11/17. Spontaneous and provoked coronary artery spasm: are they the same?A 44-yr-old man suffering fro exertional, emotional and spontaneous angina underwent coronary arteriography. During the examination he had a spontaneous attack of angina with ST elevation in the anterior leads. Injection of a contrast medium in the left coronary artery during pain showed marked spasm with anterior descending artery occlusion. The spasm was quickly relieved by nitroglycerin. Intravenous administration of 0.4 mg of ergonovine maleate reproduced the anginal episode with pain, ST elevation in the anterior leads and coronarographic patterns of a spasm occluding the anterior descending artery at the same level. After nitroglycerin, the pain disappeared and the electrocardiographic and coronarographic findings returned to basal conditions.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/17. myocardial infarction and coronary ectasia in idiopathipc mitral valve prolapse syndrome.angina pectoris and myocardial infarction occurred in two patients with idiopathic mitral valve prolapse in the absence of atherosclerotic coronary artery disease. Instead, both patients showed the presence of coronary artery ectasia on cineangiography. The anatomic localization of ectasia corresponded with segmental derangement of left ventricular wall motion. Repeated thromboemboli from ectatic vessels and/or locally liberated platelet metabolites were considered the probable mechanism of these symptoms.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
13/17. Dual isotope stress testing in congenital atresia of left coronary ostium. Applications before and after surgical treatment.A 38-year-old women presented with an 11-year history of angina pectoris. Coronary arteriography disclosed a large right coronary artery which filled the entire left coronary tree retrogradely. The left main coronary artery ended blindly and was not connected to the aortic root. There were no atherosclerotic lesions in any vessel. Exercise thallium-20l scintigrams showed a perfusion defect in the anterior region of the left ventricle and exercise first pass radionuclide ventriculography showed anterior hypokinesis of the left ventricle with an ejection fraction of 54 per cent, compared with 60 per cent at rest. An aortocoronary saphenous vein graft was constructed to the left coronary artery. Four months after operation the patient is free from symptoms. Repeat thallium scintigrams were normal. Exercise radionuclide ventriculography after operation disclosed no wall motion abnormality, and ejection fraction on exercise was 70 per cent. The mechanism of angina in this patient is unclear but may have been related to the abnormal timing of delivery of blood to the left ventricular myocardium. Dual radionuclide stress testing showed abnormalities after operation. This non-invasive approach may be useful in the assessment of the physiological significance of coronary anomalies and of the value of corrective surgery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/17. Need for sedation in a patient undergoing active compression--decompression cardiopulmonary resuscitation.The authors report the case of a 57-year-old man with a history of ischemic heart disease who presented to the emergency department with an acute myocardial infarction and hypotension. Despite aggressive pharmacotherapy, the patient's heart rate decreased, and he developed pulseless electrical activity within 15 minutes of his arrival. cardiopulmonary resuscitation (CPR) was begun with an active compression-decompression (ACD) device, and the patient became agitated, making purposeful movements. When ACD-CPR was discontinued for a rhythm check, the patient had no pulse and became motionless. Agitation and purposeful movements occurred on two subsequent occasions with the initiation of ACD-CPR. The patient required physical restraints, sedation, and paralysis for personnel to perform endotracheal intubation and facilitate treatment. The implications of this case are discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/17. The variant form of angina pectoris.Variant angina pectoris, usually not precipitated by exertion or emotional stress, often is more severe and lasts longer than classic angina. The pain tends to recur at about the same time each day. Arrhythmias, usually ventricular, occur in about 50% of cases during the peak of pain. Electrocardiograms show a characteristic ST segment elevation during pain, which is in contrast to the ST segment depression of classic angina pectoris. Pain may be due, at least in some cases, to a temporary increase in tonus of a single, large, narrowed coronary artery. Chemical changes in the myocardium and plasma catecholamine changes differ from those occurring in classic angina pectoris. The course of the disease is highly variable but the prognosis must be regarded as grave, since single large vessel disease, present in most cases, is associated with severe myocardial ischemia. patients with variant angina pectoris should be studied early with coronary arteriography and considered for coronary artery bypass surgery if appropriate.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
16/17. Clinical significance of decreased myocardial uptake of 123I-BMIPP in patients with stable effort angina pectoris.The aim of this study was to assess the feasibility of resting myocardial fatty acid metabolic imaging with 123I-beta-methyliodophenyl-pentadecanoic acid (123I-BMIPP) for the detection of patients with stable effort angina pectoris and to clarify the clinical significance of abnormal 123I-BMIPP images. Myocardial imaging with 123I-BMIPP at rest and 99Tcm-methoxyisobutyl isonitrile (99Tcm-MIBI) at rest and during treadmill exercise was performed in 46 patients with suspected effort angina pectoris. Resting 123I-BMIPP imaging detected 43% (17/40) of patients with significant (> or = 50%) coronary artery stenosis and 59% (17/29) of patients with exercise-induced myocardial ischaemia. The patients with abnormal 123I-BMIPP images terminated exercise after a shorter period (4.5 /- 2.6 vs 6.7 /- 4.1 min; P < 0.01) and at a lower rate pressure product (16,124 /- 5211 vs 20,246 /- 6564 mmHg x beats min-1; P < 0.01) than those with normal 123I-BMIPP images. The presence of ST depression during the exercise test (77 vs 52%; P < 0.05), severe coronary stenosis exceeding 90% (88 vs 43%; P < 0.01), collateral vessels (35 vs 9%; P < 0.01) and a wall motion abnormality of hypokinesis/akinesis (53 vs 30%; P < 0.05) were more frequently seen in patients with abnormal 123I-BMIPP images than in those with normal images. Resting 123I-BMIPP imaging was able to detect the presence of coronary artery stenosis and exercise-induced myocardial ischaemia with moderate sensitivity, and to determine the functional severity of coronary artery disease.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
17/17. Psychological approaches to cardiac pain.For patients with myocardial infarction, prompt and effective pain management is vital because the emotional stress caused by the pain may extend the original infarct. This article describes psychological approaches that may be used to alleviate pain in patients with myocardial infarction. The author emphasises that these approaches should not be used alone, but in conjunction with pharmacological pain relief.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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