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PubMed2004

Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing.

OBJECTIVES: This study evaluated the causes of syncope and the significance and differences in left ventricular (LV) dysfunction, coronary disease, and idiopathic dilated cardiomyopathy (DCM). BACKGROUND: Risk stratification of and indications for an automated defibrillator could differ according to the cause of LV dysfunction. METHODS: Electrophysiologic study, including atrial and ventricular programmed stimulation, was performed in 119 patients with coronary disease (group I) and 61 patients with DCM (group II) with an left ventricular ejection fraction (LVEF) <40% and syncope. Patients were followed from one to six years (mean 4 +/- 2 years). RESULTS: Sustained monomorphic ventricular tachycardia (VT) was induced in 44 group I patients (37%) and 13 group II patients (21%); ventricular flutter (>270 beats/min) or ventricular fibrillation (VF) was induced in 24 group I patients (19%) and 9 group II patients (15%); and various other arrhythmias were identified. Syncope remained unexplained in 34 group I patients (30%) and 16 group II patients (27%). Prognosis depended on the heart disease: VT or VF induction was a predictive factor of mortality in coronary disease and identified a group with high cardiac mortality (46%), compared with patients with a negative study, who had a lower mortality (6%; p < 0.001) than in other studies. Cardiac mortality was only correlated with LVEF in DCM. CONCLUSIONS: Various causes could explain syncope in 70% of patients with coronary disease and DCM, but differences were noted: VT was frequent in coronary disease with a bad prognosis, and ischemia could explain syncope; in DCM, different causes such as atrial tachycardia could be responsible for syncope, but the prognosis only depended on LVEF.

Aged↗
PubMed1995

Coronary disease mortality and risk factors in black and white men. Results from the combined Charleston, SC, and Evans County, Georgia, heart studies.

BACKGROUND: Epidemiologic studies begun in the southeastern United States in the 1960s indicated that the prevalence of coronary disease was two to three times greater among white men than black men and also showed an excess incidence of coronary disease among white men, although hypertension was twice as prevalent among blacks. This study was conducted to determine if racial differences exist in coronary heart disease mortality and coronary risk factors. METHODS: Data from the two population-based cohorts of the Charleston, SC, and Evans County, Georgia, Heart Studies were pooled to make comparisons of coronary disease mortality and its risk factors. A total of 726 black men and 1346 white men aged 35 years or older in 1960 in the combined cohort were followed up for 30 years. RESULTS: There were 125 deaths among the black men and 323 deaths among the white men attributable to coronary disease; the age-adjusted rates were 5.0 per 1000 person-years in the black men and 6.5 per 1000 person-years in white men. Black-white coronary mortality risk ratios were 0.8 when age adjusted and 0.7 when also adjusted for other cardiovascular risk factors. Elevated systolic blood pressure and cigarette smoking were significant predictors of coronary mortality in black and white men. Serum total cholesterol level was a statistically significant risk factor only in white men. Higher education level was significantly protective in black and white men. CONCLUSIONS: Black men experienced significantly less coronary disease mortality than white men. Except for cholesterol level, the risk factors for coronary mortality in black and white men were similar.

Adult↗
PubMed1991

Mitral valve prolapse and neuroticism in chest pain patients with normal and diseased coronary arteries.

Patients with chest pain and normal coronary arteries (NCA) score higher on measures of neuroticism than patients with coronary artery disease (CAD). This relationship, coupled with findings linking mitral valve prolapse (MVP) and anxiety disorders, led us to examine prospectively the possibility that a greater incidence of MVP among NCA patients accounts for their elevated neuroticism scores. One-hundred-forty-four patients completed psychological tests and a structured interview prior to cardiac catheterization. Forty-one of the 144 patients (28%) had normal coronary arteries. Within the NCA group 29 percent had MVP; within the CAD group only 13 percent had MVP. Despite the significant difference between NCA and CAD groups on measures of neuroticism, there were no differences as a function of MVP status, nor was there an interaction of MVP and coronary arterial status. These findings support the case for an association between NCA and neuroticism independent of the presence or absence of MVP.

Angina Pectoris↗
PubMed1997

[Psychopathological disorders and coronary diseases].

