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At least 19 recordsLinked to original sources
PubMed1995

Comparison of coronary angiographic narrowing in stable angina pectoris, unstable angina pectoris, and in acute myocardial infarction.

Coronary angiographic findings were compared in patients who presented with acute myocardial infarction (AMI, n = 75), unstable angina pectoris (UAP, n = 36), or stable angina pectoris (SAP, n = 36) for > or = 2 years without evidence of any previous acute event and with an angiogram within 2 years of the initial symptoms. Angiograms were evaluated blindly for severity, extent (depending on the percentage of each coronary segment showing atherosclerosis), and pattern (discrete, < 3 loci of narrowings involving < 50% of any segment; diffuse, anything exceeding this). Patients in the SAP group had more narrowed arteries (2.4 +/- 0.7 vs 1.3 +/- 0.6 [p < 0.02] and 1.4 +/- 0.6 [p < 0.02]), more stenoses (6.0 +/- 3.3 vs 2.1 +/- 1.5 [p < 0.01] and 2.6 +/- 1.7 [p < 0.05]) and occlusions (1.3 +/- 1.1 vs 0.7 +/- 0.6 [p = 0.05] and 0.3 +/- 0.5 [p < 0.02]), and a greater extent index (0.9 +/- 0.5 vs 0.5 +/- 0.3 [p < 0.02] and 0.5 +/- 0.3 [p < 0.02]) than those in the AMI and UAP groups. Furthermore, a discrete pattern was less prevalent in patients with UAP than in those with SAP or AMI (3% vs 40% [p < 0.02] and 25% [p < 0.05], respectively). In conclusion, patients who present with acute coronary syndromes have less extensive atherosclerosis than those who present with chronic stable angina. Therefore, in the former group, coronary atherosclerosis appears to be more susceptible to ischemic stimuli responsible for acute coronary syndromes.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1995

[Diagnostic methods in angina pectoris. The Angina Pectoris Study Group of the Ischemic Cardiopathy Section and Coronary Units of the Spanish Society of Cardiology].

Diagnosis and risk stratification in angina pectoris is supported on clinical evaluation, rest electrocardiogram, exercise stress test and coronary angiography. Use and timing application of that diagnostic methods depend on coronary artery disease prevalence and on clinical situation. This review describe diagnostic and prognostic value of the tests in angina pectoris.

Angina Pectoris↗
PubMed1993

Variability over time of haemostatic and other cardiovascular risk factors in patients suffering from angina pectoris. ECAT Angina Pectoris Study Group.

The variability of haemostatic factor measurements in patients presenting with angina pectoris is investigated. In all, 219 middle aged patients (almost all men) provided repeat measurements 2.5 years apart on a battery of haemostatic and haematological tests and other cardiovascular risk factors. Correlations between repeat measurements were lower than might be expected in a healthy population, reflecting a relatively large degree of variability within individuals over time. The highest correlations observed for haemostatic factors were for von Willebrand factor related antigen (r = 0.48) and fibrinogen (r = 0.45). The correlations were generally lower amongst patients who had undergone coronary surgery or angioplasty between the two measurements. We conclude that the underlying relationship of fibrinogen to coronary risk must be much greater than is generally appreciated, since even single measurements are found to be important predictors of risk, despite only moderate stability over time. The very low correlations for beta-thromboglobulin (r = 0.10) and platelet factor 4 (r = 0.03) which were observed in this study casts doubt on their potential usefulness as predictors of long-term cardiovascular risk.

Adult↗
PubMed1983

Myocardial oxygen supply/demand ratio in aortic stenosis: hemodynamic and echocardiographic evaluation of patients with and without angina pectoris.

