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Biomedical subjects

P Bobba

Publications and source records attributed to P Bobba.

At least 55 records · Page 3Linked to original sources
PubMed1980

Coronary arterial spasm in angina at rest associated with transient ST-segment changes.

In order to clarify the role of coronary arterial spasm in the pathogenesis of angina at rest, coronary arteriography was perforned during spontaneous chest pain or following intravenous administration of ergonovine maleate in 40 patients with angina at rest. Coronary vasospasm was demonstrated in 23 patients with ST-segment elevation during chest pain (group I), in 7 with ST-segment depression (group II), and in 4 with both ST-segment depression and elevation (group III). Complete spastic occlusion of the proximal or of the midportion of the left anterior descending artery was always associated with ST-segment elevation in anterior leads. In contrast, transient ST-segment depression in anterior leads was associated with diffuse narrowing of the left anterior descending artery with slow progression of the contrast medium, or complete occlusion of a small branch or of the distal segment of the left anterior descending artery. ST-segment elevation in inferior leads was associated with complete spastic occlusion or with significant spastic narrowing of the right coronary artery or of the circumflex artery. We conclude that coronary spasm can be demonstrated in a selected cohort of patients with angina at rest associated with transient ST-segment changes. In some cases the site and the severity of the spasm may produce varying degrees of ischemia, thus determining the direction of the ST-segment shift.

Adult↗
PubMed1980

Treatment of angina at rest with nifedipine: a short-term controlled study.

The effectiveness of nifedipine in treating angina pectoris at rest was evaluated in 14 patients with frequent ischemic episodes associated with S-T segment elevation or depression. The trial consisted of (1) a 48 hour control period; (2) a placebo period and a period of treatment with nifedipine of 48 hours each; and (3) a second placebo period and a second period of treatment with nifedipine of 24 hours each. The efficacy of treatment was evaluated by continuous electrocardiographic recording to detect painless ischemic episodes. During coronary angiography coronary spasm was demonstrated in five patients. The ergonovine maleate test was positive in seven of eight patients. No statistically significant difference was found in the mean daily number of ischemic episodes between the control period and the first placebo period, or between the control and the second placebo periods. Nifedipine produced a highly significant reduction in the mean daily number of episodes compared with the response to placebo during the first as well as the second period. Nifedipine is effective in angina at rest caused by coronary arterial spasm. The prevention of ischemia may be related to the ability of nifedipine to decrease calcium-dependent coronary muscle tone and to prevent coronary spasm.

Adult↗
PubMed1980

Angiographic demonstration of different pathogenetic mechanisms in patients with spontaneous and exertional angina associated with S-T segment depression.

Three patients complained of spontaneous and exertional chest pain, both associated with S-T segment depression in anterior electrocardiographic leads. In each, coronary spasm was demonstrated on coronary arteriography during a spontaneous attack of pain. Coronary arteriograms taken during exercise-induced angina did not show evidence of spastic obstruction; this suggests that exercise-induced chest pain and S-T segment depression were secondary to the increase in oxygen requirements rather than to a sudden decrease in coronary blood flow. Thus, two pathogenetic mechanisms coexisting in the same patient may cause chest pain associated with subendocardial ischemia.

Angina Pectoris↗
PubMed1980

[Changes in left ventricular function induced by isometric exercise in coronary disease].

The effects of isometric exercise on left ventricular function in 16 patients with chronic coronary heart disease were assessed by measuring left ventricular pressures and volumes under basal conditions and during a sustained effort of 2 minutes 30 seconds at 50% of the maximal effort. In 7 patients (Group I) with abnormal elevation of left ventricular end diastolic pressure (LVEDP) (over 4 mmHg) the end diastolic volume remained unchanged and the diastolic pressure-volume curve was displaced upwards. The ejection fraction fell together with the percentage filling during the first part of diastole with 50% filling occurring after 61% instead of 45% of diastole. The time constant T also increased showing abnormal relaxation. In 9 patients without abnormal elevation of LVEDP on exercise no changes in the other parameters studies were observed. Our results show that pathological elevation of LVEDP during isometric exercise is associated with a decreased ejection fraction and an abnormality of left ventricular relaxation with a reduced rate of filling during protodiastole and an upward displacement of the diastolic pressure-volume curve. The LVEDP alone is therefore an important index of the haemodynamic behaviour of the left ventricle during isometric exercise.

Coronary Disease↗
PubMed1980

[Sustained effect of nitroglycerin ointment on exercise tolerance in patients with effort angina (author's transl)].

The effect on exercise tolerance of nitroglycerin (NTG) ointment was studied by exercise test on bicycle ergometer in a selected group of patients with effort angina and angiographically proven critical coronary lesions. NTG ointment (15 mg) and placebo were administered in a double-blind cross-over randomized trial on two consecutive days; exercise test was carried out before the administration of NTG ointment and placebo, and repeated after one hour, 2 and 1/2 hours and 4 hours. Compared to control and placebo tests, NTG ointment produced a highly significant increase of duration of exercise and of total work load in all tests, as well as a significant decrease of maximal ST segment depression. After NTG ointment administration resting systolic blood pressure showed a significant decrease after one hour, 2 and 1/2 hours and 4 hours, resting heart rate a significant increase after 2 and 1/2 and 4 hours, and peak exercise heart rate a significant increase after 4 hours. Double product at rest was unaffected by NTG ointment, while at peak exercise it showed a significant increase only after 4 hours. Our data show that in patients with effort angina NTG ointment produces an important increase of exercise capacity which persists at least for 4 hours after the administration. Therefore NTG ointment seems to be of high value in the treatment of effort angina.

