1/59. The aetiology of non-exertional angina pectoris.The occurrence of angina pectoris while at rest, although long recognized, has not been satisfactorily explained. In the non-exertional attacks studied there was an increase in heart load, as estimated by the product of heart rate and systolic pressure. Angina occurred when the load exceeded a critical level. Recumbency was associated with 94% of non-exertional attacks; 58% followed a meal; in 54% both factors were present. It is suggested that recumbency causes an increase in heart load because of expansion of blood volume by transfer of fluid from interstitial spaces, and that a meal does so because of digestive activity.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/59. coronary sinus compression as a sign of cardiac tamponade.Coronary perforation and resultant cardiac tamponade are well-known but rare complications of percutaneous coronary interventions. We present a case that demonstrates coronary sinus compression caused by increasing pericardial pressure as a new sign of impending cardiac tamponade. This previously unreported angiographic sign preceded hemodynamic, symptomatic, and echocardiographic evidence of tamponade.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/59. Cold pressure test producing coronary spasm, coronary thrombosis and myocardial infarction in a patient with IgM antibodies against Coxsackie B virus.Several lines of evidence have shown that viral infections are capable of causing coronary spasm and precipitating or mimicking clinical myocardial infarction. Here we report the case of a 41-year-old woman with recurrent angina who was admitted to our hospital because of ventricular tachycardia. Laboratory examination revealed positive IgM titers against Coxsackie B virus. coronary angiography showed normal coronary arteries, but following a cold pressure test severe spasm of all coronaries with thrombotic occlusion of the second marginal branch of the circumflex artery occurred. We conclude that coronary spasm should be clinically suspected in patients with chest pain and ventricular arrhythmia in combination with IgM antibodies against Coxsackie B virus. In these patients, a cold pressure test should be avoided, and antithrombotic and antispastic therapy is recommended.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
4/59. pneumoperitoneum secondary to endoscopic harvest of saphenous vein graft.Endoscopic harvest of saphenous vein graft for coronary artery bypass grafting decreases leg wound complications compared with traditional longitudinal incision. A case of pneumoperitoneum secondary to endoscopic harvest of saphenous vein using insufflation of carbon dioxide is reported. Hypercarbia, increased peak airway pressure, but no significant changes of hemodynamics, or myocardial ischemia were noted. The management of this rare complication is described.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/59. Variant angina pectoris.A patient with variant angina pectoris due to a pedunculated calcific mass extending from the aortic valve and resulting in intermittent obstruction of the left coronary ostia is reported. No atherosclerotic disease was demonstrated by coronary angiography. During attacks, marked ST segment elevation and episodes of tachycardia were associated with a moderate rise in pulmonary artery pressure. Replacement of the calcified aortic valve resulted in total relief of symptomatology.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/59. Unusual hemodynamic response during exercise-induced angina pectoris.A patient with coronary artery disease exhibited reduction in systemic arterial pressure and striking changes in pulmonary artery wedge pressure and pulse contour during an episode of exercise-associated angina pectoris. There is suggestive evidence that these phenomena were secondary to marked but reversible exacerbation of mitral regurgitation.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/59. Pre-infarction angina secondary to calcific aortic stenosis with Bernheim's effect.Pre-infarction angina, in the absence of coronary artery disease, was found in a 62 year-old man with severe calcific aortic stenosis. After application of intraaortic balloon pump counter-pulsation, the condition was stabilized, and coronary arteriograms were safely carried out. Interestingly, an elevated right atrial and right ventricular end-diastolic pressure with an associated Bernheim's effect was demonstrated by cardiac catheterization. The hemodynamics of the right heart returned to normal after surgical correction of the aortic stenosis. The clinical indications for intra-aortic balloon pump counterpulsation in this setting are discussed.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/59. Elevation of left ventricular end-diastolic pressure due to decreased myocardial compliance during angina pectoris.The etiology for the increased left ventricular end-diastolic pressure (LVEDP), which is frequently seen during angina pectoris, remains controversial. Although left ventricular failure may be present, recent evidence suggests that a decrease in myocardial compliance may be involved. The patient reported here developed a rise in LVEDP when angina was precipitated by atrial pacing. Hemodynamic data during and after pacing showed normal left ventricular function and indicates that a decrease in myocardial compliance should have occurred.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
9/59. Coronary heart disease. Differential hemodynamic, metabolic, and electrocardiographic effects in subjects with and without angina pectoris during atrial pacing.Right atrial pacing was performed in 41 subjects with coronary heart disease. Twenty developed angina pectoris during pacing, while 21 did not. The extent of coronary artery disease, as judged by selective cinearteriography, was similar in the two groups. Both had significant increases in heart rate and pressure-time per minute, but there was no significant difference in either of these parameters between groups. Among the hemodynamic parameters measured, the only statistically significant change was in the cardiac index which fell slightly but significantly in the angina group. There were no differences in myocardial oxygen extraction either within each group or between groups. In the angina group, however, 14 of 20 subjects exhibited abnormal myocardial lactate metabolism during pacing. The mean change was highly significant (P < 0.01). In the nonangina group, eight of 21 subjects had abnormal lactate metabolism during pacing and the mean change was significant (P < 0.05). There was no correlation between abnormal lactate metabolism and electrocardiographic evidence of myocardial ischemia in either group. Sublingual nitroglycerin, given to five subjects with angina while pacing was continued, resulted in prompt relief of symptoms, but abnormal lactate metabolism and ST-segment depression were unaffected after 10 min. By contrast, when anginal symptoms were relieved in five subjects by cessation of pacing, symptomatic improvement was accompanied by marked improvement in lactate metabolism after 10 min. Although angina pectoris appears to be related statistically to subnormal left ventricular function and abnormal lactate metabolism, there is significant individual variation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/59. thromboembolism associated with pigtail catheters.Three incidents of asymptomatic arterial thromboembolism associated with polyurethane pigtail catheters occurred during 1,417 cases of left ventricular angiocardiography. No similar incident occurred with polyethylene pigtail or (dacron) Eppendorf and Gensini (style) catheters. in vitro comparison of hydraulic characteristics of polyurethane (Cordis) and polyethylene (Cook) pigtail catheters showed higher flow-pressure transmission through the tip of the Cordis polyurethane catheter favoring dislodgment of any existing clot. The problem of thrombogencity of polyethylene compared with polyurethane remains unsettled. Our experience with polyurethane pigtail catheters has resulted in limitation of their use in our laboratory.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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