Angina pectoris is a common symptom in patients with aortic stenosis without coronary artery disease. To investigate the correlates of angina pectoris, echocardiographic and hemodynamic data from 44 patients with aortic stenosis and no coronary artery disease (mean age 56 +/- 10 years) were analyzed. Twenty-three patients had no angina pectoris and 21 patients had angina pectoris. The ratio of the diastolic pressure-time index (area between the aortic and left ventricular pressure curves during diastole) to the systolic pressure-time index (area under the left ventricular pressure curve during systole), an index of the oxygen supply/demand ratio, was not different in patients with or without angina pectoris. There were no differences between patients with and without angina pectoris in echocardiographically determined wall thickness, chamber size, systolic and diastolic wall stress and left ventricular mass; in electrocardiographically defined voltage; and in hemodynamically defined aortic valve area, transaortic gradient and stroke work index. Thus, echocardiographic and hemodynamic measurements at rest are not significantly different in the presence or absence of angina pectoris in patients with aortic stenosis. Dynamic data appear to be essential for evaluation of the mechanisms of angina pectoris in patients with aortic stenosis.

Adult↗
PubMed1997

Clinical importance of late potential in patients with angina pectoris.

Angina pectoris, especially vasospastic angina, is associated with lethal ventricular tachycardia. The clinical importance of late potential in angina pectoris was assessed in 171 patients with angina-like pain. Patients were categorized into three groups based on coronary angiography. Patients in the exertional angina pectoris (AP) group exhibited at least 75% organic stenosis of a major coronary artery after intracoronary injection of a nitrate drug (82 patients). Patients in the chest pain syndrome (CPS) group had no significant organic stenosis of the coronary artery and the acetylcholine-loading test produced negative results (39 patients). Patients in the vasospastic angina (VSA) group had a positive acetylcholine-loading test (50 patients). When the filtered QRS duration was prolonged to above 130 msec and/or the root-mean-square voltage in the last 40 msec was below 15 microV in VCM-3000, the late potential was judged to be positive. The incidence of late potential was higher in the AP group (23.2%) and the VSA group (38.0%) than in the CPS group (7.7%) (p < 0.05, p < 0.01). Comparison of late potential incidence between patients with coronary vasospasm below 90% (group 1) and patients with above 90% (group 2) induced by the acetyl-choline-loading test in the VSA group showed more late potential in group 2 than in group 1 (84.2% vs 15.8%). Late potential was present in 19 (23.2%) patients in the AP group, but only 2 (10.5%) had under 90% degrees of coronary stenosis and the other 17 (89.5%) had greater than 90% degrees of stenosis. Thus, late potential was mainly observed in patients with severe organic stenosis. These results suggest that the origin of late potential is associated with inhomogeneous electrical excitation induced by frequent angina attack and the duration of total or near total occlusion. Strict clinical management is required for patients with VSA or AP associated with late potential.

Acetylcholine↗
PubMed1990

[Insurance related medical aspects of angina pectoris].

Angina pectoris or chest pain is the main symptom of coronary insufficiency which may lead to reversible or irreversible ischaemia. It must be distinguished from other cardiac or thoracic causes. Nervous or functional disorders hardly influence life expectancy. Unstable angina pectoris, pre-infarction syndrome or post-infarction angina cannot be accepted for life insurance. We have divided stable angina pectoris into four classes in accordance with the NYHA classification. We have indicated the relevant extra mortality. Separate consideration must be given to additional factors adversely affecting the risk.

Adult↗
PubMed1996

Can improved quality of care reduce the costs of managing angina pectoris?

Angina pectoris is a common symptom in patients over 50 years and is usually secondary to myocardial ischaemia resulting from coronary artery disease. The management of angina should be aimed at the maintenance or improvement of quality of life and delaying death. There are three strategies that may be adopted: medical, percutaneous transluminal coronary angioplasty and surgery. The majority of patients with angina can be controlled symptomatically most of the time by medical treatment alone. Any assessment of cost of treatment must take into account the cost of investigation, treatment, the morbidity associated with procedures or side effects of drugs, together with that of recurrent hospitalization, prolonged life and premature death. In addition, the duration of treatment has a major bearing on cost. Taking these factors into account, medical therapy is the least expensive short- and long-term treatment for angina pectoris. A medical approach to treatment also has considerable advantages over an interventional approach in terms of major morbidity. Only one of six surgical trials has demonstrated a survival benefit.

Angina Pectoris↗
PubMed1987

Efficacy of a new calcium antagonist PN 200-110 (isradipine) in angina pectoris.