Adult↗
PubMed1980

[Angina at rest. Clinical, electrocardiographic and angiographic observations in 107 patients].

107 patients suffering from angina at rest associated with ST segment changes underwent coronary arteriography. 46 patients showed ST segment elevation during ischemic attacks (group I) while 61 patients exhibited ST segment depression during chest pain (group II). Non-significant coronary artery disease was more frequent in group I patients (group I 15%, group II 5%) as well as one vessel disease (group I 33%, group II 15%) while multivessel disease and left main involvement were more frequent in group II patients (group I 28%, group II 60%). Depression of left ventricular function was found in similar percentage of cases in both groups. During hospitalization all patients were treated with calcium antagonists (Nifedipine 10/20 mg every six hours) and/or nitrates (2% nitroglycerin ointment 2 inches every six/four hours) with one death (occurring after coronary arteriography) and eleven non-fatal myocardial infarctions. 50 patients underwent coronary bypass grafting with four perioperative deaths and six nonfatal myocardial infarctions. Most of the surgically treated patients were poorly responsive to medical treatment and had multivessel disease or left main involvement. Since these features are known to be related to a poor prognosis with medical treatment, surgical results in such patients seem satisfactory.

Adult↗
PubMed1980

[Positive exercise test in the absence of pain. Characteristic of a high-risk population?].

157 consecutive patients (pts) with suspected coronary artery disease and an ischemic ecg response during exercise test (ET) were studied. During ET 61 of them (group I) had neither chest pain nor anginal equivalent, while 96 (group II) experienced angina. There were no significant differences between the two groups in regard to age, sex, prior myocardial infarction, history of angina or hypertension. During ET pts of group I tolerated a higher work load (group I 3467 Kpm, group II 2594 Kpm, P less than 0,05) and had a higher maximal heart rate (group I 128,3 b/min, group II 120,4 b/min, P less than 0,05) with a more marked ST segment depression (group I 2,4 mm, group II 1,8 mm, P less than 0,01) and with a more elevated incidence of arrhythmias (group I 18%, group II 7%, P less than 0,05). The coronary angiography showed significant obstruction (greater than or equal to 75%) in 91,7% of group I and in 91,6% of group II (prevalence of single vessel disease in group I and multiple vessel disease in group II). No significant difference was found between group I and II in regard to left ventricular ejection fraction (group I 51%, group II 53%), left ventricular end-diastolic pressure (group I 12,9 mmHg group II 13,6 mmHg) and left ventricular end-diastolic volume (group I 102,3 ml/m2, group II 104,2 ml/m2). We conclude that ST segment depression during ET in asymptomatic pts at risk for cardiovascular disease is predictive of coronary artery disease as in symptomatics. These subjects have, compared with symptomatics, a higher work load tolerance but with more marked ecg ischemic changes and more frequent arrhythmias during ET, thus representing a group of coronary population at potentially higher risk.

Adult↗
PubMed1979

Coronary arterial spasm as a cause of exercise-induced ST-segment elevation in patients with variant angina.

Four patients with variant angina pectoris exhibited reproducible exercise-induced chest pain and ST-segment elevation. Coronary arterial spasm was documented with arteriography during exercise-induced ST-segment elevation (three patients) or after intravenous administration of ergonovine maleate (one patient). Our observations show that in patients with variant angina exercise can trigger coronary arterial spasm, thus inducing anginal pain and ST-segment elevation.

Adult↗
PubMed1979

[Clinical and angiographic study and pathogenic mechanism of Prinzmetal's angina. Apropos of 31 cases].

31 patients presenting with Prinzmetal variant angina were divided into three groups according to their angiographic appearances. Group I comprised 9 patients with normal or coronary arteries with lesions less than 50% narrowing. Group II comprised 12 patients with single vessel disease. Group III comprised the other 10 patients with significant lesions on two or all three principal arteries. No clinical or electrocardiographical differences were found between the groups as to age, sex or the clinicapresentation of the chest pain. Most patients with normal or nearly normal coronary arteries had normal electrol cardiogrammes between attacjs (8 out of 9) and electrical changes mainly over the inferior wall (8 out of 9). Exercise electrocardiography reproduced ST elevation in 4 of the 9 patients but, in contrast to the patients in the other two groups, never ST depression. However, these features are not specific for patients in Group I as they were observed in 4 patients in the other two groups. Spontaneous or induced coronary spasm were observed in 27 patients, confirming its role as the mechanism of Prinzmetal angina, whatever the anatomical appearance of the coronary tree.

Adult↗
PubMed1979

Paroxysmal atrioventricular tachycardia involving an anomalous pathway with antegrade unidirectional block.

37 consecutive patients with frequent episodes of palpitation and/or dizziness underwent electrophysiological study. They had no signs of ventricular preexcitation during either sinus rhythm or atrial pacing. In 17 (46%), the supraventricular tachycardia was sustained by a reentry mechanism involving an anomalous AV pathway with unidirectional antegrade block (AV tachycardia). Some findings were accepted to demonstrate the existence of the anomalous pathway (AP) and others, its participation in the reentry circuit. The possible location of the AP was established in 15 cases at the following sites: left lateral in 5 cases, left posterior in 5 cases, left posteromedial in 1 case, right posterior in 1 case, right anterior in 1 case, posterior septal in 1 case, and anterior septal in 1 case. The rate of the AV tachycardia can be influenced not only by the ventriculoatrial interval but also by the other pathways included in the reentry circuit. It may change conspicuously in cases with dual AV pathway and anomalous AV pathway in relation to the modality of antegrade conduction by the AV node.

Adolescent↗