherlands)

    Hautvast, RWM; TerHorst, GJ; DeJong, BM; DeJongste, MJL; Blanksma, PK; Paans, AMJ; Korf, J

    Spinal cord stimulation applied at thoracic level 1 (T1) has a neurally mediated anti-anginal effect based on antiischaemic action in the myocardium. Positron emission tomography was used to study which higher brain centres are influenced by spinal cord stimulation. Nine patients with a spinal cord

  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

    -T, CK-MB mass, total CK activity, CK-MB activity, and lactate dehydrogenase isoenzyme (LD-1). ST segment monitoring was carried out during PTCA and for the following 24 hours. None of the patients showed electrocardiographic (ECG) evidence of myocardial infarction. However, Tn-T was elevated in three...... patients (0.23 to 1.32 micrograms/L), and in these three and an additional three patients CK-MB mass was also elevated (7.0 to 27.5 micrograms/L). Total CK activity and LD-1 were only elevated in one of these six patients. None had elevated CK-MB activity. ST segment depression on ECG recording...

  20. Dose-effect relationship of adenosine provoked angina pectoris-like pain--a study of the psychophysical power function.

    Science.gov (United States)

    Sylvén, C; Borg, G; Brandt, R; Beermann, B; Jonzon, B

    1988-01-01

    In an analysis of the psychophysical power function of chest pain induced by adenosine, this agent was repeatedly given in increasing doses into a peripheral vein to six healthy volunteers (five men) aged 23-44 years. On the first day the maximum tolerable dose was determined. On the second day seven doses of adenosine (20, 30, 40, 50, 60, 80 and 100% of the maximum dose) were given single blind in randomized order followed by another seven doses in reversed order. The heart rate was calculated from electrocardiographic recordings. Chest pain was continuously rated according to the CR-10 scale. Before the adenosine test, the perception of sourness was tested similarly with six concentrations of citric acid (1-100 mM). The psychophysical power functions were similar for the perception of sourness provoked by citric acid and chest pain provoked by adenosine, with exponents of 0.69 +/- 0.21 and 0.60 +/- 0.32, respectively. The two modalities showed the same high goodness of fit to the power function (rxy being 0.965 +/- 0.030 and 0.967 +/- 0.033, respectively). For adenosine the group mean relation was R = 1.66(S-2.36)0.6, rxy = 0.999. No signs of tolerance were observed for the chest pain provoked by adenosine. In conclusion, chest pain provoked by adenosine follows a psychophysical power function as with other sensory modalities.

  1. 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...

  2. Bezold-Jarisch reflex in a patient undergoing endoscopic sympathectomy for management of refractory angina pectoris: a case report

    OpenAIRE

    Caldas, Wendell Jackson de Macêdo; Barbosa, Maíra Ferreira; Dias, Cremilda Pinheiro

    2018-01-01

    Abstract Background and objectives Ischemic cardiomyopathy is characterized by imbalance between supply and demand of myocardial oxygen. Endoscopic transthoracic sympathectomy is a therapeutic option indicated in refractory cases. However, the patient's position on the operating table may favor ischemic coronary events triggering the Bezold-Jarisch reflex. Case report A female patient, 47 years old, with refractory ischemic cardiomyopathy, admitted to the operating room for endoscopic trans...

  3. Outcomes after revascularisation with everolimus- and sirolimus-eluting stents in patients with acute coronary syndromes and stable angina pectoris

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Hansen, Henrik S

    2014-01-01

    ): cardiac death, myocardial infarction (MI), stent thrombosis, or target vessel revascularisation within 18 months. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated for the endpoints. At 18-month follow-up, patients with ACS had higher rates of MACE compared to patients with SAP (8...

  4. Relationship of health-related quality of life with fatigue and exercise capacity in patients with coronary artery disease.

    Science.gov (United States)

    Staniute, Margarita; Bunevicius, Adomas; Brozaitiene, Julija; Bunevicius, Robertas

    2014-08-01

    The study objective was to evaluate the relationship of health-related quality of life (HRQoL) with fatigue and exercise capacity in coronary artery disease (CAD) patients. A total of 1072 consecutive CAD patients on admission to a cardiac rehabilitation program were evaluated for HRQoL (36-item Short Form Medical Outcome Questionnaire; SF-36), body mass index, clinical characteristics (New York Heart Association (NYHA) class, angina pectoris class, coronary interventions, treatment with beta blockers, hypertension and diabetes), symptoms of depression and anxiety (Hospital Anxiety and Depression Scale), fatigue (Multidimensional Fatigue Inventory-20; MFI-20), and exercise capacity (bicycle ergometer test). In univariate regression analyses lower scores on all SF-36 domains were associated with greater scores on all MFI-20 subscales. Exercise capacity was associated with all SF-36 domains, except for social functioning and mental health domains. In multivariate regression analyses, after adjusting for age, gender, body mass index, NYHA class, angina pectoris class, hypertension, diabetes, coronary interventions, treatment with betablockers, and symptoms of depression and anxiety, greater limitation due to physical and due to emotional problems, poor social functioning, decreased energy/vitality, worse general health perception, reduced mental component summary and lower global SF-36 score were independently associated with higher MFI-20 general fatigue score. Reduced physical functioning, greater pain, and reduced physical component summary SF-36 scores were associated with greater MFI-20 physical fatigue score. Lower SF-36 mental health score was associated, with greater MFI-20 mental fatigue score. In CAD patients undergoing rehabilitation, poor HRQoL is associated with greater fatigue and decreased exercise capacity independently from mental distress and CAD severity score. © The European Society of Cardiology 2013.

  5. 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)

  6. 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

  7. 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 ...

  8. 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...

  9. Combined analysis of six lipoprotein lipase genetic variants on triglycerides, high-density lipoprotein, and ischemic heart disease: cross-sectional, prospective, and case-control studies from the Copenhagen City Heart Study

    DEFF Research Database (Denmark)

    Wittrup, HH; Andersen, RV; Tybjærg-Hansen, A

    2006-01-01

    CONTEXT: Genetic variants in lipoprotein lipase may affect triglycerides, high-density lipoprotein (HDL), and risk of ischemic heart disease (IHD). OBJECTIVE: The objective of this study was to investigate the influence of T(-93)G, G(-53)C, Asp9Asn, Gly188Glu, Asn291Ser, and Ser447Ter lipoprotein...... lipase genotypes on triglycerides, HDL, and IHD. DESIGN: The cross-sectional study involved 9004 adults. The prospective study consisted of 8817 adults developing 1001 IHD events over 23 yr. The case-control study involved 7818 non-IHD individuals vs. cohorts of 915 and 1062 IHD patients, respectively....... SETTING: The study was performed in the Danish general population (the Copenhagen City Heart Study). PARTICIPANTS: IHD was angina pectoris or myocardial infarction. MAIN OUTCOME MEASURES: Triglycerides, HDL, and IHD were the main outcome measures. RESULTS: Cross-sectionally, triglycerides varied...

  10. 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...

  11. 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....

  12. 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

  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. Association between periodontal disease and non-communicable diseases

    Science.gov (United States)

    Lee, Jae-Hong; Oh, Jin-Young; Youk, Tae-Mi; Jeong, Seong-Nyum; Kim, Young-Taek; Choi, Seong-Ho

    2017-01-01

    Abstract The National Health Insurance Service–Health Examinee Cohort during 2002 to 2013 was used to investigate the associations between periodontal disease (PD) and the following non-communicable diseases (NCDs): hypertension, diabetes mellitus, osteoporosis, cerebral infarction, angina pectoris, myocardial infarction, and obesity. Univariate and multivariate logistic regression analyses adjusting for potential confounders during the follow-up period—including age, sex, household income, insurance status, residence area, health status, and comorbidities—were used to estimated odds ratios (ORs) with 95% confidence intervals (CIs) in order to assess the associations between PD and NCDs. We enrolled 200,026 patients with PD and 154,824 subjects with a healthy oral status. Statistically, significant associations were found between PD and the investigated NCDs except for cerebral and myocardial infarction after adjusting for sociodemographic and comorbidity factors (P osteoporosis (OR = 1.22, 95% CI = 1.18–1.27, P periodontitis pathogenesis as a triggering and mediating mechanism. PMID:28658175

  15. 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

  16. 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...

