Uncomplicated Angina Research Articles

Clinical characteristics and cigarette smoking in relation to prognosis of angina pectoris in Framingham.

A long-term follow-up study of 130 Framingham, Massachusetts, men with newly diagnosed uncomplicated angina pectoris was undertaken in an attempt to identify medical and personal characteristics which could predict the likelihood of a future coronary event. Analyses indicated that, among the baseline characteristics, systolic blood pressure and electrocardiographic findings were the most powerful independent predictors of the outcome. Elevated blood pressure or an abnormal electrocardiogram increased coronary risk more than twofold. The lack of association between smoking at diagnosis and a new event appeared to be related to changes in habits after angina onset. Further scrutiny of the data indicated that, irrespective of blood pressure and electrocardiographic findings, those less than 60 years of age at angina onset who were nonsmokers or quitters during follow-up had a definite prognostic advantage over similarly aged continuing smokers. These results could not be explained by differences in coronary risk factors prior to symptom onset or by changes in factors other than smoking during follow-up. The findings suggest that stopping the cigarette smoking habit can improve both short-term and long-term prognosis in the younger patient and angina pectoris.

Aggregation of coronary risk factors in families of men with fatal and non-fatal coronary heart disease.

The occurrence of main coronary risk factors was assessed in the families of 211 men under age 56 from East Finland. Fifty men were survivors of a recent myocardial infarction, 55 had died of myocardial infarction, 53 suffered from uncomplicated angina, and 53 were healthy reference men. Familial hyperlipidaemia was twice and familial hypertension three times as common in case as in reference families; other risk factors were equally common in both. Familial hypercholesterolaemia was commonest in the families of men with fatal myocardial infarction, and multiple type familial hyperlipidaemia in those of men with angina. Any increase in familial aggregation of coronary heart disease was invariably paralleled by increased aggregation of hyperlipidaemia and hypertension, with the most impressive aggregation of both traits in case families with a maternal history of early coronary death. It is concluded that most of the familial aggregation of coronary heart disease is mediated by familial aggregations of hyperlipidaemia and hypertension.

Familial aggregation of coronary heart disease in a high incidence area (North Karelia, Finland).

Occurrence of coronary heart disease was assessed in families of 211 men under the age of 56 from East Finland. Fifty men were survivors of recent myocardial infarctions, 55 had died of myocardial infarction, 53 suffered from uncomplicated angina pectoris, and 53 were healthy reference men. Overall prevalence of coronary heart disease was similar in familes of all case probands. By age 70, case fathers had a 6 times greater cumulative risk (a 36% chance) of dying from coronary heart disease than reference fathers, whereas there was only a small difference between case and reference mothers. Cumulative risk of developing fatal or non-fatal coronary heart disease by age 65 was 4.5-fold for case brothers (70%) and 2.6-fold for case sisters (40%), when compared with reference sibs. The risk was greatest for case sibs with a parental, especially a maternal, history of premature coronary heart disease. Clinical manifestations of coronary heart disease showed similarities within sibships. Cardiac deaths were commonest in sibs of the fatal myocardial infarction probands, whereas angina was commonest in sibs of the angina pectoris probands.

Natural history of angina pectoris in the Framingham study: Prognosis and survival

The evolution of 303 cases of angina in a general population sample of 5,127 persons was ascertained and revealed that the lot of the angina victim is not a happy one. Prognosis as to survival and progression to more serious coronary manifestations was discouraging in men. One in 4 men with angina can expect to have a coronary attack within 5 years. The risk is half this for women. About 30 percent of those over 55 will die within 8 years, and 44 percent of the coronary deaths will be sudden. Mortality was close to that which follows the posthospital phase of myocardial infarction. Surprisingly, survival in men with uncomplicated angina was no better than that for angina which follows an infarction. Angina was more likely to be the presenting complaint of coronary disease in women (65 percent) than in men (37 percent). In men 45 percent of angina arose out of myocardial infarction compared to 15 percent in women. Half of those sustaining initial myocardial infarctions had angina following it, 31 percent experiencing it for the first time. In those with angina who sustained an infarction, the angina disappeared in only 15 percent of men and no women, a rate lower than the 30 percent spontaneous rate of disappearance. Only 23 percent of infarctions were preceded by angina. Almost 1 in 4 myocardial infarctions were silent or went unrecognized. Such infarctions were rare in persons with prior angina.

Comparison of Adrenergic Beta-blocking Drugs in Angina Pectoris

The symptomatic, electrocardiographic, and haemodynamic effects of two adrenergic beta-blocking drugs, oxprenolol and propranolol, have been compared in equipotent intravenous doses in six patients with uncomplicated angina pectoris during treadmill exercise. The method of comparison included double-blind assessment and analysis with placebo control and randomized serial comparison in each patient. Both drugs produced an equal amelioration in symptoms in most of the patients. This was closely correlated with improvement in the electrocardiographic changes and a significant reduction in the exercising heart rate and systemic arterial pressure. This method of double-blind combined subjective and objective assessment carries distinct advantages in the comparative assessment of drug treatments in angina pectoris.

