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Results for “Angina Pectoris, Variant”

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At least 1,333 records · Page 74Linked to original sources
PubMed2002

How to study the prevalence and mechanisms of racial differences in coronary vasomotor response.

The rapid progress of therapeutic modalities of cardiovascular diseases have led to the development of clinical practice guidelines on the basis of large scale clinical trials. However, an individual response of each patient may not match the mean effect of an intervention in these trials. Therefore, recommendations based on clinical trials performed in a given patient population may not be applicable to the other races. Here, we assessed epidemiological and pathophysiological differences in cardiovascular diseases across racial groups. The incidence of coronary artery disease is the lowest in Japan of all the industrialized nations. Our previous study that compared post-hospital course of acute myocardial infarction in Japanese and Caucasians in North America demonstrated that cardiac events were significantly less in Japanese even when the initial infarct size was similar. Ischemic heart disease constitutes the most common cause of heart failure in the United States but nonischemic cardiomyopathy occurs more frequently in Japan. On the other hand, vasospastic angina is by far more common in the Japanese population. The first comparative study we carried out in Japanese and Italian patients with acute myocardial infarction also showed that percentage of vasospasm in the infarct-related arteries is 3 times higher in Japanese. Thus, coronary spasm appears to be more important as well as the pathogenesis of myocardial infarction in Japan. This fact was reflected by the more frequent use of calcium antagonists in Japan during the acute phase of myocardial infarction. On the other hand, the use of inotropic agents has now been contraindicated for the treatment of patients with chronic heart failure, however it may not be the case in the Japanese population in whom mortality is relatively low. Cardiotonic therapy could be justified in Japanese as it allows optimal care in the context of relief of symptoms and an improved quality of life. Therefore, each racial group should obtain specific evidence aimed at developing its own guidelines for therapy rather than translating major guidelines developed for other populations.

Angina Pectoris, Variant↗
PubMed2002

[Rest delayed images on 99mTc-MIBI myocardial SPECT as a noninvasive screen for the diagnosis of vasospastic angina pectoris].

Diagnostic usefulness of 99mTc-MIBI myocardial SPECT at rest was examined in 39 cases of coronary vasospastic angina pectoris who were diagnosed by a positive reaction to ergonovine provocation. SPECT was performed 45 minutes (early image) and 3 hours (delayed image) after the intravenous injection of approximately 600 MBq of MIBI. Decrease in accumulation was ranked by four defect scores (0: normal; 1: slight decrease; 2: moderate decrease; 3: severe decrease) and the total defect score was evaluated semiquantitatively. The washout rate between the normal area and the spasm area was also evaluated quantitatively using bull's eye. As a result, 15 cases (15/39; 38.4%) showed decreased accumulation in the early image and 27 cases (27/39; 69.2%) showed decreased accumulation in the delayed image. All of the cases which showed decreased accumulation in the early image had decreased accumulation in the delayed image as well. In 6 cases (6/34; 17.6%) showed ST wave changes during exercise ECG and 16 cases (16/34: 47%) showed decreased accumulation in the exercise myocardial SPECT. The washout rate of MIBI in the decreased accumulation area was significantly higher than that of the normal area. Of 32 ergonovine induced vasospastic area, 23 areas (72%) exhibited decreased accumulation in the delayed image for the same area. Decreased accumulation in the delayed image in MIBI was due to the enhanced washout, which, in turn, indicated declined retention of MIBI by mitochondrial membrane. In coronary vasospastic angina pectoris, spasm induced ischemia was thought to have an effect on the mitochondria. This study suggested that even with a normal exercise ECG and exercise myocardial SPECT, there's a strong possibility of coronary vasospastic angina pectoris if a decreased accumulation was found in the delayed image in the MIBI myocardial SPECT at rest. Hence, in diagnosing coronary vasospastic angina pectoris, the delayed image in the MIBI myocardial SPECT at rest was believed to be useful.

Aged↗
PubMed2002

[Potential role of leptin and insulin resistance assessed by the glucose clamp technique in coronary artery disease].

OBJECTIVES: Leptin may correlate with insulin resistance and be an important factor in patients with coronary artery disease. Therefore, we examined whether plasma leptin levels and insulin resistance are linked with coronary artery disease. METHODS: Plasma leptin levels and insulin resistance, assessed by the hyperinsulinemic euglycemic clamp technique, were measured in control subjects (n = 12, mean age 62 +/- 10 years), and in patients with obstructive coronary artery disease (n = 15, mean age 64 +/- 8 years) or vasospastic angina (n = 12, mean age 62 +/- 12 years). RESULTS: Plasma leptin levels were significantly higher (p < 0.017) in patients with obstructive coronary artery disease (8.4 +/- 2.7 ng/ml) and vasospastic angina (7.9 +/- 2.1 ng/ml) than in patients without obstructive coronary artery disease (4.7 +/- 1.4 ng/ml). Mean glucose infusion rate was significantly (p < 0.017) lower in patients with obstructive coronary artery disease (4.39 +/- 1.78 mg/kg/min) and vasospastic angina (3.57 +/- 1.72 mg/kg/min) than in patients without obstructive coronary artery disease (8.74 +/- 1.05 mg/kg/min). The plasma levels of leptin were negatively correlated with mean glucose infusion rate (r = -0.67, p < 0.01). The other coronary risk factors were similar in these three groups. CONCLUSIONS: Plasma leptin levels are correlated with insulin resistance and may be associated with coronary artery disease.