  17. 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...

  18. Usefulness of cardiorespiratory fitness to predict coronary heart disease risk independent of physical activity.

    Science.gov (United States)

    Williams, Paul T

    2010-07-15

    Cardiorespiratory fitness has often been interpreted as a surrogate measurement of physical activity rather than an independent coronary heart disease (CHD) risk factor per se. Fitness is also known to be highly heritable, however, and rats bred selectively for treadmill endurance have low CHD risk phenotypes even in the absence of physical activity. Therefore, I assessed whether cardiorespiratory fitness predicted CHD independent of physical activity in 29,721 men followed prospectively for 7.7 years as part of the National Runners' Health Study. Specifically, CHD deaths and incident participant-reported physician-diagnosed myocardial infarction, revascularization procedures (coronary artery bypass grafting and percutaneous coronary intervention), and angina pectoris during follow-up were compared to baseline cardiorespiratory fitness (10-km footrace performance, meters/second). Nonfatal end points for the 80% of these men who provided follow-up questionnaires included 121 nonfatal myocardial infarctions, 317 revascularization procedures, and 81 angina pectora. The National Death Index identified 44 CHD deaths. Per meter/second increment in baseline fitness, men's risks decreased 54% for nonfatal myocardial infarction (p fitness is a CHD risk factor, largely independent of physical activity, which warrants clinical screening. Copyright (c) 2010. Published by Elsevier Inc.

  19. 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.

  20. 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

  1. Risk Factors in the Initial Presentation of Specific Cardiovascular Disease Syndromes

    Science.gov (United States)

    2013-03-03

    Heart Diseases; Cardiovascular Diseases; Acute Myocardial Infarction; Unstable Angina; Chronic Stable Angina; Ischemic Stroke; Cerebrovascular Accident; Subarachnoid Hemorrhage; Transient Ischemic Attack; Abdominal Aortic Aneurysm; Peripheral Arterial Disease; Sudden Coronary Death; Ventricular Arrhythmia; Sudden Death; Cardiac Arrest; Heart Failure

  2. 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.

  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. 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.

  5. 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

  6. The Association between Antidepressant Medications and Coronary Heart Disease in Brazil: A Cross-sectional Analysis on the Brazilian Longitudinal Study of Adult Health (ELSA-Brazil

    Directory of Open Access Journals (Sweden)

    Andrew eKemp

    2015-01-01

    Full Text Available Background: Recent studies have highlighted associations between use of antidepressant medications and coronary heart disease (CHD. Tricyclic antidepressants are not recommended in patients with CHD as they may increase morbidity and mortality. However, this class of antidepressants are freely prescribed in public health pharmacies, while access to other classes of antidepressants is restricted in Brazil. Here we examine the associations between antidepressant use and prevalent CHD in a large cohort from Brazil. Methods: Participants included 14,994 civil servants aged 35 to 74 from the baseline assessment of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil. CHD (n=710 included stable angina, myocardial infarction and coronary revascularization. Univariate (unadjusted and multivariate (adjusted logistic regression analyses were conducted to estimate odds ratios and confidence intervals. Results: After full adjustment for covariates, tricyclic antidepressants (TCA use (n=156 was associated with a 2-fold increase in prevalent CHD, relative to non-use (n=14,076. Additional sensitivity analysis revealed a three-fold association for myocardial infarction (OR: 2.962, 95% CI: 1.413-6.210 and coronary revascularization (OR: 2.915, 95% CI: 1.275-6.662. There were no significant associations between antidepressant use and stable angina pectoris. Conclusions: Findings highlight a strong association between TCA use and prevalent CHD. While the cross-sectional design is an important limitation of the present study, findings have important implications for the treatment of cardiac patients in Brazil.

  7. Serum Uric Acid Levels and Onset of Cardiovascular Diseases: a CALIBER Study

    Science.gov (United States)

    2018-02-06

    Stable Angina; Unstable Angina; Myocardial Infarction; Unheralded Coronary Heart Disease Death; Heart Failure; Cardiac Arrest; Transient Ischaemic Attack; Ischemic Stroke; Subarachnoid Hemorrhage; Intracerebral Hemorrhage; Peripheral Arterial Disease; Abdominal Aortic Aneurysm; Atrial Fibrillation

  8. 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.

  9. 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.

  10. Cardiovascular Disease Outcomes Among the NASA Astronaut Corps

    Science.gov (United States)

    Charvat, Jacqueline M.; Lee, Stuart M. C.; Wear, Mary L.; Stenger, Michael B.; Van Baalen, Mary

    2018-01-01

    BACKGROUND: Acute effects of spaceflight on the cardiovascular system have been studied extensively, but the combined chronic effects of spaceflight and aging are not well understood. Preparation for and participation in spaceflight activities are associated with changes in the cardiovascular system such as decreased carotid artery distensibility and decreased ventricular mass which may lead to an increased risk of cardiovascular disease. Additionally, astronauts who travel into space multiple times or for longer durations may be at an increased risk across their lifespan. To that end, the purpose of this study was to determine the incidence of common cardiovascular disease (CVD) outcomes among the NASA astronaut corps during their active career and through retirement. METHODS: Cardiovascular disease outcomes were defined as reports of any of the following: myocardial infarction (MI), revascularization procedures (coronary artery bypass graft surgery [CABG] or percutaneous coronary intervention [PCI]), hypertension, stroke or transient ischemic attack [TIA], heart failure, or total CVD (as defined by the AHA - combined outcome of MI, Angina Pectoris, heart failure, stroke, and hypertension). Each outcome was identified individually from review of NASA's Electronic Medical Record (EMR), EKG reports, and death certificates using ICD-9 codes as well as string searches of physician notes of astronaut exams that occurred between 1959 and 2016. RESULTS: Of 338 NASA astronauts selected as of 2016, 9 reported an MI, 12 reported a revascularization procedure, (7 PCI and 5 CABG), 4 reported Angina (without MI), 5 reported heart failure, 9 reported stroke/TIA, and 96 reported hypertension. Total CVD was reported in 105 astronauts. No astronaut who had an MI or revascularization procedure flew a spaceflight mission following the event. All MI, revascularization, and stroke events occurred in male astronauts. When reviewing astronaut ECG reports, abnormal ECG reports were found

  11. 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

  12. 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.

  13. 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 ...

  14. Radiation risk of individual multifactorial diseases in offspring of the atomic-bomb survivors: a clinical health study.

    Science.gov (United States)

    Tatsukawa, Yoshimi; Cologne, John B; Hsu, Wan-Ling; Yamada, Michiko; Ohishi, Waka; Hida, Ayumi; Furukawa, Kyoji; Takahashi, Norio; Nakamura, Nori; Suyama, Akihiko; Ozasa, Kotaro; Akahoshi, Masazumi; Fujiwara, Saeko; Shore, Roy

    2013-06-01

    There is no convincing evidence regarding radiation-induced heritable risks of adult-onset multifactorial diseases in humans, although it is important from the standpoint of protection and management of populations exposed to radiation. The objective of the present study was to examine whether parental exposure to atomic-bomb (A-bomb) radiation led to an increased risk of common polygenic, multifactorial diseases-hypertension, hypercholesterolaemia, diabetes mellitus, angina pectoris, myocardial infarction or stroke-in the first-generation (F1) offspring of A-bomb survivors. A total of 11,951 F1 offspring of survivors in Hiroshima or Nagasaki, conceived after the bombing, underwent health examinations to assess disease prevalence. We found no evidence that paternal or maternal A-bomb radiation dose, or the sum of their doses, was associated with an increased risk of any multifactorial diseases in either male or female offspring. None of the 18 radiation dose-response slopes, adjusted for other risk factors for the diseases, was statistically significantly elevated. However, the study population is still in mid-life (mean age 48.6 years), and will express much of its multifactorial disease incidence in the future, so ongoing longitudinal follow-up will provide increasingly informative risk estimates regarding hereditary genetic effects for incidence of adult-onset multifactorial disease.