REVERSIBLE LEFT-VENTRICULAR FAILURE IN ANGINA PECTORIS

Clinical, electrocardiographic, and hæmodynamic observations were made on six patients with uncomplicated angina pectoris and six normal controls during rest and during supine leg exercise. During angina precipitated by exercise the most striking clinical finding was breathlessness due to acute left-ventricular failure; the rapid disappearance of symptoms after stopping exercise was accompanied by the rapid return to normal of left-ventricular function. The deterioration in left-ventricular function was accompanied by striking and equally rapidly reversible electrocardiographic S-T depression. It is suggested that the production of angina may be explained predominantly by the hæmodynamic consequences of the acute left-ventricular failure.

ECG Criteria for Angina Pectoris Derived from Resting Frank Lead Electrocardiograms

Eighty-one men patients in the age range 40 to 80 with uncomplicated angina were evaluated for ST segment and ST-T interval abnormalities using the orthogonal lead system of Frank. Electrocardiograms were recorded on FM magnetic tape and analyzed by a digital computer. It was found that by using one of the following three criteria: 0.0 sec ST amplitude in X ≤ −0.09 mV, 4/8 ST-T amplitude in Y ≤ −0.03 mV or 0.04 sec ST amplitude in Z ≥ 0.02 mV, the diagnosis of angina could be made correctly in 51.8 percent of the cases. These criteria would also misclassify 7.8 percent of normal persons as angina patients. Left ventricular hypertrophy (LVH) cannot be separated from angina on the basis of ST segment and ST-T interval abnormalities. Patients have to be tested for high voltage for effective separation of these two entities. Comparison between the diagnostic value of the exercise electrocardiogram and the resting VCG (Frank) in angina pectoris was made.

Intermittent claudication. Incidence in the Framingham Study.

A general population sample of adult men and women was followed biennially over 14 years during which time 79 men and 46 women developed initial symptoms of intermittent claudication. A detailed examination of the incidence of this manifestation of atherothrombosis in comparison to that of coronary heart disease and atherothrombotic brain infarction was undertaken. As for coronary heart disease (CHD), the incidence of intermittent claudication increased with age. Women lagged behind men by 10 years in incidence. Atherothrombotic brain infarction in contrast exhibited no male predominance and after the early sixties the women actually surged ahead. Uncomplicated angina, surprisingly, resembled brain infarction more than intermittent claudication in the age-sex trend. A pronounced increase in risk of intermittent claudication was noted for persons with CHD in general and angina in particular, suggesting a common underlying basis for claudication and coronary disease. The principal hazard for subjects with claudication appeared to derive from an increased propensity to cardiovascular morbidity and mortality rather than from the consequences of impaired circulation to the limb. Risk of death was twofold for those with claudication as compared to those without.

Multiple lead electrocardiograms in angina pectoris

The increased general use of unipolar limb and multiple precordial leads makes it desirable to re-evaluate the role of electrocardiography in medical practice. In the present study the twelve lead electrocardiograms (three standard, three augmented unipolar limb, and six unipolar precordial leads) of patients with uncomplicated angina pectoris are compared with those of a group of subjects similar in age but without clinical symptoms or signs of heart disease. The purpose is to determine what such tracings show in patients with angina pectoris and to differentiate these findings from those of patients with acute myocardial infarction on the one hand and those with no symptoms or signs of heart disease on the other. The changes in Q, RS-T, and T characteristic of acute myocardial infarction are well known and are of considerable diagnostic importance when well defined and progressive. When such findings are borderline, however, their significance is difficult to evaluate. For example, small Q waves, slight elevation or depression of RS-T segments, or low amplitude T waves may represent: (1) the earliest objective evidence of acute myocardial infarction; (2) the only residual evidence of past infarction; (3) myocardial disease without infarction; or (4) they may occur in the absence of myocardial damage. The limits and variations of normal in unipolar limb and precordial electrocardiograms have not been established with certainty, and the frequency of borderline tracings in apparently normal adults is not well known. Until sufficient experience has accumulated to be certain of these fundamentals, it is possible that the significance of minor changes may be overemphasized. Not uncommonly, unipolar limb and multiple precordial leads are obtained only when cardiac disease is suspected. This may result in inadequate experience with the normal variations.

CORONARY DISEASE IN YOUTH

It has become apparent in recent years that atherosclerosis, particularly of the coronary arteries, can no longer be regarded as the natural result of old age or as a medical curiosity when it occurs in the early decades of life. It is no longer rare in practice to encounter men under 40 who have fallen victim to disease of the coronary arteries, as manifested by coronary thrombosis or uncomplicated angina pectoris or both, long before they have reached the peak of their usefulness. It seems important, therefore, to determine how frequently serious coronary disease attacks persons in youth and early middle age and what its clinical characteristics in such persons may be. Furthermore, if clues are to be discovered that may aid in its prevention or disclose any underlying causative factors, exclusive of the aging process, the younger patients must be studied carefully. It was with these thoughts in mind