Aged↗
PubMed2000

The effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus.

OBJECTIVE: To investigate the effect of left ventricular diastolic dysfunction on the pathogenesis of angina decubitus (AD). METHODS: The study population consisted of three groups: 20 individuals without cardiovascular studied as group I. Group II included 20 patents with coronary artery disease and without AD. Thirty-one patients with AD and ejection fraction (EF) > 50% were studied as group III. Group II and III were matched for age, EF and extent of coronary artery disease. RESULTS: Left ventriculography (LVG) showed that left ventricular (LV) first 1/3 filling fraction (1/3FF) was significantly lower in group III than in group II and I (both P < 0.001), but LV late 1/3 FF was much higher in group III than in group II and I (P < 0.05, P < 0.01). Left ventricular end-diastolic pressure (LVEDP) was markedly increased before and after LVG in group II and III as compared with group I (both P < 0.05, both P < 0.001). The difference of LVEDP caused by left atrial contraction (left atrial contraction pressure difference, LACPD) before and after LVG was much higher in group III than in group I ( P < 0.01, P < 0.001). However, there we significant differences in LVEDP and in LACPD between before and after LVG only in group III (both P < 0.01). CONCLUSION: The patients with AD have LV diastolic dysfunction, which may be closely related to the pathogenesis of angina decubitus.

Adult↗
PubMed1992

[The use of ergonovine in the hemodynamics laboratory].

In our department we have reviewed the use of ergonovine maleate as a provocative agent for inducing coronary spasm during coronary arteriography. From January 1978 to December 1991 the test has been performed in 116 patients. According to their symptoms, the patients were divided into 4 groups: (A) patients with exertional angina: 16 patients (13.8%), (B) patients with angina at rest: 64 patients (55.2%), (C) patients with atypical chest pain: 29 patients (25%), and (D) patients with previous myocardial infarct: 7 patients (6%). We have subdivided the patients with angina at rest, according to the electrocardiogram recorded during pain, into: (1) 16 patients with ST-segment elevation; (2) 14 patients with ST-segment depression or T wave inversion; (3) 5 patients with electrocardiogram unchanged during angina; (4) 29 patients with no electrocardiogram recorded during angina. In 67 patients (57.7%) the coronaries were normal, 17 patients (14.6%) had mild irregularities, 26 patients (22.4%) had non critical fixed obstructions (< or = 70%), and in 6 patients (3.5%) there were fixed coronary narrowings > or = 70%. The left ventricle was normal in 85 subjects (73.2%), hypo or akinetic in 31 (26.8%). After routine coronary angiography and ventriculography, ergonovine maleate, 0.05 up to 0.4 mg, was given intravenously. The ergonovine test was considered positive when a focal spasm narrowed a normal coronary artery, or one with a mild fixed obstruction (< or = 50%) to more than 70%, or when a 70% stenosis became occluded. The development of angina and/or electrocardiographic changes were not taken as a criteria of positivity. Thirteen tests (11.2%) were considered positive.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

A case of coronary artery spasm during oral surgery under general anesthesia.

A case of coronary artery spasm during oral surgery under general anesthesia is reported. The patient, aged 44 years, 160 cm in height, and 55 kg in weight, was scheduled for radical surgery for right maxillary sinusitis and was healthy except for the disease requiring surgery. Just before the start of the surgery, severe and persistent hypotension with tachycardia after local injection of 3% propitocaine with 0.03 IU/mL felypressin (Citanest-Octapressin) was followed by sudden ST elevations in the ECG. Immediate continuous intravenous injection of nitroglycerin was thought to be effective. The patient recovered without any sequelae.

Adult↗
PubMed1976

[Myocardial "bridges". A new pathogenetic problem in angina without coronary obstruction (author's transl)].

Six patients showing at coronary angiography normal coronary arteries during dyastole, but a segmental constriction of the left anterior descending artery during systole, were studied. Four of these patients in which the degree of systolic artery narrowing was more evident had typical angina and positive stress test. In two of these cases, a probable idiopathic cardiac hypertrophy was present. The pathogenetic significance of the angiographic findings are discussed, on the basis of common knowledge of coronary physiology and of pathophysiology of angina with normal coronary arteries.

Adult↗
PubMed2004

[Nicergoline-induced Prinzmetal angina. "Heartache" instead of headache].

A 56 year old woman was admitted to our hospital with crescendo chest pain in the last ten days. Her past history included hypertension treated by 100 mg metoprolol for more than ten years and right carotid endarterectomy. She complained headache and a treatment of 20 mg nicergoline (ergoline derivate) daily was started. Her chest pains started always one hour after the nicergoline intake. The chest pain was accompanied by breathing difficulties and sweating of 5 min duration at first but the next days it lasted longer and longer. Next morning following her admission, one hour after the nicergoline administration she had severe chest pain again. The ECG showed ST-segment elevation in inferior leads resolved after nitroglycerin administration. The angiogram revealed normal coronary artery. Nicergoline was stopped. The patient was treated with felodipine and remains free of symptoms. Nicergoline was good for head but worse for heart in this case.

Angina Pectoris, Variant↗