  15. ENDOTHELIAL DYSFUNCTION IN ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    N. E. Zakirova

    2008-01-01

    Full Text Available Aim. To assess the role of endothelial vasodilating, vasoconstrictive and adhesive dysfunction in the development of angina pectoris (AP in patients with ischemic heart disease (IHD.Material and methods. 83 patients with IHD were included in the study. 30 patients had AP of functional class (FC-II, 27 patients - FC-III and 26 patients - FC-IV. The control group consisted of 25 healthy persons. Bicycle ergometry, daily ECG monitoring and echocardiography were used for verification of IHD. Endothelial vasodilating function was assessed by endothelium-dependent (EDVD and endothelium-independent vasodilatation (EIDVD of brachial artery. Vasoconstrictive function was assessed by the level of endothelin (ET-1. Endothelial adhesive function was evaluated by plasma concentration of intracellular adhesion molecules – JCAM-1, VCAM-1 and Е-selectin.Results. Normal EDVD and EIDVD were observed in patients with AP of FC-II. The more severe FC of AP the more prominent endothelial vasodilating dysfunction was revealed as well as the higher levels of ET-1 and intracellular adhesion molecules. Patients with AP of FC-IV had hyperexpression of JCAM-1, VCAM-1, Е-selectin and ET-1 and low levels of EDVD and EIDVD.Conclusion. Progression of IHD related with growing endothelial vasodilating, vasoconstrictive and adhesive dysfunction.

  16. 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...

  17. 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...

  18. 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

  19. The role of psychosocial stress at work for the development of cardiovascular diseases: a systematic review.

    Science.gov (United States)

    Backé, Eva-Maria; Seidler, Andreas; Latza, Ute; Rossnagel, Karin; Schumann, Barbara

    2012-01-01

    A systematic review was carried out to assess evidence for the association between different models of stress at work, and cardiovascular morbidity and mortality. A literature search was conducted using five databases (MEDLINE, Cochrane Library, EMBASE, PSYNDEX and PsycINFO). Inclusion criteria for studies were the following: self-reported stress for individual workplaces, prospective study design and incident disease (myocardial infarction, stroke, angina pectoris, high blood pressure). Evaluation, according to the criteria of the Scottish Intercollegiate Guidelines Network, was done by two readers. In case of disagreement, a third reader was involved. Twenty-six publications were included, describing 40 analyses out of 20 cohorts. The risk estimates for work stress were associated with a statistically significant increased risk of cardiovascular disease in 13 out of the 20 cohorts. Associations were significant for 7 out of 13 cohorts applying the demand-control model, all three cohorts using the effort-reward model and 3 out of 6 cohorts investigating other models. Most significant results came from analyses considering only men. Results for the association between job stress and cardiovascular diseases in women were not clear. Associations were weaker in participants above the age of 55. In accordance with other systematic reviews, this review stresses the importance of psychosocial factors at work in the aetiology of cardiovascular diseases. Besides individual measures to manage stress and to cope with demanding work situations, organisational changes at the workplace need to be considered to find options to reduce occupational risk factors for cardiovascular diseases.

  20. [Identification of circulatory diseases and their risk during medical examination of an adult population: methodological aspects].

    Science.gov (United States)

    Kalinina, A M; Ipatov, P V; Kaminskaya, A K; Kushunina, D V

    2015-01-01

    To study the efficiency of a methodology for the active detection of coronary heart disease (CHD) and cerebrovascular diseases (CVD) during medical examination and to determine the need and possible ways of its improvement. The medical examinations of 19.4 million people (94.6% of all the citizens who had undergone medical examinations in all the regions of Russia in 2013) were analyzed and the methodological aspects of identification of the circulatory diseases (CDs) that were induced by coronary and cerebral vessel atherosclerosis and had common risk factors, primarily CHD and CVD, were assessed. The medical examinations revealed 2,915,445 cases of CDs and their suspicions, during which its clinical diagnosis was established in 57.2%. The suspected disease requiring that its diagnosis should be further specified; off-medical examinations revealed hypertension in more than 770,000 cases, CHD in 232,000, and CVD in 146,000. The proportion of stable angina pectoris of all angina cases was much higher at a young age (25.6%) than at middle (15.6%) and elderly (11.3%) ages. Brachiocephalic artery stenoses were detected in almost 13,000 cases. According to the official health statistics, within the years preceding the introduction of large-scale medical examinations, there was a slight rise in new CD cases among the adult population of Russia, which was more significant in 2013 (according to the preliminary data) than in 2012. The methodology for the active detection of CDs through a two-step medical examination, which is used during a follow-up, makes it possible to substantially increase detection rates for CDs. There has been shown to be a need for the better quality and completeness of diagnostic examination in real practice.

  1. Cardiac valvular abnormalities are frequent in systemic lupus erythematosus patients with manifest arterial disease.

    Science.gov (United States)

    Jensen-Urstad, K; Svenungsson, E; de Faire, U; Silveira, A; Witztum, J L; Hamsten, A; Frostegård, J

    2002-01-01

    The objective of this study was to study cardiac valve morphology and function and ventricular function in systemic lupus erythematosus (SLE) patients with and without co-existing cardiovascular disease (CVD) and in population controls. Twenty-six women (52 +/- 8.2 years) with SLE (SLE cases) and a history of CVD (angina pectoris, myocardial infarction, cerebral infarction or intermittent claudication) were compared with 26age-matched women with SLE but without manifest CVD (SLE controls) and 26 age-matched control women (population controls). Echocardiographywas performed to assess valvular abnormalities and manifestations of ischaemic heart disease. Thirteen of the 26 SLE cases but only one of the SLE controls and one of the population controls had cardiac valvular abnormalities. Three of the SLE cases had already undergone valve replacement and another had significant aortic insufficiency; the other nine had thickening of mainly mitral leaflets without hemodynamic significance. Among SLE cases, patients with valvular abnormalities had higher homocysteine (P valvular disease. In contrast atherosclerosis as determined by IMT, oxidized LDL as measured by the monoclonal antibody E06, autoantibodies against epitopes of OxLDL (aOxLDL) or phospholipids (aPL), disease duration or activity, or acute phase reactants did not differ between SLE cases with or without valvular abnormalities. Valvular abnormalities were not more common in SLE cases with stroke as compared to those with myocardial infarction, angina or claudication. In conclusion, valvular abnormalities are strongly associated with CVD in SLE. Raised levels of homocysteine and triglycerides characterize patients with cardiac valve abnormalities.

  2. 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

  3. Radiation risk of individual multifactorial diseases in offspring of the atomic-bomb survivors: a clinical health study

    International Nuclear Information System (INIS)

    Tatsukawa, Yoshimi; Yamada, Michiko; Ohishi, Waka; Hida, Ayumi; Akahoshi, Masazumi; Fujiwara, Saeko; Cologne, John B; Hsu, Wan-Ling; Furukawa, Kyoji; Takahashi, Norio; Nakamura, Nori; Suyama, Akihiko; Ozasa, Kotaro; Shore, Roy

    2013-01-01

    There is no convincing evidence regarding radiation-induced heritable risks of adult-onset multifactorial diseases in humans, although it is important from the standpoint of protection and management of populations exposed to radiation. The objective of the present study was to examine whether parental exposure to atomic-bomb (A-bomb) radiation led to an increased risk of common polygenic, multifactorial diseases—hypertension, hypercholesterolaemia, diabetes mellitus, angina pectoris, myocardial infarction or stroke—in the first-generation (F 1 ) offspring of A-bomb survivors. A total of 11 951 F 1 offspring of survivors in Hiroshima or Nagasaki, conceived after the bombing, underwent health examinations to assess disease prevalence. We found no evidence that paternal or maternal A-bomb radiation dose, or the sum of their doses, was associated with an increased risk of any multifactorial diseases in either male or female offspring. None of the 18 radiation dose–response slopes, adjusted for other risk factors for the diseases, was statistically significantly elevated. However, the study population is still in mid-life (mean age 48.6 years), and will express much of its multifactorial disease incidence in the future, so ongoing longitudinal follow-up will provide increasingly informative risk estimates regarding hereditary genetic effects for incidence of adult-onset multifactorial disease. (paper)

  4. 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

  5. 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.

