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M M Gandhi

Publications and source records attributed to M M Gandhi.

4 recordsLinked to original sources
PubMed1995

Incidence, clinical characteristics, and short-term prognosis of angina pectoris.

OBJECTIVES: To estimate the clinical incidence and short-term prognosis of patients presenting with typical angina pectoris in the general population. DESIGN: Prospective survey of all patients referred by 117 general practitioners from a random sample of 17 general practices serving a population of 191,677 with a median follow up of 16 months. SETTING: A special open access chest pain clinic, based in the non-invasive cardiology department of a teaching hospital, set up for this study. PATIENTS: 110 consecutive patients < or = 70 years age with no history of coronary heart disease presenting for the first time with typical angina. MAIN OUTCOME MEASURES: Age and sex specific incidences, persistence of chest pain, revascularisation procedures, myocardial infarction, and death. RESULTS: The crude annual incidence of angina pectoris (95% confidence interval) was 0.83 (0.66 to 1.0) per thousand population aged 31-70 years; the rates were 1.13 (0.85 to 1.40) for men and 0.53 (0.33 to 0.72) for women. On resting electrocardiography 5% of patients had > or = 1 mm horizontal or downsloping ST depression, 5% had Q/QS patterns, and in one (1%) there was complete left bundle branch block. Among the 103 patients who underwent a Bruce protocol exercise test, 29% had > or = 3 mm ST segment depression induced at a low workload. Of 107 patients at a median (range) follow up of 15.8 (7-30) months, angina remitted spontaneously in 12 patients (11%), 20 (19%) underwent revascularisation, eight (7%) sustained a non-fatal myocardial infarction, and four (4%) died. CONCLUSION: Incidence of new cases of angina pectoris in the United Kingdom is conservatively estimated from this study to be 22,600 patients per annum. Almost one third of these patients will have positive exercise tests at low workload, so the potential for coronary angiography and revascularisation is considerable. With one in 10 patients experiencing a non-fatal myocardial infarction or coronary death within a year of presentation the prognosis of angina is not benign. Further research is required to identify those patients in the general population who would benefit most from coronary revascularisation.

Adult↗
PubMed1995

Management of angina pectoris in general practice: a questionnaire survey of general practitioners.

BACKGROUND: Little is known about the current management of angina pectoris in general practice. AIM: This survey set out to assess general practitioners' perceptions of current investigation and treatment for angina pectoris. METHOD: A postal questionnaire was sent to all 217 general practitioners listed with the Hampshire Family Health Services Authority who have access to a regional cardiac centre in Southampton. RESULTS: The response rate was 79% (171 of 217). The majority (80%) of general practitioners reported referring 10% or fewer of their patients with angina to a cardiologist at the regional centre, and 72% reported referring a quarter or fewer of their patients to a hospital physician. Most (77%) considered an exercise test useful for diagnosis of angina, but almost half (47%) were uncertain about its prognostic value. Most respondents (79%) were not confident of interpreting the results of an exercise test. The majority (79%) believed that there was scientific evidence to show that coronary angioplasty relieves symptoms and 21% were of the opinion that it prolongs survival. Ninety six per cent believed coronary artery bypass grafting relieves symptoms and 62% that it prolongs survival. CONCLUSION: General practitioners do not appear to refer the majority of patients with angina pectoris for hospital investigation, and express divergent and contradictory opinions about exercise testing and the scientific evidence for the benefits of coronary angioplasty and coronary artery bypass surgery. Easier access to cardiological investigation and population based data about the value of exercise testing and survival benefits from coronary intervention are required to optimize selection of patients in the community who are most likely to benefit from coronary revascularization.

Angina Pectoris↗
PubMedDate not supplied

Ambulatory myocardial ischaemia in stable angina.

Episodes of ischaemic ST segment depression detected by continuous ambulatory electrocardiographic (Holter) monitoring have been extensively investigated for over two decades, but no consensus has emerged about their clinical significance. This review examines the prevalence and reported prognostic importance of ambulatory myocardial ischaemia in patients with stable angina, and discusses whether or not detection and treatment of ischaemic episodes in ambulant angina patients can be justified on the basis of the available evidence.

Adrenergic beta-Antagonists↗