Angina pectoris is one of the major syndromes against which to test the therapeutic effectiveness of any new calcium antagonist. An interim analysis of the efficacy and safety of a new dihydropyridine calcium antagonist (PN 200-110 [isradipine]) in patients with confirmed coronary artery disease is reported. The study was carried out in 3 centers; 50 patients of an anticipated 96 have completed the double-blind comparative phases in 3 separate studies. Preliminary results from the placebo-controlled study indicate that PN 200-110 was significantly more effective than placebo in reducing the anginal attack rate and glyceryl trinitrate consumption in the 15 patients so far enrolled. Dose-response comparisons against nifedipine in 21 patients and against isosorbide dinitrate in 14 patients demonstrate that PN 200-110 has a similar antianginal efficacy profile to both drugs. No significant change in any of the monitored safety factors was noted in any of the patients taking PN 200-110. The side-effects profile compared favorably with that of nifedipine. These interim results suggest that PN 200-110 will prove to be an effective and safe drug for the treatment of angina pectoris.

Angina Pectoris↗
PubMed1984

Alpha- and beta-blockade in angina pectoris.

Angina pectoris encompasses a clinically diverse group of syndromes in which the common factor is myocardial ischaemia resulting from an imbalance between oxygen requirement and delivery. Anginal pain is most frequently precipitated by exercise, but may occur without any apparent cause at rest. Fixed obstructions in the coronary vessels, often attended by thickening of the overlying coronary artery media, are the most frequent cause of ischaemic cardiac pain. The resulting myocardial fibrosis impairs efficient filling and emptying of the ventricles, further aggravating the functional embarrassment resulting from the reduced coronary blood flow. In stable coronary heart disease the increased energy demands during exercise are associated with the rapid development of a haemodynamic profile characteristic of acute left ventricular failure. This results in further substantial increases in pressure work, wall stress and oxygen consumption of the left ventricle. The reflex sympathoadrenal consequences of these primary haemodynamic changes lead to further mechanical and electrical embarrassment of the ischaemic heart. Increased stimulation of beta 1- and beta 2-receptors in the heart increases heart rate and contractility and thereby myocardial oxygen demand. Increased stimulation of alpha-receptors in the peripheral veins and arteries indirectly increases left ventricular oxygen demand still further by increasing preload and afterload, respectively. The reduced blood flow to the endocardium enhances its sensitivity to increased sympathoadrenal stimulation and facilitates initiation of arrhythmias. Blockade of all adrenergic activity, particularly in the myocardium, coronary arteries and peripheral blood vessels should, therefore, help alleviate the myocardial ischaemia. There is a rational argument for the use of alpha-blockade in coronary heart disease, particularly in conjunction with beta-blockade. Attenuation of the risk of coronary spasm and ventricular arrhythmias and reduction of pressure work and left ventricular afterload are amongst the potential attributes of alpha-blockade. Alone, however, their utility is severely limited by the risks of hypotension and reduction in coronary perfusion pressure and reflex oxygen-wasting tachycardia. Alone, alpha-adrenoceptor antagonists have no place in the treatment of angina pectoris. beta-Adrenoceptor blocking drugs competitively inhibit catecholamines at both cardiac and peripheral vascular beta-adrenergic receptors. Their main advantage is that they reduce many of the important determinants of myocardial oxygen consumption, particularly by reducing the heart rate during exercise.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenergic alpha-Antagonists↗
PubMed1982

Effect of the calcium antagonistic agent nifedipine on platelet aggregation response to exercise in patients with angina pectoris.

Angina pectoris patients were divided into two groups of unstable angina and stable angina, platelet aggregation was measured at rest and after treadmill exercise tolerance, and then the effects before and after the administration of nifedipine (Adalat) were examined. As a result, no significant difference in platelet aggregation at rest was seen in either group between before and after the administration of nifedipine, but the acceleration of platelet aggregation response to exercise was significantly inhibited by nifedipine. Moreover, the extent of inhibition was more notable in unstable angina group. It was discussed that such an inhibitory effect of nifedipine on platelet aggregation response to exercise could be related to vasospasm and in its turn possibly takes part in the development of myocardial ischemia.

Adult↗