  6. 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/

  7. Avaliação de coagulação, fibrinólise e proteína C em pacientes de risco e com doenças coronarianas Evaluation of coagulation, fibrinolysis and protein C in risk patients and patients presenting coronarian diseases

    Directory of Open Access Journals (Sweden)

    Christiane Vieira Reis

    2003-01-01

    genetic or acquired factors may contribute to break this balance leading to hypo or hypercoagulability states. In coronarian diseases, such as angina pectoris and acute myocardial infarction, an exacerbated activation of the platelets and clot proteins occurs, favouring thrombus formation. In order to restore hemostasia, the fibrinolytic system intervention occurs, what promotes the clot lysis removing obstruction from the vessels. In this work, the clot and fibrinolysis systems and protein C, a natural anticoagulant, were evaluated. Twenty patients with coronarian diseases including angina pectoris (n = 8 and acute myocardial infarction (n = 12 were studied, besides patients showing potential risk for developing cardiovascular disease (n = 17. The group of infarcted patients was matched to healthy subjects under the clinical and laboratory points of view (control group, n = 12. The results for angina and infarction groups revealed a significant difference in fibrinogen plasma levels compared to control group. Activated protein C plasma levels also showed a significant difference between the risk and infarction groups. The other hemostatic evaluated parameters did not differ significantly between the studied groups. However, a tendency to hypercoagulability was observed in the patient groups compared to the control group.

  8. The prevalence of angina symptoms and association with cardiovascular risk factors, among rural, urban and rural to urban migrant populations in Peru

    Directory of Open Access Journals (Sweden)

    Gilman Robert H

    2010-10-01

    Full Text Available Abstract Background Rural-to-urban migration in low- and middle-income countries causes an increase in individual cardiovascular risk. Cost-effective interventions at early stages of the natural history of coronary disease such as angina may stem an epidemic of premature coronary deaths in these countries. However, there are few data on the prevalence of angina in developing countries, whilst the understanding the aetiology of angina is complicated by the difficulty in measuring it across differing populations. Methods The PERU MIGRANT study was designed to investigate differences between rural-to-urban migrant and non-migrant groups in specific cardiovascular disease risk factors. Mass-migration seen in Peru from 1980s onwards was largely driven by politically motivated violence resulting in less 'healthy migrant' selection bias. The Rose angina questionnaire was used to record chest pain, which was classified definite, possible and non-exertional. Mental health was measured using the General Health Questionnaire (GHQ-12. Mantel-Haenszel odds ratios (adjusted for age, sex, cardiovascular disease risk factors and mental health were used to assess the risk of chest pain in the migrant and urban groups compared to the rural group, and further to assess the relationship (age and sex-adjusted between risk factors, mental health and chest pain. Results Compared to the urban group, rural dwellers had a greatly increased likelihood of possible/definite angina (multi-adjusted OR 2.82 (1.68- 4.73. Urban and migrant groups had higher levels of risk factors (e.g. smoking - 20.1% urban, 5.5% rural. No diabetes was seen in the rural dwellers who complained of possible/definite angina. Rural dwellers had a higher prevalence of mood disorder and the presence of a mood disorder was associated with possible/definite angina in all three groups, but not consistently with non-exertional chest pain. Conclusion Rural groups had a higher prevalence of angina as

  9. Computed Tomography of Prosthetic Heart Valves

    NARCIS (Netherlands)

    Habets, J.

    2012-01-01

    Prosthetic heart valve (PHV) dysfunction is an infrequent but potentially life-threatening disease with a heterogeneous clinical presentation. Patients with PHV dysfunction clinically can present with symptoms of congestive heart failure (dyspnea, fatigue, edema), fever, angina pectoris, dizziness

  10. [[Length polymorphism of minisatellite repeat B2-VNTR of the bradykinin B2 receptor gene in healthy Russians and in patients with coronary heart disease].

    Science.gov (United States)

    Suchkova, I O; Pavlinova, L I; Larionova, E E; Alenina, N V; Solov'ev, K V; Baranova, T V; Belotserkovskaia, E V; Sasina, L K; Bader, M; Denisenko, A D; Mustafina, O E; Khusnutdinova, E K; Patkin, E L

    2014-01-01

    Bradykinin B2 receptor is involved in many processes, including the regulation of blood pressure and smooth muscle contraction, vasodilation, inflammation, edema, cell proliferation, pain. It is suggested that this receptor may be one of the factors that have cardioprotective and infarct-limiting effects. It is assumed that certain genetic variants in both coding and non-coding regions ofBDKRB2 gene may influence its expression. In the 3'-untranslated region of BDKRB2 exon 3 the minisatellite repeat B2-VNTR is located. B2-VNTR has previously been shown to affect the BDKRB2 mRNA stability. Therefore, it is important to perform the molecular genetic analysis of this minisatellite in patients with different forms of coronary heart disease in order to reveal possible associations between specific B2-VNTR alleles and certain clinical forms of coronary heart disease. In the present study, a comparative analysis of the allele and genotype frequencies of B2-VNTR was carried out in groups of healthy individuals and patients with two clinical forms of coronary heart disease (angina pectoris and myocardial infarction), ethnically Russian. The results of the B2-VNTR length polymorphism analysis indicate that this tandem repeat may be attributed to a class of low polymorphic and non-hypervariable minisatellite. In all analyzed groups we revealed three B2-VNTR alleles, consisting of 43, 38 and 33 repeat units. Alleles of 43 and 33 repeats were major in all investigated groups. No statistically significant differences were found in the B2-VNTR allele and genotype frequencies between men and women in control group, and also between healthy men and men with angina pectoris and myocardial infarction. Thus, B2-VNTR length polymorphism was not associated with these clinical forms of coronary heart disease in Russian men. However, we do not exclude the possibility of association between the B2-VNTR short alleles (38 and 33 repeats) and cardioprotective effects of bradykinin B2 receptor

  11. 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.

  12. 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.

  13. ОЦЕНКА ВЛИЯНИЯ ПОЧЕЧНЫХ ФАКТОРОВ РИСКА НА ВЕРОЯТНОСТЬ РАЗВИТИЯ РЕЦИДИВА СТЕНОКАРДИИ У БОЛЬНЫХ, ПОДВЕРГШИХСЯ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА, ОПТИМИЗАЦИЯ МЕДИКАМЕНТОЗНОЙ ТЕРАПИИ

    Directory of Open Access Journals (Sweden)

    Е. С. Левицкая

    2012-01-01

    Full Text Available The aim of the study was to estimate the impact of renal risk factors (RRF, as well as drug therapy in patients with coronary heart disease and indication for revascularization in the risk of recurrence of angina pectoris. 90 patients with coronary heart disease and indications for the restoration of coronary blood flow were surveyed. The high prevalence of renal risk factors among the patients examined was established. It was revealed that within increase in the maximum risk of recurrence of stenosis of CA the risk of the development of angina pectoris after coronary revascularization is increasing, and with the presence of renal risk factors (microalbuminuria, β2-microglobulinuria, and chronic kidney disease, there is an additional increase in the risk of recurrence of angina pectoris. The analysis of the data demonstrated a significant reduction in risk of recurrence of angina pectoris with the ACE inhibitors and metoprolol tartrate prescription before myocardial revascularization.

  14. MAGNESIUM METABOLISM AND CLINICAL CHARACTERISTICS OF PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    A. V. Yezhov

    2010-01-01

    Full Text Available Aim. To study relationship of the clinical state and cardiac functional parameters with magnesium metabolism indices in patients with chronic ischemic heart disease (IHD.Material and methods. Patients with stable angina pectoris, II-III class (n=480 were involved into the study. Evaluation of the following items was performed: disease course, anxiodepressive syndrome intensity, exercise tolerance, blood and urine electrolyte profile, systolic and diastolic left ventricle function, endothelium-dependent and endotheliumnondependent vasodilatation, i/v magnesium load test, Holter electrocardiogram monitoring.Results. High prevalence of systemic magnesium deficiency (17.9 and 37.5% according to serum and erythrocyte levels, respectively was found in IHD patients. Severity of magnesium deficiency in IHD patients depended on duration of disease, experience of myocardial infarction, myocardial ischemia seriousness, disorders of endothelium vasodilating function and left ventricle diastolic function, severity of concomitant anxiety. Exercise tests were changed in IHD patients with magnesium deficiency.Conclusion. The study data let to consider that magnesium deficiency involves into the IHD pathogenesis.

