1/7. DATA: a decision aid for management of the patient with stable angina pectoris.OBJECTIVE: The patient with stable disabling angina must choose between bypass surgery, coronary angioplasty, or medical therapy. Estimation of comparative outcomes of these alternative therapies is difficult. DESIGN: Utilizing artificial intelligence, an expert-system computerized decision aid, DATA (Decision Aid for Therapy of Angina), was developed to run on a personal computer and to calculate the probability of each possible clinical event based on individual patient characteristics. For each therapeutic option, relative clinical outcomes and anticipated charges are computed. Ten patients were evaluated retrospectively by DATA and by a group of cardiologists. RESULTS: DATA agreed with the primary therapy given to all patients. The physician group underestimated the value of alternative therapies and underestimated charges for all therapies. CONCLUSIONS: This decision aid allows comparison of alternative therapies in terms of relative patient outcome and anticipated costs can be better estimated.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. nicorandil can induce severe oral ulceration.OBJECTIVE: To increase physicians' and dentists' awareness that nicorandil is a potential inducer of severe mouth ulceration. STUDY DESIGN: Nine new cases of ulceration from 3 European countries were included in this study. RESULTS: Oral ulceration developed within 9 months of beginning nicorandil therapy, and ulcers resolved within 1 month of withdrawal of the drug. No lesions developed on other epithelia. CONCLUSIONS: A number of drugs used in the care of patients with cardiovascular disease can cause oral adverse effects. nicorandil, a new potassium-channel activator used in some countries to treat angina pectoris, precipitates persistent ulcerative stomatitis in some patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Case 2. Hyperlipidemia.A 58-year-old man with typical angina since 1994 presents to his physician. His angina is relatively stable and laboratory results indicate that his lipids are elevated. Recommendations for lipid management are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Cardiac adverse events following smallpox vaccination--united states, 2003.During January 24-March 21, smallpox vaccine was administered to 25,645 civilian health-care and public health workers in 53 jurisdictions as part of an effort to prepare the united states in the event of a terrorist attack using smallpox. Seven cases of cardiac adverse events have been reported among civilian vaccinees since the beginning of the smallpox vaccination program. In addition, 10 cases of myopericarditis have been reported among military vaccinees. This report summarizes data on the seven cases reported among civilians and provides background information on recent military vaccinees. Although a causal association between vaccination and adverse cardiac events in the civilian population is unproven, as a precautionary measure, CDC recommends that persons with physician-diagnosed cardiac disease with or without symptoms (e.g., previous myocardial infarction, angina, congestive heart failure, or cardiomyopathy) be excluded from vaccination during this smallpox preparedness program.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Cervical angina caused by atlantoaxial instability.Cervical angina is defined as a paroxysmal precordialgia that resembles true cardiac angina caused by cervical spondylosis. Cervical angina most commonly results from compression of the C7 ventral root. We present here a case of cervical angina caused by atlantoaxial instability. This case had marked atlantoaxial instability but no flexibility of the middle to lower levels of the cervical spine. Although there was mild C7 root compression on the radiologic findings, the chest pain was induced by neck motion, and the precordialgia disappeared after posterior atlantoaxial fusion without C7 root decompression. Therefore, we diagnosed this case as cervical angina caused by spinal cord compression at the C1-C2 level. It was speculated that a perturbation of the sympathetic nervous system or a hypofunction of the pain suppression pathway in the posterior horn of the spinal cord caused the pectoralgia. Although cervical angina is a rare disease, physicians should be aware of it; if there are no abnormal findings on cardiac examinations for angina pectoris, they should examine the cervical spine. Cervical angina due to atlantoaxial instability is one of the differential diagnoses of precordialgia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Exacerbation of angina pectoris by prazosin.A case of angina pectoris worsened by prazosin is presented. Since a hypertensive population includes many patients with known or occult coronary artery disease, physicians should use prazosin cautiously in this subgroup, particularly when beta-adrenergic antagonists cannot be used concurrently.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. The spectrum of coronary artery spasm. The variable variant.Angina from coronary artery spasm is not rare. Because new and effective medical therapy is now available, it is imperative that the physician recognize this syndrome when it occurs. Coronary artery spasm can present clinically as unstable rest angina with reversible ST-segment elevation and bradyarrhythmias and tachyarrhythmias. In this setting, Prinzmetal's variant angina is generally promptly recognized and appropriately treated. The diagnosis is variant angina, however, often is not so obvious. chest pain may be exertional or seem noncardiac in origin. The chest pain syndrome may be chronic and stable as well as unstable. The ECG may show ST-segment depression, rather than elevation. Five cases of coronary artery spasm that emphasize the variable features of variant angina and offer aid for the prompt diagnosis and treatment of the syndrome are presented here.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |