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PubMedDate not supplied

[Some mechanisms and causes of silent myocardial ischemia].

Some causes of silent heart attack in patients with ST-segment depression are presented in the article. Silent myocardial ischemia was shown to have some common features associated with heart attack with pain syndrome (HAPS). They are the duration of a heart attack, heart rate and the extent of ST-segment depression. It means that the previously proposed theory of "threshold ischemia" does not always reflect real causes of the pain absence during myocardial ischemia events. Nowadays the pain threshold in patients with silent myocardial ischemia has been noted by investigators to exceed that in patients with HAPS by more than 50-100%. Certain differences in mechanisms of pain reception at the level of receptor, its modulation and consequent reception by different parts of the central nervous system were established. It was also shown that the sympathetic-adrenal system and opioid hormones influence significantly on pain sensitivity by the human body. Thus, there are many causes of silent myocardual ischemia and it is still not fully accepted by all researchers.

Heart Function Tests↗
PubMed1985

Plasma fibrinogen--a major coronary risk factor.

The role of plasma fibrinogen as a potential indicator of susceptibility to heart attacks was studied in a sample of 297 men aged 40-69 years at entry who were initially free from overt coronary heart disease. During a mean observation period of 7.3 years (range 0.1-16.1) new heart attacks occurred in 40 men. There was a significant positive correlation between initial plasma fibrinogen levels and the subsequent incidence of heart attacks. In men with high cholesterol or high systolic blood pressure levels the incidence of heart attacks was respectively six times and 12 times greater in those with high plasma fibrinogen levels than in those with low fibrinogen levels. In multivariate models plasma fibrinogen was a highly significant and independent explanatory variable, at least as important as serum cholesterol, blood pressure or cigarette smoking. These results suggest that high plasma fibrinogen levels are an important coronary risk factor and should be included in profiles used to identify those at high risk of heart attacks.

Adult↗
PubMed1978

[Epidemiological survey of cerebro-cardiovascular diseases at Iwamizawa in Hokkaido (author's transl)].

Since 1969, we have investigated epidemiological studies of cerebro-cardiovascular diseases in the suburbs of Iwamizawa city in Hokkaido, the northernmost island of Japan. Cross-sectional surveys of 1,092 persons, equivalent to 90.3% of inhabitants over 40 years of age, revealed that the prevalence of hypertension amounted to 34%, and that the prevalence of abnormal ECG, CTR, fundi, albuminuria, glucosuria and overweight in the hypertensive group were significantly higher than in the normotensive group. After a 5-year cohort follow-up study concerning the incidence of strokes and heart attacks, age was found to be the highest risk factor in both incidents and hypertension was the second highest in cerebrovascular accidents, but not so high in heart attacks. In addition, we measured plasma renin activity (PRA) as a risk factor. On the basis of our observations, it is evident that the casual PRA of the rural Japanese population in Hokkaido, who usually excrete sodium more than 200 mEq per day, is valuable for our study. PRA was inversely proportional to systolic blood pressure in the normotensives and total group, but no correlation was found in the hypertensives alone. Observing 13 renin-determined accidents (8 strokes & 5 heart attacks) prospectively, incidence of strokes and heart attacks occurred more frequently in the high- and low-renin subgroups than in the normal-renin subgroup. Based on multivariate analysis, the following conclusion was drawn: systolic pressure, high renin, diastolic pressure and low renin, in this sequence, contribute largely toward the discrimination of cerebro-cardiovascular accident from no cerebro-cardiovascular accident. Thus it was suggested that the casual PRA was useful to predict the occurrence of vascular complications, in addition to the existence of hypertension. It has been said that the mortality rate of CVA in Hokkaido is less than the average of the rest of northern parts in Japan. By the vital statistics and our survey, it was clear that seasonal variation of the death rate from CVA and heart attack, which increases in the winter season, is weaker in Hokkaido than in Honshu. It is of interest to speculate that it is due to better-equipped heating in houses in Hokkaido than in other northern parts of Honshu.

Adolescent↗
PubMed1988

Familial aggregation of coronary heart disease: partial mediation by high density lipoproteins?

The potential explanation of coronary heart disease inheritance by the major coronary risk factors was explored in a random sample of 1044 males, aged 40-70 years, who formed part of the Jerusalem Lipid Research Clinic Prevalence Study. Standardised data were available on personal and family history, coronary risk factors, resting and exercise electrocardiography. Twelve percent of subjects had coronary heart disease (previous myocardial infarction or electrocardiographic changes) and 20% had a family history of heart attack before 60 years in first degree relatives. In the presence of a family history of heart attack, the mean level of high density lipoprotein-cholesterol (HDL-C) was 5 mg/dl lower in cases of coronary heart disease than in controls. No such difference existed in the absence of a family history of heart attack. In multiple logistic regression, HDL-C was a significant negative predictor of coronary heart disease presence, but only in subjects having a positive family history. A 1 standard deviation (10 mg/dl) increment in HDL-C was associated with a two-thirds reduction in heart disease risk. Other risk factors did not predict the occurrence of coronary heart disease to any significant extent in subjects with a positive family history of heart attack. In an overall logistic model combining family history with other risk factors, the significant predictors of heart disease were: age, total plasma cholesterol, hypertension, family history and HDL-C. The interaction term, family history X HDL-C, was also a significant negative predictor of heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

Effect of longer-term modest salt reduction on blood pressure.

BACKGROUND: Many randomised trials assessing the effect of salt reduction on blood pressure show reduction in blood pressure in individuals with high blood pressure. However, there is controversy about the magnitude and the clinical significance of the fall in blood pressure in individuals with normal blood pressure. Several meta-analyses of randomised salt reduction trials have been published in the last few years. However, most of these included trials of very short duration (e.g. 5 days) and included trials with salt loading followed by salt deprivation (e.g. from 20 to 1 g/day) over only a few days. These short-term experiments are not appropriate to inform public health policy which is for a modest reduction in salt intake over a prolonged period of time. A meta-analysis by Hooper et al is an important attempt to look at whether advice to achieve a long-term salt reduction (i.e. more than 6 months) in randomised trials causes a fall in blood pressure. However, most trials included in this meta-analysis achieved a small reduction in salt intake; on average, salt intake was reduced by 2 g/day. It is, therefore, not surprising that this analysis showed a small fall in blood pressure, and that a dose-response to salt reduction was not demonstrable. OBJECTIVES: To assess the effect of the currently recommended modest reduction in salt intake (WHO 2003; SACN 2003; Whelton 2002), on blood pressure in individuals with normal and elevated blood pressure. To assess whether the magnitude of the reduction in blood pressure is dependent on the magnitude of the reduction in salt intake. SEARCH STRATEGY: We searched MEDLINE, EMBASE, Cochrane library, CINAHL, and reference list of original and review articles. SELECTION CRITERIA: We included randomised trials with a modest reduction in salt intake and a duration of 4 or more weeks. DATA COLLECTION AND ANALYSIS: Data were extracted independently by two persons. Mean effect sizes were calculated using both fixed and random effect models using Review Manager 4.2.1 software. Weighted linear regression was used to examine the relationship between the change in urinary sodium and the change in blood pressure. We used funnel plots to detect publication and other biases in the meta-analysis. MAIN RESULTS: Seventeen trials in individuals with elevated blood pressure (n=734) and 11 trials in individuals with normal blood pressure (n=2220) were included. In individuals with elevated blood pressure the median reduction in 24-h urinary sodium excretion was 78 mmol (4.6 g/day of salt), the mean reduction in systolic blood pressure was -4.97 mmHg (95%CI:-5.76 to -4.18), and the mean reduction in diastolic blood pressure was -2.74 mmHg (95% CI:-3.22 to -2.26). In individuals with normal blood pressure the median reduction in 24-h urinary sodium excretion was 74 mmol (4.4 g/day of salt), the mean reduction in systolic blood pressure was -2.03 mmHg (95% CI: -2.56 to -1.50) mmHg, and the mean reduction in diastolic blood pressure was -0.99 mmHg (-1.40 to -0.57). Weighted linear regression analyses showed a correlation between the reduction in urinary sodium and the reduction in blood pressure. REVIEWERS' CONCLUSIONS: Our meta-analysis demonstrates that a modest reduction in salt intake for a duration of 4 or more weeks has a significant and, from a population viewpoint, important effect on blood pressure in both individuals with normal and elevated blood pressure. These results support other evidence suggesting that a modest and long-term reduction in population salt intake could reduce strokes, heart attacks, and heart failure. Furthermore, our meta-analysis demonstrates a correlation between the magnitude of salt reduction and the magnitude of blood pressure reduction. Within the daily intake range of 3 to 12 g/day, the lower the salt intake achieved, the lower the blood pressure.

Aldosterone↗
PubMed2002

Beta-blockers and diabetes: the bad guys come good.

Type 2 diabetes is becoming very common and is closely linked to physical inactivity and obesity. It is associated with clustering of coronary risk factors and 60-80% of cases have hypertension. The first therapeutic action is appropriate adjustment of life style. Anti-hypertensive therapies such as diuretics, ACE inhibitors and calcium antagonists have been effective in reducing cardiovascular events in type 2 diabetes, though calcium antagonists may be less effective than older therapies and ACE-inhibitors in reducing the risk of heart attacks and heart failure (but possibly more effective in stroke reduction). Beta-blockers (BBs) have a poor image as a potential therapy due to apparent adverse effects on surrogate end-points such as insulin-resistance. However large, controlled trials have shown BBs to be highly effective in reducing the risk of cardiovascular events and death in post myocardial infarction patients with diabetes. The UKPDS study in type 2 diabetics with hypertension showed first-line beta-blockade to be at least as effective as ACE-inhibition in preventing all primary macrovascular and microvascular end-points. The active ingredient appears to be beta-1 blockade, acting not only to lower blood pressure but also to prevent sudden death and cardiovascular damage stemming from chronic beta-1 stimulation associated with raised noradrenaline activity. By contrast, in the LIFE study atenolol was less effective than the angiotensin receptor antagonist losartan in reducing cardiovascular events and all-cause mortality in mainly elderly hypertensives with diabetes. Thus the best beta-blocker results in reducing hard cardiovascular end-points occur in hypertension studies (including the UKPDS study) involving younger/middle aged (say less than 60-65 years) patients, with relatively high sympathetic activity, relatively compliant/elastic arteries (narrow pulse-pressure) and normally functioning beta-1 receptors. In elderly hypertensive patients beta-blockers may be given as second-line therapy on the back of a low-dose diuretic (but possibly as first line agent in elderly hypertensives with prior myocardial infarction). Thus inappropriate attention to surrogate end-points can lead to faulty prescribing habits. Beta-blockers, currently severely underprescribed, should be considered as a first line therapeutic option for all diabetics with ischaemic heart disease or younger/middle aged diabetics with hypertension (but co-prescribed with low dose diuretic therapy in the elderly). The active ingredient for cardiovascular protection appears to be beta-1 blockade; optimal efficacy in lowering blood pressure and safety e.g. reducing risk of bronchoconstriction, is achieved by choosing an agent with high beta-1 selectivity.

Adrenergic beta-Antagonists↗
PubMed2000

The mercury sphygmomanometer should be abandoned before it is proscribed.

Both in clinical practice and medical research, blood pressure is still largely measured by auscultation using a mercury sphygmomanometer. Blood pressure is the most important predictor of life expectancy. Treatment of high blood pressure reduces strokes, heart attack and heart failure. Accurate measurement is therefore essential. At a large London teaching hospital, just under 500 mercury sphygmomanometers and their associated cuffs were examined. More than half had serious problems that would have rendered them inaccurate in measuring blood pressure. At the same time, assessment of the technical knowledge needed to measure blood pressure by the ausculatory technique was also carried out amongst medical and nursing staff. This showed a considerable level of ignorance. These results inevitably lead to inaccurate measurement of blood pressure with serious consequences. In addition mercury is a non-degradable pollutant, eventually accumulating on the sea bed. The use of mercury in sphygmomanometers is already in the process of being eliminated in Scandinavia and Holland and other countries are likely to follow. Our results suggest that mercury sphygmomanometers are not adequately maintained and require expertise that is not available for accurate measurement of blood pressure. Their use should be dispensed with on these grounds before a ban for other and, perhaps less justifiable reasons. Validated automatic devices, which are less liable to measurement and observer error should be used instead. At the same time a concerted effort is needed to instruct health care professionals on the importance of more accurate measurement of blood pressure. Journal of Human Hypertension (2000) 14, 31-36.

Adult↗
PubMed1999

Diabetes and hypertension in Mexican American families: relation to cardiovascular risk.

There is a strong familial predisposition to type 2 diabetes, hypertension, and cardiovascular disease. The authors evaluated the association between a family history of these diseases and a large panel of cardiovascular risk factors in 1,431 Mexican American subjects who were enrolled in the San Antonio Family Heart Study in San Antonio, Texas. The baseline phase of the study covered 1992-1996. Diabetes and hypertension were diagnosed according to standard clinical criteria, while cardiovascular disease was defined as a history of heart attack or heart surgery. The prevalence of diabetes, hypertension, and cardiovascular disease in this population was 15%, 12%, and 3%, respectively. For each unaffected subject, the authors computed a family history score based on the presence or absence of disease in parents and older siblings, and correlations between cardiovascular risk factors and family history scores were estimated by using likelihood-based variance component methods. Diabetes family history score was significantly correlated with a broad panel of cardiovascular risk factors, including glucose and insulin, obesity, blood pressure, triglycerides, and total cholesterol. Hypertension family history score was significantly correlated with glucose, blood pressure, body mass index, waist circumference, total cholesterol, and triglycerides. These results support the idea that genes that confer a risk for diabetes, and to a lesser extent hypertension, adversely alter the cardiovascular risk profile long before the manifestation of clinical disease.

Adult↗
PubMed1995

Profiling Antihypertensive Therapy.

The objectives of treating hypertension are to achieve adequate control of blood pressure (BP) and maintain it under tight control. Maintenance of tight control of BP will most likely prevent stroke, heart attack, and heart failure, cause regression of left ventricular hypertrophy, and quite possibly preserve or improve renal function. The last two salutary effects combined will further reduce the morbidity and mortality in the treated hypertensive subjects. Choice of antihypertensive drugs is of significant importance so that our efforts to control hypertension do not grossly alter the quality of life. The cost of therapy is also an important consideration. Thus, thiazide diuretics, beta-blockers, and central inhibitors that are relatively inexpensive and adequately lower BP should be a common choice. However, if drowsiness interferes with work, or impotence becomes a threat for the marital partner or significant other, adjustment has to be made. The metabolic abnormalities consisting mainly of impaired glucose tolerance, hypercholesterolemia, and insulin resistance often induced by these relatively inexpensive drugs have put calcium channel blocker and ACE inhibitor group of drugs on the top of the list for antihypertensive therapy. They are far more expensive, yet offer no greater antihypertensive advantage than a diuretic or central inhibitor, except in special circumstances.

Journal Article↗
PubMed2005

Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1,340 consecutive examinations.

Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) is a comprehensive endoscopic assessment of the sensory and motor components of a swallow. Previous studies addressing patient safety issues with respect to FEESST included relatively small numbers of patients and paid almost no attention to patient characteristics. The purpose of this study was to determine the incidence of FEESST-related complications in the outpatient and inpatient settings and to analyze patient diagnoses that led to the performance of FEESST. We performed a prospective study of FEESST complications in 1,340 consecutive evaluations performed over a 4 1/2-year period. The primary outcome variables were incidence of epistaxis and airway compromise. The secondary outcome variable was underlying patient diagnoses. The incidence of epistaxis was 1 in 1,340 (0.07%). There were no instances of airway compromise. Stroke was the most common reason for the performance of FEESST (343; 25.6%), followed by cardiac-related dysphagia (298; 22.2%) following open heart surgery (169/298; 56.7%), heart attack, congestive heart failure, or new arrhythmia. The remaining causes were head and neck cancer (207; 15.4%), pulmonary disease (141; 10.5%), chronic neurologic disease (124; 9.3%), and acid reflux disease (80; 6.0%). We conclude that FEESST is a relatively safe procedure for the sensory and motor assessment of dysphagia in a cohort of patients with a wide variety of underlying diagnoses. The emergence of cardiac surgery as a common cause of dysphagia warrants further study.

Adult↗
PubMed1991

Choosing the optimum therapy for older hypertensive patients.

The older hypertensive patient (greater than or equal to 60 years) is at progressive risk of suffering from cardiovascular complications of hypertension (heart attack, congestive heart failure, stroke, occlusive peripheral arterial disease and renal failure). In this age group, hypertension is quantified as a blood pressure equal to or greater than 160/95mm Hg (average of 3 times 3 readings). With an increasing baseline risk, the returns of antihypertensive treatment increase, at least up to the age of 80 years. Prospective therapeutic trials have shown considerable benefits regarding prevention of stroke and congestive heart failure. This particularly applies to thiazide-type diuretics. Before any treatment is undertaken, the cardiovascular status of the older hypertensive patient should be assessed with utmost care, because target organ damage may turn the normalisation of blood pressure into a disadvantage. The profiles of currently available drugs are reviewed against the background of aging. There is not yet any firm evidence to support the thesis that some drug classes are better suited than others for treating older hypertensive patients, although some caution with alpha 1-blockers and centrally acting agents seems appropriate. Finally, some practical recommendations are presented on the build-up of optimum therapy in individual patients.

Aged↗
PubMed2002

Homeostasis model assessment of insulin resistance in relation to the incidence of cardiovascular disease: the San Antonio Heart Study.

OBJECTIVE: The prospective association between insulin levels and risk of cardiovascular disease (CVD) is controversial. The objective of the present study was to investigate the relationship of the homeostasis model assessment of insulin resistance (HOMA-IR), as well as insulin levels, with risk of nonfatal and fatal CVD over the 8-year follow-up of the San Antonio Heart Study. RESEARCH DESIGN AND METHODS: Between 1984 and 1988, randomly selected Mexican-American and non-Hispanic white residents of San Antonio participated in baseline examinations that included fasting blood samples for glucose, insulin, and lipids, a glucose tolerance test, anthropometric measurements, and a lifestyle questionnaire. Between 1991 and 1996, 2,569 subjects who were free of diabetes at baseline were reexamined using the same protocol. RESULTS: Over the follow-up period, 187 subjects experienced an incident cardiovascular event (heart attack, stroke, heart surgery, angina, or CVD death). Logistic regression analysis indicated that risk of a CVD event increased across quintiles of HOMA-IR after adjustment for age, sex, and ethnicity (P for trend <0.0001; quintile 5 vs. quintile 1, odds ratio [OR] 2.52, 95% CI 1.46-4.36). Additional adjustment for LDL, triglyceride, HDL, systolic blood pressure, smoking, alcohol consumption, exercise, and waist circumference only modestly reduced the magnitude of these associations (P for trend 0.02; quintile 5 vs. quintile 1, OR 1.94, 95% CI 1.05-3.59). Furthermore, there were no significant interactions between HOMA-IR and ethnicity, sex, hypertension, dyslipidemia, glucose tolerance (impaired glucose tolerance versus normal glucose tolerance), or obesity. The magnitude and direction of the relationship between insulin concentration and incident CVD were similar. CONCLUSIONS: We found a significant association between HOMA-IR and risk of CVD after adjustment for multiple covariates. The topic remains controversial, however, and additional studies are required, particularly among women and minority populations.

Adult↗
PubMed2003

Hypertension. Contemporary challenges in geriatric care.

Hypertension has been unequivocally linked to morbid complications such as heart attack, congestive heart failure, renal failure, and stroke. Despite the availability of myriad effective antihypertensive agents, blood pressure remains either untreated or inadequately controlled to even conservative goals in many patients. Only 68.4% of hypertensive individuals are aware of their condition, only 53.6% are under treatment, and nearly 75% fail to reach the recommended target pressure of 140/90 mm Hg. Significantly, only 40 to 50% of hypertensives will be controlled on a single agent, while most patients with more severe hypertension will require 3 or even 4 agents. This article reviews the overall approach to the hypertensive patient, with special emphasis on target blood pressures in special populations and problems frequently encountered in the older patient.

Aged↗
PubMedDate not supplied

Motivations of professionals for involvement in the delivery of a heart disease education and support program.

This paper describes the motivations of individuals (N = 101) assisting in the delivery of a program of information and support for heart attack and heart surgery patients and their partners. The majority of those surveyed were recruited through association with charitable foundations or through a professional colleague and are motivated by the personal satisfaction derived from providing education and support to those recovering from heart disease.

Adult↗
PubMed1998

Job-related diseases and occupations within a large workers' compensation data set.

The objective of this report is to describe workers' job-related diseases and the occupations associated with those diseases. The methods include aggregation and analysis of job-related disease and occupation data from the Bureau of Labor Statistics' Supplementary Data System (SDS) for 1985 and 1986--the last years of data available with workers' compensation categories: death, permanent total, permanent partial, and temporary total and partial. Diseases are ranked according to their contribution to the four workers' compensation (WC) categories and also ranked within occupations according to the number of cases. Occupations are ranked according to their contribution to specific diseases within one of the four categories. The following diseases comprise the greatest numbers of deaths: heart attacks, asbestosis, silicosis, and stroke. Within the permanent total category, the diseases with the greatest contributions are heart attack, silicosis, strokes, and inflammation of the joints. For the permanent partial category, they are hearing loss, inflammation of joints, carpal tunnel syndrome, and heart attacks. For the temporary total and partial category, they are: inflammation of joints, carpal tunnel syndrome, dermatitis, and toxic poisoning. Hearing loss or inflammation of joints are associated with more than 300 occupations. Circulatory diseases comprise a larger share of job-related diseases than is generally acknowledged. Occupations contributing the most heart attack deaths are truck drivers, managers, janitors, supervisors, firefighters, and laborers. Ratios of numbers of deaths to numbers of disabilities are far higher for illnesses than injuries. Occupations that are consistent in their high ranking on most lists involving a variety of conditions include nonconstruction laborers, janitors, and construction laborers. The large SDS, though dated, provides a tentative national look at the broad spectrum of occupational diseases as defined by WC and the occupations associated with those diseases in 1985 and 1986. Some description of the spectrum of diseases encountered today is possible especially for occupations, such as those mentioned above for which employment has expanded in the 1990s.