  15. Relation of time to complete redistribution and the severity of coronary artery disease

    International Nuclear Information System (INIS)

    Nishimura, Tsunehiko; Uehara, Toshiisa; Hayashida, Kohei; Kozuka, Takahiro; Saito, Muneyasu; Sumiyoshi, Tetsuya

    1985-01-01

    The relation between the severity of coronary artery disease and the time to complete redistribution (RD) was investigated in 66 patients with angina pectoris (AP) (28 SVD, 18 DVD and 20 TVD) and 104 patients with myocardial infarction (MI) (45 SVD, 36 DVD and 23 TVD). Stress thallium scan was performed immediately, 30 minutes (early) and 4 hours (delayed) after exercise. RD was classified into three groups (complete, incomplete and no RD). Early complete RD was observed in 15 (23 %) of AP and 3 (3 %) of MI cases. In both cases, the incidence of early RD was higher in SVD compared to DVD and TVD. And diffuse slow washout calculated from exercise and RD study disturbed the incidence of early RD in DVD and TVD. In the early RD cases of AP, coronary stenosis showed mild and collateral was not correlated, however, in the complete or incomplete RD of MI, coronary stenosis showed severe (> 90 %) and the frequency of collateral was higher compared to no RD cases. In MI cases, complete, incomplete and no RD were observed in 22 %, 25 % and 53 %, respectively. In the latter, a- or dys-kinesis at infarct zone was often observed which showed myocardial viability. In conclusion, early RD was observed about 20 % of coronary artery disease and the time to complete RD was closely related to the severity of coronary artery disease. In addition, the sensitivity for detecting transient thallium defect was influenced by the delay in beginning imaging. (author)

  16. 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.

  17. 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.

  18. 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 ...

  19. 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...

  20. 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...

  1. 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...

  2. 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.

  3. 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...

  4. Studies on Tl-201 single photon emission computed tomography (SPECT) of myocardium in patients with ischemic heart disease

    International Nuclear Information System (INIS)

    Igarashi, Takeki; Yokoi, Toshio; Ueda, Mitsuru; Horimoto, Masashi; Funayama, Naoki; Takenaka, Takashi; Tasho, Teruo; Tsutsuji, Yuko; Oi, Tsuyoshi

    1985-01-01

    Seventy-six patients with IHD were divided into 2 groups, A) angina pectoris (n=50) and B) previous myocardial infarction(n=26). Each group was classified into three subgroups, without considering hypertension, that is 1) without complication, 2) with hypercholesterolemia, and 3) with diabetes mellitus. We studied and compared the findings of ECG, Echocardiogram (ECHO) and Emission CT (ECT) in these patients at rest. In the previous myocardial infarction group (Group B), we could find 100% ischemic patterns on ECG, 100% asynergy of either IVS or the posterior wall on ECHO and higher percentages of various grade of perfusion defects on ECT compared with group A. In group A, the percentages of perfusion defects were similar in three subgroups. But interestingly, in the hypercholesterolemic group, we could find diffuse moth-eaten like low perfusion areas on ECT. Further study is required whether this finding is peculiar for angina pectoris with hypercholesterolemia or an artifact on ECT. The percentage of ischemic patterns on ECG was lower than in the other groups. In angina pectoris with diabetes mellitus, asynergy in ECHO finding was a significantly higher percentage, compared with other groups. We believe, that ECG, ECHO and ECT are of compensatory importance in the diagnosis of patients with IHD. (author)

  5. Leukocyte Counts, Myeloperoxidase, and Pregnancy-Associated Plasma Protein A as Biomarkers for Cardiovascular Disease: Towards a Multi-Biomarker Approach

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    M. B. I. Lobbes

    2010-01-01

    Full Text Available We evaluated leukocyte counts and levels of CRP, fibrinogen, MPO, and PAPP-A in patients with stable and unstable angina pectoris, acute myocardial infarction, and healthy controls. All biomarkers were analyzed again after 6 months. Leukocyte counts and concentrations of fibrinogen, CRP, MPO, and PAPP-A were significantly increased in patients with acute myocardial infarction. Leukocyte counts and concentrations of MPO were significantly increased in patients with unstable angina pectoris compared with controls. After 6 months, leukocyte counts and MPO concentrations were still increased in patients with acute myocardial infarction when compared to controls. Discriminant analysis showed that leukocyte counts, MPO, and PAPP-A concentrations classified study group designation for acute coronary events correctly in 83% of the cases. In conclusion, combined assessment of leukocyte counts, MPO, and PAPP-A was able to correctly classify acute coronary events, suggesting that this could be a promising panel for a multibiomarker approach to assess cardiovascular risk.

  6. Relationship of daily arterial blood pressure monitoring readings and arterial stiffness profile in male patients with chronic obstructive pulmonary disease combined with arterial hypertension

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    Karoli N.A.

    2013-06-01

    Full Text Available The aim of the study was to determine correlation between arterial blood pressure daily rhythm and daily profile of arterial stiffness in male patients with chronic obstructive pulmonary disease (COPD and arterial hypertension. Materials et methods: Prospective investigation comprised 45 male patients with COPD and arterial hypertension. Individuals of 40 years younger and 80 years elder, patients with diabetes, stroke, angina pectoris, or heart infarction, vascular diseases, and exacerbation of chronic disease, bronchial and pulmonary diseases of other etiology were excluded from the analyses. Comparison group included 47 patients with essential arterial hypertension and without chronic respiratory diseases closely similar on general parameters with patients from main clinical series. Twenty-four-hour arterial blood pressure monitoring (ABPM and daily arterial stiffness monitoring were performed using BPLab® MnSDP-2 apparatus (Petr Telegin, Russian Federation. Results: Patients with COPD combined with arterial hypertension with raised arterial stiffness measures prevail over individuals in essential hypertension group. There is pathological alteration of the ABPM circadian rhythm and raised «Pressure load» values in raised arterial stiffness group. Conclusion: We found ABPM raised parameters in patients with COPD and arterial hypertension. It confirms necessity of ABPM in daily arterial stiffness assessment in patients with COPD.

  7. Study on the correlation between the concentration of plasma lipoprotein-associated phospholipase A2 and coronary heart disease

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    Jin-Ming Cen

    2015-06-01

    Full Text Available Objective: This study explores the correlation between plasma lipoprotein-associated phospholipase A2 (Lp-PLA2 and coronary heart disease (CHD by comparing the level of plasma Lp-PLA2 in the plasma of patients with different types of CHD. Methods: Blood samples were collected from 56 patients diagnosed with CHD by the Department of Cardiology of the First People's Hospital of Foshan and 34 healthy subjects from February 2013 to January 2014. We measured the concentration of plasma Lp-PLA2 and determined the levels of total cholesterol (Tch, triglyceride (TG, apolipoprotein A1 (Apo-A1, apolipoprotein B (Apo-B, high density lipoprotein-cholesterol (HDL-c, low density lipoprotein-cholesterol (LDL-c, lipoprotein a (Lp(a, glucose (Glu, and high-sensitivity C-reactive protein (hs-CRP. The concentration of plasma Lp-PLA2 in the healthy control group and each subgroup of CHD patients were compared and analyzed for correlations of plasma Lp-PLA2 between the patients in different CHD subgroups and several laboratory indicators. Results: The concentration of plasma Lp-PLA2 in each subgroup of CHD was significantly higher than in the control group (P < 0.05. The concentration of Lp-PLA2 in the unstable angina pectoris (UAP group and acute myocardial infarction (AMI group were significantly higher than in the stable angina pectoris (SAP group (P < 0.05, and the concentration of plasma Lp-PLA2 in the AMI group was significantly higher than in the UAP group (P < 0.05. The concentration of plasma Lp-PLA2 in the CHD group merely showed a positive correlation (r = 0.493, P < 0.05 with the hs-CRP group, but the levels of Tch, TG, Apo-A1, Apo-B, HDL-c, LDL-c, Lp(a and Glu did not. Conclusions: The concentration of plasma Lp-PLA2 in patients with CHD was higher than that in the control group. The concentration of plasma Lp-PLA2 in the subgroups of CHD patients varied greatly from each other. The inflammatory response of atherosclerosis might be resulted

  8. Dynamics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease

    Science.gov (United States)

    Malinova, Lidia I.; Simonenko, Georgy V.; Denisova, Tatyana P.; Tuchin, Valery V.