The role of psychological factors in the genesis of coronary diseases has been considered for a long time. Friedman took it upon himself to describe a personality profile (pattern A) constituting a risk factor for coronary heart disease of which, however, the practical interest seems limited. The association of psychopathological conditions and coronary heart disease has on the other hand not been extensively studied. Recent epidemiological data show that anxiety and depressive states represent a high comorbidity with coronary heart diseases. Panic attacks remain underestimated; they seem to participate in a complex physiopathological mechanism along with ischemic coronary heart diseases. Recent studies have shown that the existence of a depressive illness during coronary heart disease and particularly in the time period following a myocardial infarction, constitutes an independent risk factor, thus increasing the mortality rate. The evolution of coronary heart disease seems greatly influenced by the existence of anxious or depressive states, the diagnosis and the treatment of these states represent a major interest towards a better management of coronary patients.

Anxiety Disorders↗
PubMed1976

[Quantitative K and Na levels in different parts of the heart in cases of sudden death from coronary disease, acquired heart valve defects and violent death].

The quantitative potassium and sodium contents in the separate regions of the heart and m. rectus abdominis in cases of sudden and violent death were investigated. The disturbances of the electrolyte metabolism of potassium and sodium were established to be the earliest changes in coronary disease (acute coronary insufficiency resulting from functional disturbances of the coronary circulation and myocardial infarction). The decrease of the quantitative potassium contents and sodium increase in myocardium depend on the ischemia duration and the stage of the myocardial lesion. The highest potassium decrease was observed in the left ventricle and right auricle. Not very high but even decrease of potassium and sodium contents in the separate heart regions was observed in the deceased by electrocution and strangulation, the decrease being most negligible in the deceased by electrocution. The changes observed in potassium and sodium contents are not pathognomic signs of coronary disease. Only the sharp, focal decrease of the contents of those element is a reliable sign of myocardial infarction.

Abdominal Muscles↗
PubMedDate not supplied

Anomalous LAD and CX artery arising separately from the proximal right coronary artery--a case report of single coronary artery with coronary artery disease.

Coronary artery anomaly has been reported at a rate of 0.6% to 1.3% in routine angiographic series. Moreover, single coronary artery is one of the rarest anomalies among coronary anomalies. Eventhough patients with coronary anomalies are usually asymptomatic, they may also be associated with myocardial ischemia, ventricular fibrillation, syncope, congestive heart failure, and sudden death. In this article, we report a case of single coronary artery anomaly with the left anterior descending (LAD) and left circumflex (LCx) coronary artery arising separately from the proximal right coronary artery. Since the presented case was associated with ischemic heart disease, coronary artery bypass grafting was carried out. He is currently well.

Coronary Angiography↗
PubMed2006

[Screening of asymptomatic individuals for coronary disease using CT-calcium measurement in the coronary arteries].

Coronary calcification is a specific marker for coronary atherosclerosis. It is therefore reasonable to assume that the risk ofcardiac events can be assessed by the quantification of the extent of coronary calcium. Until now, the predictive value of coronary calcium and its advantage over conventional risk factors has not been proven by any of the available prospective cohort studies. It is particularly likely that assessment of coronary atherosclerosis will help in the decision to initiate or discard a specific therapy in patients with an intermediate risk for cardiac events. Recently it has been suggested that the Framingham risk score (FRS) be replaced by a score corrected by assessing the amount of coronary calcium, which can be obtained by multislice spiral computed tomography (MSCT). To this end, the Commission Law Population Investigation has approved a study proposal to evaluate the effects of coronary-calcium screening in 4000 asymptomatic individuals with an intermediate likelihood of coronary artery disease. Based on the amount of calcium (calcium score > 100) obtained by MSCT, different treatment strategies will be initiated over a period of 5 years. Hard endpoints will be myocardial infarction, stroke and mortality due to cardiovascular disease.

Biomarkers↗
PubMed1976

The clinical and angiographic spectrum of isolated, nondominant, left circumflex coronary disease.

