Incidence Of Chest Pain Research Articles

Hyperventilation and ergonovine tests in prinzmetal's variant angina pectoris in men

Hyperventilation and ergonovine tests were carried out in a group of 30 patients with variant angina to assess the sensitivity of the 2 tests and to correlate the response with spontaneous disease activity. Hyperventilation produced a positive response in 83% (25 of 30) and ergonovine in 93% (28 of 30) of the patients. After hyperventilation 22 of 25 showed ST-segment elevation, 2 ST depression and 1 T-wave pseudonormalization; after ergonovine ST-segment elevation developed in 23 patients, ST depression in 4 and T-wave pseudonormalization in 1. In all cases the electrocardiographic changes occurred in the same leads as during the spontaneous attacks. The incidence of chest pain and ventricular arrhythmias was similar during both tests; spontaneous remission of ischemia, however, was more frequent (48 vs 14%) after hyperventilation than after ergonovine. Acute ischemia developed at a mean of 218 ± 112 seconds after the end of hyperventilation in 19 of 25 positive tests; at that time double product was not significantly different from basal values. The sensitivity of hyperventilation was similar (95 vs 100%) to ergonovine in the patients with ≥1 daily attack, while in those with < 1 daily attack the sensitivity of hyperventilation decreased to 55% compared to 77% with ergonovine. Thus, in variant angina the sensitivity of both tests correlates with disease activity. Hyperventilation is a safe provocative test with a sensitivity similar to ergonovine in patients with active disease; however, in patients with sporadic attacks hyperventilation has a lower sensitivity than ergonovine and therefore a limited diagnostic value.

Lovastatin vs Cholestyramine Therapy for Primary Hypercholesterolemia

To the Editor.— Lovastatin is a remarkable drug. Better than any other medication yet available, lovastatin promptly lowers low-density lipoprotein cholesterol levels, with few apparent side effects. When I and my internist colleagues in west central Maine began prescribing lovastatin in October 1987, we were struck soon by what seemed like an unusual incidence of chest pain in patients recently started on therapy with the drug. In November 1987 one of 18 and in December 1987 seven of 20 admissions to Franklin Memorial Hospital for chest pain involved patients taking lovastatin. In three cases (two individual patients), starting lovastatin therapy did not seem to have changed the previous tempo of coronary symptoms. However, five patients with severe coronary atherosclerosis experienced a distinct acceleration of coronary symptoms between five and 49 days after starting lovastatin therapy; four developed newly unstable angina and one suffered an acute myocardial infarction. Was this a

Effect of first and subsequent use of hemodialyzers on patient well-being: the rise and fall of a syndrome associated with new dialyzer use.

In a single large dialysis unit in which dialyzers are routinely subjected to multiple use, the incidence rates of intradialytic symptoms during first use and reuse were compared. Dialyses administered during two periods were analyzed: During the first (26,592 treatments), dialyzers were processed by a manual method before both first and subsequent use. During the second (12,395 treatments), dialyzers were processed by an automated machine method before first and subsequent use. During the first (manual processing) period, 12 symptoms were found to occur more frequently during first use than during reuse. The most striking findings related to chest pain (2.8 times more frequent with first use), back pain (6 times), and concurrent chest and back pain (42 times). Thus, a "first-use syndrome" characterized by chest and back pain was clearly evident. During the second (machine processing) period, the previously noted increased symptom incidence during first use was no longer present. In particular, the incidence of chest pain and back pain was no longer greater during first use than during reuse. Our results suggest that subjecting dialyzers to an automated reuse processing system before first use can markedly diminish the incidence of first-use syndrome.

Mechanism and significance of a decrease in ejection fraction during exercise in patients with coronary artery disease and left ventricular dysfunction at rest

The purpose of this study was to determine whether an exercise-induced decrease in ejection fraction in patients with coronary artery disease and left ventricular dysfunction at rest represents ischemia or the nonspecific response of a compromised left ventricle to exercise stress. Accordingly, radionuclide ejection fraction responses of 246 patients with coronary artery disease and an ejection fraction at rest of less than 0.50 were compared with those of a "nonischemic" control group of 48 patients with idiopathic dilated cardiomyopathy and a similar degree of ventricular dysfunction. The significance of the ejection fraction response in the group with coronary artery disease was further examined by relating it to the angiographic extent of coronary artery disease, severity of angina, incidence of chest pain and electrocardiographic ST segment depression during exercise and long-term prognosis. The ejection fraction decreased by greater than or equal to 0.01 and greater than or equal to 0.05 during exercise in 48 and 28%, respectively, of the patients with coronary artery disease compared with only 8 and 2%, respectively, of the patients with cardiomyopathy. When exercise was limited by fatigue at a submaximal heart rate, the ejection fraction decreased in 25% of the patients with coronary artery disease but in none of the patients with cardiomyopathy. Patients with coronary artery disease whose ejection fraction decreased during exercise had a significantly higher incidence of three vessel disease, exercise-induced chest pain or ST depression and late mortality than did patients whose ejection fraction did not decrease. These relations were confirmed equally in subgroups of patients with moderate (ejection fraction 0.30 to 0.49) and severe (ejection fraction less than 0.30) left ventricular dysfunction. Thus, in patients with coronary artery disease and left ventricular dysfunction at rest, a decrease in ejection fraction during exercise is more likely to indicate ischemia than a nonspecific left ventricular response to exercise stress. In the individual patient, a decrease of 0.05 or greater, or a decrease during submaximal exercise, appears to be highly specific for ischemia. A decrease in ejection fraction identifies a subgroup of patients with a high prevalence of multivessel coronary artery disease and a high risk of death during long-term follow-up on medical therapy.