    2007-02-01

    Dynamics of glucose concentration in human organism is an important diagnostic characteristic for it's parameters correlate significantly with the severity of metabolic, vessel and perfusion disorders. 36 patients with stable angina pectoris of II and III functional classes were involved in this study. All of them were men in age range of 45-59 years old. 7 patients hospitalized with acute myocardial infarction (aged from 49 to 59 years old) form the group of compare. Control group (n = 5) was of practically healthy men in comparable age. To all patients intravenous glucose solution (40%) in standard loading dose was injected. Capillary and vein blood samples were withdrawn before, and 5, 60, 120, 180 and 240 minutes after glucose load. At these time points blood pressure and glucose concentration were measured. In prepared blood smears shape, deformability and sizes of erythrocytes, quantity and degree of shear stress resistant erythrocyte aggregates were studied. Received data were approximated by polynomial of high degree to receive concentration function of studied parameters, which first derivative elucidate velocity characteristics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease and practically healthy persons. Received data show principle differences in dynamics of morphofunctional erythrocyte properties during intravenous glucose injection in patients with coronary heart disease as a possible mechanism of coronary blood flow destabilization.

  9. 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

  10. PRESENTACIÓN DE UN CASO CON SÍNDROME X O ANGINA MICROVASCULAR / Report of a case with cardiac syndrome X or microvascular angina

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    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

  11. A Whole-Food Plant-Based Diet Reversed Angina without Medications or Procedures

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    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.

  12. 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....

  13. 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.

  14. 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.

  15. 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

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    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.

  16. Exercise stress myocardial imaging, left ventricular performance and hemodynamic changes in the patients with coronary artery disease

    International Nuclear Information System (INIS)

    Miyamoto, Atsushi; Ando, Joji; Murakami, Rinji; Kanamori, Katsushi; Kobayashi, Takeshi; Yasuda, Juichi

    1982-01-01

    The findings of myocardial scintigraphy and left ventriculography of 33 patients with coronary artery disease and 13 normals at rest and during exercise were studied. In most cases, the hypoperfusion areas of 201 TI-myocardial imaging corresponded to areas of wall motion abnormality on left ventriculography. However, these two methods gave different results in detecting postlateral lesions in the multivessel disease patients. X-ray cineangiography and RI ventriculography provided corresponding information about wall motion abnormality except when the lesions were localized to the apical region. The combination of these two techniques for the tests before and after exercise was valuable clinically, especially in angina pectoris patients. In anginal attacks, localized systolic abnormality, an increase in diastolic and end-systolic volume, an associated slight increase in heart output, and a decrease in ejection fraction and in a systolic blood pressure/end-systolic volume ratio were observed; these changes suggested heart disfunction caused by ischemia. Thus the grading of coronary artery lesions necessitated evaluation of myocardial perfusion abnormality and of changes in cardiac function at rest and during exercise. (Ueda, J.)

  17. Evaluation of left ventricular function during exercise in patients with ischemic heart disease using multigated blood pool scintigraphy

    International Nuclear Information System (INIS)

    Ohmori, Yoshiaki; Kanoh, Yasushi; Shiotani, Hideyuki; Fujitani, Kazuhiro; Fukuzaki, Hisashi; Kajiya, Teishi; Nakashima, Yoshiharu; Maeda, Kazumi.

    1985-01-01

    Multigated blood pool scintigraphy (exercise RI ventriculography) and exercise stress thallium-201 myocardial scintigraphy were performed in 44 ischemic heart disease (IHD) patients (16 with angina pectoris and 28 with old myocardial infarction) and 11 healthy persons. Furthermore, blood circulation was examined in 38 of the subjects. Work load was significantly greater, and the number of diseased vessels and the incidence of indicators for transient ischemia during exercise were significantly lower in the group with a remarkably increased left ventricular ejection fraction (EF) during exercise than in the group with a remarkably decreased EF. In the group with unchanged EF, reginal left ventricular wall movement could be assessed using phase analysis. In IHD patients with a remarkably decreased EF at rest, EF was scarcely changed during exercise, and indicators for transient ischemia were not observed frequently. There was a highly significnat correlation between EF during exercise and pulmonary artery wedge pressure or cardiac index during exercise, suggesting that EF is a noninvasive indicator for coronary circulation during exercise. Exercise RI ventriculography was considered useful for evaluating the physiology of IHD. (Namekawa, K.)

  18. Usefulness of thallium-201 myocardial SPECT using dipyridamole infusion combined with submaximum exercise of the detection of the ischemic heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Shimizu, Akinori; Baba, Shinsuke; Iwagaki, Naofumi; Toyonaga, Shinji; Sunayama, Masayuki; Suzuki, Seiyuu; Takasugi, Kenta; Shibata, Tsuneo [Sumitomo Besshi Hospital, Niihama, Ehime (Japan)

    1995-05-01

    The present study assessed the usefulness and safety of myocardial single photon emission computed tomography with combined iv dipyridamole infusion and submaximum exercise (DE-SPECT). The subjects were 89 patients with arteriographically significant coronary artery disease (CAD+) and 21 patients with arteriographically non-proven CAD (CAD-). There was no change in cardiovascular dynamics after iv dipyridamole infusion in the group of CAD-. In the group of CAD+, on the other hand, dipyridamole infusion significantly induced ischemia even when combined exercise was minor. DE-SPECT has a sensitivity of 99% and specificity of 91%. Furthermore, 25 selected CAD + patients underwent myocardial SPECT after iv dipyridamole infusion and 3-minute stepping exercise (DS-SPECT). Although DE-SPECT was positive in all 25 patients, DS-SPECT was false negative in 12% (3/25) with a sensitivity of 88%. These 3 false-negative patients had a single vessel disease and could tolerate exercise. Although angina pectoris like symptoms occurred by DE-SPECT in approximately 80% of the CAD+ group, there was no serious complication. In conclusion, DE-SPECT increased diagnostic sensitivity for ischemic heart disease. (N.K.).

  19. Mid term results after bone marrow laser revascularization for treating refractory angina

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    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. 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.

  1. Recent advances in the management of chronic stable angina I: approach to the patient, diagnosis, pathophysiology, risk stratification, and gender disparities.

    Science.gov (United States)

    Kones, Richard

    2010-08-09

    The potential importance of both prevention and personal responsibility in controlling heart disease, the leading cause of death in the USA and elsewhere, has attracted renewed attention. Coronary artery disease is preventable, using relatively simple and inexpensive lifestyle changes. The inexorable rise in the prevalence of obesity, diabetes, dyslipidemia, and hypertension, often in the risk cluster known as the metabolic syndrome, drives the ever-increasing incidence of heart disease. Population-wide improvements in personal health habits appear to be a fundamental, evidence based public health measure, yet numerous barriers prevent implementation. A common symptom in patients with coronary artery disease, classical angina refers to the typical chest pressure or discomfort that results when myocardial oxygen demand rises and coronary blood flow is reduced by fixed, atherosclerotic, obstructive lesions. Different forms of angina and diagnosis, with a short description of the significance of pain and silent ischemia, are discussed in this review. The well accepted concept of myocardial oxygen imbalance in the genesis of angina is presented with new data about clinical pathology of stable angina and acute coronary syndromes. The roles of stress electrocardiography and stress myocardial perfusion scintigraphic imaging are reviewed, along with the information these tests provide about risk and prognosis. Finally, the current status of gender disparities in heart disease is summarized. Enhanced risk stratification and identification of patients in whom procedures will meaningfully change management is an ongoing quest. Current guidelines emphasize efficient triage of patients with suspected coronary artery disease. Many experts believe the predictive value of current decision protocols for coronary artery disease still needs improvement in order to optimize outcomes, yet avoid unnecessary coronary angiograms and radiation exposure. Coronary angiography remains the