Administrative Personnel↗
PubMed1975

Ischemic heart disease and pulmonary ventilatory function.

The results of spirometric examinations on 4, 331 Israeli male civil service employees, aged 45 years or more, were analyzed according to the presence or absence of certain aspects of ischemic heart disease. Vital capacity was lower in individuals with a previously history of a heart attack, in those with definite or suspected angina pectoris and in those with ECG evidence of myocardial ischemia, probable or possible myocardial infarction, left bundle branch block or nonspecific T wave changes in subjects without these findings. The differences were small, but statistically significant. Vital capacity was lower in subjects with a recent history of a heart attack (within three years) than in those whose heart attack had occurred more than three years prior to the examination. The ratio of forced expiratory volume in the first second to forced vital capacity was not significantly different between individuals with or without a past history of heart attack, angina pectoris or ECG evidence of coronary heart disease.

Angina Pectoris↗
PubMed1992

Physical activity and stroke in British middle aged men.

OBJECTIVES: To assess the relation between physical activity and stroke and to determine the overall benefit of physical activity for all major cardiovascular events. DESIGN: Prospective study of a cohort of men followed up for 9.5 years. SETTING: General practices in 24 towns in England, Wales, and Scotland (British regional heart study). SUBJECTS: 7735 men aged 40-59 at screening, selected at random from one general practice in each of 24 towns. MAIN OUTCOME MEASURES: Fatal and non-fatal strokes and heart attacks. RESULTS: 128 major strokes (fatal and non-fatal) occurred. Physical activity was inversely associated with risk of stroke independent of coronary risk factors, heavy drinking, and pre-existing ischaemic heart disease or stroke (relative risk 1.0 for inactivity, 0.6 moderate activity, and 0.3 vigorous activity; test for trend p = 0.008). The association remained after excluding men reporting regular sporting (vigorous) activity. However, vigorous physical activity was associated with a marginally significant increased risk of heart attack compared with moderate or moderately vigorous activity in men with no pre-existing ischaemic heart disease or stroke (relative risk 1.6%; 95% confidence interval 0.96 to 2.8). In men with symptomatic ischaemic heart disease or stroke those doing moderately vigorous or vigorous activity had a risk of heart attack slightly higher than that in inactive men (relative risk = 1.6; 0.8 to 3.3). CONCLUSIONS: Moderate physical activity significantly reduces the risk of stroke and heart attacks in men both with and without pre-existing ischaemic heart disease. More vigorous activity did not confer any further protection. Moderate activity, such as frequent walking and recreational activity or weekly sporting activity, should be encouraged without restriction.

Adult↗
PubMedDate not supplied

[Six-month's clinical course of patients with unstable angina admitted at the emergency room].

OBJECTIVE: to know the mortality rate after six months in patients with unstable angina. MATERIAL AND METHODS: A representative sample of patients who were admitted at the emergency room with unstable angina diagnosis during a period of two years was selected. The presence of angina pectoris, heart attack and death was registered during their stay at the emergency room. A six-month follow-up took place to evaluate the frequency of angina, heart attack and death related to ischemic acute coronary syndrome, as well as the determination of the relative risk of factors associated to mortality. RESULTS: From the 110 admitted patients, we lost 4; 106 conformed the total of the cohort. There was a mortality rate within the emergency room of 1.8% and of 5.7% in six months. Heart attack was present in 6.6% and angina pectoris in 27.1% during their stay at the emergency room. None of the analyzed risk factors showed any relatively significant risk associated to mortality; the relative risk for age, sex, presence of angina during the stay at the emergency room, acute changes in EKG, history of diabetes mellitus, hypertension, current smoking and ischemic cardiac disease, analyzed with the Mantel-Haenszel test, did not show any significant differences by the Mann-Whitney U among the values of the laboratory markers, arterial tension when admitted, pain intensity, evolution time of diabetes, hypertension, hypercholesterolemia and previous ischemic heart disease. CONCLUSIONS: A low frequency of angina, heart attack and mortality was found during their stay at the emergency room, as well as a low mortality rate in six months; none of the risk factors was significantly associated to death.

Adult↗