Clinicopathologic aspects of ischemic heart disease in the elderly.

Clinicopathologic correlation studies were performed to clarify the characteristic features of myocardial infarction (MI) in the elderly. A total of 203 cases of MI were found in 1, 000 consecutive autopsy of the aged. There were 113 men and 90 women with an average age of 78.5 years.There were 117 cases of large MI and 82 fresh MI. With aging, there was a tendency of decrease in ratio of large MI, and increase in middle-sized MI. When coronary stenosis of more than 75% was considered to be significant, there were 97 cases of 3 vessel disease, 51 of 2 vessel dis-ease, and 30 of 1 vessel disease; that is 178 cases (87.7%) showed significant stenosis in at least 1 vessel. Remaining 25 cases of MI had no sig-nificant coronary stenosis. In general, large MI had marked coronary stenosis. Some of the MI without significant coronary stenosis were explained by uncommon pathogenesis such as disseminated intravascular coagulation or atrial fibrillation. Incidence of coronary thrombi was the highest (76.7%) in large and fresh MI.Electrocardiographic diagnosis was correct in 65% of large fresh MI. Incidence of chest pain was 48% in large acute MI and 27.8% in middle MI, whereas various complications such as shock (60%), congestive heart failure (53.3%), and arrhythmia (65%) were frequently found. Causes of death in large acute MI were arrhythmia in 16 cases, cardiac rupture in 13, and sudden death in 8.There were 15 cases of cardiac rupture, which occurred within 5 days from the onset of acute MI in all. Site of MI and rupture was anterior in 8, inferior in 5, and lateral in 2, including 1 case of septal perforation in anterior MI. There were 21 cases of papillary muscle dysfunction. From analysis of clinical sequence of MI and mitral regurgitation, 3 types of the syndrome were classified; 15 cases due to old MI, 2 cases due to acute MI, and 4 cases of mitral regurgitation followed by MI. There were 24 cases of conduction disturbances in 82 cases of acute MI (29%). In atrioventricular (A-V) block, site of lesions in conduction system was examined by the serial sections, which was located at the A-V node in 2, A-V bundle in 4, and bilateral bundle branches in 4.

Mortality and incidence of chest pain after an exercise intervention programme.

One hundred and sixty-six middle-aged Finnish men free of clinical coronary heart disease (CHD), but having at least one CHD risk factor, participated in an 18-month controlled exercise intervention study, one-half as an exercising group and the other half as a matched control group; thereafter all 166 followed a partially controlled exercise programme for the next year. These men formed the intervention group for the present follow-up study covering the subsequent 6 years. The reference group for the follow-up comprised 152 men who fulfilled the same inclusion criteria for the original study as the intervention subjects, but who had been excluded from the study for non-medical reasons, mainly because they could not be pair-matched. Mortality statistics were collected, and a postal questionnaire on chest pain symptoms and physical activity was sent to all of the men 8 years after the start of the study. On CHD death and four deaths occurred in the reference group, and one CHD and no other deaths in the intervention group. Severe chest pain possibly suggestive of myocardial infarction was more common in the reference group than in the intervention group, but no difference was found in angina pectoris symptoms. The level of recent physical activity or smoking did not affect the chest pain symptoms independently.

Open evaluation of labetalol in the treatment of angina pectoris occurring in hypertensive patients.

1 In nine hypertensive subjects with angina pectoris, labetalol diminished the incidence of chest pain occurring spontaneously or induced by exercise. 2 Labetalol lowered BP in all subjects. 3 Exercise tolerance at maximum levels was increased by labetalol. 4 Improved cardiac function by labetalol may be related to decreased afterload on the left ventricle, and diminished oxygen utilization by the myocardium.

Effect of estrogenic hormone on serum lipids in patients with coronary arteriosclerosis.

The oral administration of large amounts of ethinyl estradial daily to patients with coronary arteriosclerosis and to control subjects consistently produced a favorable effect upon the serum lipid pattern. However, toxic effects of the estrogen prohibited its prolonged use. The clinical status of the patient as evidenced by the incidence of chest pain or the electrocardiogram were not altered during the period of the study.