  2. Recent advances in the management of chronic stable angina I: Approach to the patient, diagnosis, pathophysiology, risk stratification, and gender disparities

    Science.gov (United States)

    Kones, Richard

    2010-01-01

    The potential importance of both prevention and personal responsibility in controlling heart disease, the leading cause of death in the USA and elsewhere, has attracted renewed attention. Coronary artery disease is preventable, using relatively simple and inexpensive lifestyle changes. The inexorable rise in the prevalence of obesity, diabetes, dyslipidemia, and hypertension, often in the risk cluster known as the metabolic syndrome, drives the ever-increasing incidence of heart disease. Population-wide improvements in personal health habits appear to be a fundamental, evidence based public health measure, yet numerous barriers prevent implementation. A common symptom in patients with coronary artery disease, classical angina refers to the typical chest pressure or discomfort that results when myocardial oxygen demand rises and coronary blood flow is reduced by fixed, atherosclerotic, obstructive lesions. Different forms of angina and diagnosis, with a short description of the significance of pain and silent ischemia, are discussed in this review. The well accepted concept of myocardial oxygen imbalance in the genesis of angina is presented with new data about clinical pathology of stable angina and acute coronary syndromes. The roles of stress electrocardiography and stress myocardial perfusion scintigraphic imaging are reviewed, along with the information these tests provide about risk and prognosis. Finally, the current status of gender disparities in heart disease is summarized. Enhanced risk stratification and identification of patients in whom procedures will meaningfully change management is an ongoing quest. Current guidelines emphasize efficient triage of patients with suspected coronary artery disease. Many experts believe the predictive value of current decision protocols for coronary artery disease still needs improvement in order to optimize outcomes, yet avoid unnecessary coronary angiograms and radiation exposure. Coronary angiography remains the

  3. Correlated biochemical modifications of plasma lipoproteins in coronary heart disease: an accelerating pathologic factor.

    Science.gov (United States)

    Sima, A; Hobai, I; Stancu, C; Cinteză, M; Gherasim, L

    1996-01-01

    We investigated the presence of biochemically modified plasma lipoproteins as pathologic factor for coronary heart disease in 15 patients with angina pectoris (CHD-P) vs 20 normal subjects (N). Decreased HDL were the most significant pathological feature present in P over 66 years old, while, P under 66 had, in addition to low HDL-Cholesterol (HDL-C), high levels of plasma cholesterol (C), LDL-Cholesterol (LDL-C), and lipid peroxides (TBARS), together with the presence of desialylated LDL and VLDL. We demonstrated by statistic analysis that these risk factors are correlated: high plasma C with a more pronounced imbalance between LDL and HDL, which, in turn, is associated with high TBARS levels, and also with circulating desialylated VLDL; high plasma TBARS values with desialylated LDL. We detected an increased level of autoantibodies towards autologous LDL and VLDL, in P vs N. The level of autoantibodies anti-LDL correlated with LDL-C level and with LDL desialylation, thus modified circulating LDL being most probably atherogenic. Circulating anti-LDL autoantibodies together with the low level of HDL might contribute to acceleration and aggravation of the atherosclerotic process.

  4. Incremental value of the CT coronary calcium score for the prediction of coronary artery disease

    International Nuclear Information System (INIS)

    Genders, Tessa S.S.; Pugliese, Francesca; Mollet, Nico R.; Meijboom, W. Bob; Weustink, Annick C.; Mieghem, Carlos A.G. van; Feyter, Pim J. de; Hunink, M.G.M.

    2010-01-01

    To validate published prediction models for the presence of obstructive coronary artery disease (CAD) in patients with new onset stable typical or atypical angina pectoris and to assess the incremental value of the CT coronary calcium score (CTCS). We searched the literature for clinical prediction rules for the diagnosis of obstructive CAD, defined as ≥50% stenosis in at least one vessel on conventional coronary angiography. Significant variables were re-analysed in our dataset of 254 patients with logistic regression. CTCS was subsequently included in the models. The area under the receiver operating characteristic curve (AUC) was calculated to assess diagnostic performance. Re-analysing the variables used by Diamond and Forrester yielded an AUC of 0.798, which increased to 0.890 by adding CTCS. For Pryor, Morise 1994, Morise 1997 and Shaw the AUC increased from 0.838 to 0.901, 0.831 to 0.899, 0.840 to 0.898 and 0.833 to 0.899. CTCS significantly improved model performance in each model. Validation demonstrated good diagnostic performance across all models. CTCS improves the prediction of the presence of obstructive CAD, independent of clinical predictors, and should be considered in its diagnostic work-up. (orig.)

  5. Traditional Chinese Herbal Products for Coronary Heart Disease: An Overview of Cochrane Reviews

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    Yu Qiu

    2012-01-01

    Full Text Available Objective. The aim of this overview was to evaluate and summarize Cochrane reviews of traditional Chinese herbal products (TCHPs as the treatment for coronary heart disease (CHD. Methods. We searched the Cochrane Database that was concerned with the effectiveness of TCHPs for CHD. We also searched the Cochrane Central Register of Controlled Trials. Reviews and primary studies of TCHP as the treatment of any type of CHD were included. Data were extracted according to predefined inclusion criteria by two independent reviewers. Results. Six Cochrane reviews were included. They related to a wide range of TCHPs for different types of CHD. Four reviews were concerned with angina pectoris (unstable or stable, one review was concerned with heart failure, and for acute myocardial infarction. No reviews concluded that TCHPs were definitely effective for CHD because of the weak evidence. Eight primary studies were TCHPs from CHD. These studies also maybe result in bias, but better than before. Conclusion. Several Cochrane reviews of TCHPs for the treatment of different types of CHD have recently been published. None of these reviews got definite conclusion favoring the effectiveness of TCHPs due to the weak evidence. With the improved quality of the new registered RCTs. The potential role of TCHPs in treating CHD is anticipated to be detected.

  6. Antianginal efficacy of the combination of felodipine-metoprolol 10/100 mg compared with each drug alone in patients with stable effort-induced angina pectoris

    DEFF Research Database (Denmark)

    Emanuelsson, H; Egstrup, K; Nikus, K

    1999-01-01

    OBJECTIVE: The primary objective of this randomized, double-blind, parallel group trial was to compare the antianginal and antiischemic efficacy of a combination tablet of felodipine-metoprolol 10/100 mg once daily with both drugs given separately once daily in patients with stable effort......-daily treatment with either felodipine-metoprolol 10/100 mg, felodipine 10 mg, or metoprolol 100 mg. The duration of active double-blind treatment was 4 weeks. There were 3 primary efficacy variables in the study; time until end of exercise, time until onset of chest discomfort, and time until 1-mm ST depression...... during a standardized exercise test. RESULTS: The number of patients randomized was 397. There was a statistically significant improvement in time until end of exercise with felodipine-metoprolol 10/100 mg compared with metoprolol 100 mg (P =.04) and felodipine 10 mg compared with metoprolol 100 mg ( P...

  7. [The diagnostic value of delta-R and delta-Q as positive criteria of the ergometry test in a group of patients with angina pectoris of effort].

    Science.gov (United States)

    Doria, G; Cangemi, F; Gulizia, M; Cuocina, N; Tosto, A; Circo, A

    1989-11-01

    ECG-exercise tests were performed in 29 patients affected by effort chest pain. All patients underwent coronary angiography and/or revealed positive results in the cycloergometer effort test. The aim of the study was to evaluate ultrasonic variations in the R and Q waves due to maximal effort, so as to increase the information provided by the effort ECG. In the coronary angiographic test, 21 out of 29 patients revealed significant hemodynamic coronary stenosis; 10 patients were affected by previous myocardial necrosis; 8 patients showed no hemodynamic coronary lesions (OV). In the OV patients a statistically significant increase was observed in the Q wave at maximal effort in comparison with average basal values; on the other hand, there was a decrease, although not significant, in voltage at peak effort in patients with coronary stenosis. R wave amplitude was smaller in comparison to basal values in OV patients, while a significant increase was observed in the 21 patients with coronary lesions.