Sixteen of 994 patients with arteriosclerotic heart disease and dominant right coronary arteries had isolated left circumflex obstruction. Of these, 6 patients had significant (75%) narrowing in the main circumflex, 10 in 1 or the marginal branches and 1 in the atrioventricular groove branch. Angina was mild in 5, moderate to severe in 8, and unstable in 1. Four patients had prior myocardial infarction (MI), and 1 had a recent MI complicated by posterior papillary muscle rupture. The EKG was normal in 5, showed an MI in 2, LBBB in 1, RBBB in 2, ST-T wave changes in 3, LVH in 2, and atrial fibrillation in 2. Left ventricular angiography performed in the right anterior oblique projection revealed normal contraction in 9 patients, apical hypokinesis in 4, posterobasal hypokinesis in 1, and diffuse hypokinesis in 2. The left ventribular end diastolic pressure was normal in 11 patients and elevated in 5. The cardiac index was normal in 12 patients and reduced in 2. Isolated, nondominant, left circumflex coronary disease is an uncommon entity in symptomatic patients. However, when present, it may produce significant clinical and hemodynamic impairment.

Adult↗
PubMed1998

Acute and late clinical outcome after rotational atherectomy for complex coronary disease.

Rotational atherectomy is effective acutely in treating complex coronary disease, but less is known about its long-term clinical outcome. We examined the acute results and late clinical outcome in 178 patients undergoing treatment with this device. Rotational atherectomy was used to treat 240 lesions in 178 individual patients. Nineteen percent had multilesion or staged multivessel procedures, and 71% had AHA-ACC Type B2/C lesions. The procedure was completed successfully in 94% of patients. Major complications occurred in 6% (death 1%, Q-MI 2.8%, and emergency bypass surgery 2.2%). Clinical follow-up was available for 167 (94%) patients at 13+/-6 months. Thirty-five percent required additional catheterization because of recurrent symptoms or an abnormal stress test. Clinical restenosis was confirmed in 18%, and an additional 2.2% of patients had progression of disease in previously untreated segments. At the end of 1 year, 14% had undergone repeat target vessel revascularization. Cumulatively at follow-up, approximately 80% had avoided an acute major complication and repeat revascularization for restenosis. Rotational atherectomy provides excellent acute and good late clinical results. At 1 year follow-up, the likelihood of developing clinical restenosis or significant progression of disease was 1 in 5, and patients had a 1 in 7 chance of requiring revascularization because of restenosis. These findings are encouraging and indicate that rotational atherectomy can be performed safely and with a high degree of acute and late clinical success in complex coronary disease characterized by multivessel or multilesion involvement and a predominance of B2 and C lesions.

Aged↗
PubMed1977

Effect of aortocoronary saphenous vein bypass grafting on death and sudden death. Comparison of nonrandomized medically and surgically treated cohorts with comparable coronary disease and left ventricular function.

The effect of saphenous vein bypass grafting on the incidence of sudden cardiac death and total cardiovascular death was studied by comparing the survival of subsets of surgically and medically treated patients with coronary disease who were similar in two major prognostic variables: extent of coronary disease and ejection fraction. Significant differences in some baseline variables existed between medical and surgical subgroups with similar ejection fraction and extent of coronary disease. Medically treated patients tended to be in a lower functional class, to have more extensive ventricular contraction abnormalities, to have a larger end-diastolic volume, and to have fewer distal vessels feasible for grafting. Surgically treated patients with two vessel disease and normal or moderately reduced election fraction had improved survival when compared with medically treated patients with two vessel disease and similar ejection fraction. Improved survival of borderline statistical significance was also seen in surgically treated patients with three vessel disease and moderately reduced ejection fraction. When categorized according to end-diastolic volume, surgically treated patients with two vessel disease and normal or moderately increased end-diastolic volume also had improved survival over similarly defined medically treated patients. The sudden death rates for subgroups of mecically treated patients were 1.8 to 10.9 times higher than the rates in subgroups of surgically treated patients with a comparable extent of coronary disease and ejection fraction.

Adult↗
PubMed1982

Absence of chest pain relief in patients diagnosed with minimal or absent coronary disease.

Patients with chest pain and minimal or no coronary disease have a good prognosis for survival, yet many continue to experience chest pain. We analyzed factors related to unimproved chest pain among 548 medically treated patients one year after undergoing angiography at Duke University Medical Center. Variables from the history and catheterization findings were entered in a stepwise logistic regression function with follow-up pain as the dependent variable. For an unbiased subset of 196 patients we entered behavioral variables including 4 MMPI scales and coronary prone behavior type. Hypochondriasis was the most significant predictor of continuing pain. While the etiology of pain in symptomatic patients with insignificant or absent coronary disease has yet to be determined, these findings indicate that an excess identification of personal somatic complaints is prospectively associated with continuing, unimproved pain.

Age Factors↗