  8. Dietary factor VII activation does not increase plasma concentrations of prothrombin fragment 1+2 in patients with stable angina pectoris and coronary atherosclerosis

    DEFF Research Database (Denmark)

    Bladbjerg, E-M; Münster, A M; Marckmann, P

    2000-01-01

    and angiographically verified coronary atherosclerosis. They were served a low-fat (5% of energy from fat) breakfast and lunch and a high-fat (40% of energy from fat) breakfast and lunch on 2 different days. Venous blood samples were collected at 8:15 AM (fasting), 12:30 PM, 2:00 PM, 3:30 PM, and 4:45 PM and analyzed...

  9. Study of sympathetic nervous function under effort induced ischemia in patients with angina pectoris with I-123 metaiodobenzylguanidine (MIBG) myocardial SPECT images

    International Nuclear Information System (INIS)

    Tanaka, Takeshi; Aizawa, Tadanori; Kato, Kazuzo; Ogasawara, Ken; Sakuma, Toru; Kirigaya, Hajime; Hirosaka, Akira; Igarashi, Masaki

    1990-01-01

    I-123 metaiodobenzylguanidine (MIBG) is a norepinephrine analog, which can be used to study the sympathetic nervous function of the heart. With MIBG myocardial SPECT images sympathetic nervous function under effort induced ischemia were studied in 18 patients with significant coronary artery lesions. In 5 patients with effort induced ischemic region in stress Tl-201 myocardial images rest MIBG images were collected and then exercise stress test was performed. Patients continued exercising for 3 minutes after onset of symptom. Post-stress MIBG images were collected. Definite ischemic region was noted in stress Tl-201 myocardial images, however no differences were noted between rest and post-stress MIBG images. These results suggested that exercise induced ischemia did not enhance release of uptaken MIBG. In 13 patients with significant coronary artery lesions symptom-limited exercise stress test was performed MIBG and Tl-201 were simultaneously injected at onset of symptom and patients continued exercising for an additional one minute. In 6 cases (46%, 6/13) MIBG defects with Tl-201 uptake were noted. These results showed that exercise induced ischemia depressed net MIBG uptake and that sympathetic nervous function (MIBG images) may be more sensitive to ischemic damage than muscle (Tl-201 images). It is suggested that exercise induced ischemia depressed reuptake of norepinephrine at sympathetic nervous endings. MIBG myocardial SPECT images may be useful for evaluating sympathetic nervous function under ischemia. (author)

  10. 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

  11. 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

  12. 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.

  13. Clinical and genetic investigation of a Japanese family with cardiac fabry disease. Identification of a novel α-galactosidase A missense mutation (G195V).

    Science.gov (United States)

    Nakagawa, Naoki; Maruyama, Hiroki; Ishihara, Takayuki; Seino, Utako; Kawabe, Jun-ichi; Takahashi, Fumihiko; Kobayashi, Motoi; Yamauchi, Atsushi; Sasaki, Yukie; Sakamoto, Naka; Ota, Hisanobu; Tanabe, Yasuko; Takeuchi, Toshiharu; Takenaka, Toshihiro; Kikuchi, Kenjiro; Hasebe, Naoyuki

    2011-01-01

    Fabry disease is an X-linked lysosomal storage disorder caused by mutations of the α-galactosidase A gene (GLA), and the disease is a relatively prevalent cause of left ventricular hypertrophy mimicking idiopathic hypertrophic cardiomyopathy. We assessed clinically 5 patients of a three-generation family and also searched for GLA mutations in 10 family members. The proband had left ventricular hypertrophy with localized thinning in the basal posterior wall and late gadolinium enhancement (LGE) in the near-circumferential wall in cardiovascular magnetic resonance images and her sister had vasospastic angina pectoris without organic stenosis of the coronary arteries. LGE notably appeared in parallel with decreased α-galactosidase A activity and increased NT-pro BNP in our patients. We detected a new GLA missense mutation (G195V) in exon 4, resulting in a glycine-to-valine substitution. Of the 10 family members, 5 family members each were positive and negative for this mutation. These new data extend our clinical and molecular knowledge of GLA gene mutations and confirm that a novel missense mutation in the GLA gene is important not only for a precise diagnosis of heterozygous status, but also for confirming relatives who are negative for this mutation.

  14. [A comparison of the clinical efficacy of enalapril maleate analogs in patients with heart failure and ischemic heart disease].

    Science.gov (United States)

    Dunaev, V V; Berezin, A E

    1998-01-01

    The authors examined 68 patients aged from 42 to 68 years with ischemic heart disease without a history of myocardial infarction and with angina pectoris of exertion functional class 2-3 and circulatory insufficiency class 2 (according to NYHA criteria). The criteria serving as the reason for relating patients to the follow-up group were left-ventricular end-diastolic volume > 160 ml, ejection fraction 0.55, threshold power of endured loads within a range of 71.5 +/- 2.30 watt. After stabilization of the clinical status by means of basic therapy (nitrates, blockers of slow calcium channels, diuretics, antiaggregants), all patients were divided into two follow-up groups. The first group consisted of 36 patients who received renitec (10 mg/24 h), patients of group 2 were given enap in the same dose. The course of treatment lasted 12 weeks. The effectiveness of treatment was controlled by echocardiography according to the standard methods in M- and B-regimens. Analysis of the obtained data showed that within 12-day follow-up renitec demonstrated higher effectiveness and lesser incidence of side-effects than did enap given in the same dose.

  15. The correlation between serum total bilirubin and outcomes in patients with different subtypes of coronary artery disease.

    Science.gov (United States)

    Huang, Fang-Yang; Peng, Yong; Huang, Bao-Tao; Yang, Yong; Pu, Xiao-Bo; Chen, Shi-Jian; Gui, Yi-Yue; Xia, Tian-Li; Chen, Fei; Liu, Rui-Shuang; Zhu, Ye; Chen, Mao

    2017-02-01

    The relation between serum total bilirubin (TBi) and mortality in patients with established coronary artery disease (CAD) remains undefined. We try to investigate the role of the subtypes of CAD in the association. A total of 3013 patients with angiographically obstructive CAD were enrolled. A retrospective analysis was conducted. Patients were divided into 3 groups as follows: stable CAD (SCAD), unstable angina pectoris (UAP) and acute myocardial infarction (AMI). The predictive values of TBi for 30-day and long-term mortality were assessed using logistic and Cox regression, respectively. Higher initial serum TBi levels were significantly associated with increased risk of short-term mortality (OR 2.35, 95% CI 1.15-4.77) in AMI group. However, the association was absent among patients with SCAD and UAP. Serum TBi was able to independently predict the long-term mortality in SCAD (HR 0.34, 95% CI 0.16-0.70) and UAP (HR 0.49, 95% CI 0.31-0.78) groups. However, there was no significant relation between TBi and long-term mortality in AMI groups. The different subtypes of CAD affected the relation between serum TBi and clinical prognosis. Initial serum TBi was positively correlated with short-term mortality of AMI patients, and negatively correlated with long-term mortality in SCAD or UAP patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Association between Periodontal disease and Prostate cancer: Results of a 12-year Longitudinal Cohort Study in South Korea

    Science.gov (United States)

    Lee, Jae-Hong; Kweon, Helen Hye-In; Choi, Jung-Kyu; Kim, Young-Taek; Choi, Seong-Ho

    2017-01-01

    The incidence of prostate cancer (PC) accompanying periodontal disease (PD) is anticipated to increase due to population aging. The aim of this study was to determine the association between PD and PC using data in the National Health Insurance Service-Health Examinee Cohort (NHIS-HEC). A random stratified sample of 187,934 South Koreans was collected from the NHIS database from 2002 to 2013. We assessed the relationship between PD and PC while adjusting for potential confounding factors (sex, age, household income, insurance status, residence area, hypertension, diabetes mellitus, cerebral infarction, angina pectoris, myocardial infarction, smoking status, alcohol intake, and regular exercise). The overall incidence of PC with PD among those aged 40 years and older was 0.28% (n = 531). In the multivariate Cox proportional-hazard regression analysis with adjustment for confounding factors, PD was associated with a 14% higher risk of PC (HR = 1.14, 95% CI = 1.01-1.31, P = 0.04