ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

The history, technic, and complications of coronary angiography have been discussed. Myocardial infarction caused by the procedure occurs in 0.3-0.9% of all cases. Two leading groups report an incidence of 1/1000 to 1/2500 deaths related to the procedure. Angiographic anatomy has been described. Indications for the procedure are: intractable angina in patients with or without a history of myocardial infarction and unexplained left ventricular failure or failure due to a left ventricular aneurysm. Among the debatable indications are: unexplained ECG changes, aortic valve disease, preinfarction patterns, cardiogenic shock, and follow-up angiograms after bypass surgery. If immediate surgery is not contemplated, left ventricular failure and a recent myocardial infarction are contraindication to the procedure. The limitations of the procedure are the radiographic resolution and the inconsistent anatomic pattern of minor vessels.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

The relationships among angina pectoris, stress tests, and arteriography are complex. The majority of patients with angina pectoris can be adequately diagnosed by a careful history. Considerable attention to detail and repeated questioning is often necessary before the pain syndrome can be accurately classified. The resting electrocardiogram is of limited value in the diagnosis despite the fact that there is a high positive correlation between abnormal ST-T changes on the electrogram and significant obstructive lesions on coronary arteriograms. The value of the electrocardiogram is enhanced, and its specifiicity and sensitivity increased, when used in combination with exercise stress. The lowest error percentage is achieved by utilizing rate-standardized exercise tests and multiple leads with loads that produce heart rate responses of 80-90% of the expected maximum. Coronary arteriography gives the most specific anatomic information in patients with ischemic cardiac pain but will not directly disclose the cause of the pain. This fact assumes considerable importance when the pain has atypical features or when the patient is in the age group that has a high prevalence of coronary atherosclerosis. Similarly, the presence of past myocardial infarction is likely to be associated with obstructive disease, regardless of the cause of the patient's current symptoms. The exact role of lipid and other metabolic abnormalities in producing coronary arteriographic changes in the absence of symptoms needs further clarification, although the available data suggest that marked elevations in lipid fractions are frequently associated with atherosclerotic change, regardless of symptoms. Finally, the data imply that the anatomic abnormalities and functional consequences of the coronary atherosclerotic process are more important predictors of the patient's course than any specific symptomatic expression such as angina pectoris.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

Severe angina pectoris may be reduced to tolerable levels by suppressing below the pain threshold those factors elevating systolic blood pressure and heart rate and prolonging systolic ejection period. Their product parallels myocardial oxygen consumption (MVO2) as noted in several excellent reviews. The level of this product associated with angina, the “angina index,” defines the individual threshold for onset of angina.Prevention of angina-inducing physical and psychic stress is desirable, but often impractical, and the use of nitroglycerin preceding or following stress may lead to years of acceptable life. Prolonged, spontaneous, or readily induced angina, especially with a change in pattern, may be due to an acute coronary occlusive episode, whether defined as a prodromal period or an actual myocardial infarct. This form of attack requires close observation and appropriate care. The psychic stress-prone patient may repeatedly present a benign duplicate of such pain production, producing a diagnostic challenge. Routine protection of the angina patient, especially against arrhythmias, is discussed.Different therapeutic modalities for control of intractable angina are presented, many with promise, but those currently giving the best results are: (1) elimination of precipitating conditions, i.e. (a) brady- and tachyarrhythmias, (b) hypertension, (c) hyperthyroidism, (d) mechanical obstruction of ventricular outflow, and (e) heart failure (2) beta-adrenergic blocking agents, i.e. propranolol, with or without nitrates or nitroglycerin; and (3) surgical revascularization preceded by selective coronary angiography.The aortocoronary saphenous vein bypass has been effective in prompt relief of angina in patients with viable myocardium and potentially good flow in the distal artery, with acceptably low operative mortality from skilled teams. Mechanical efficiency and thus congestive failure may improve, and there is hope for increased longevity. Contraindications are poorly defined, especially as related to its performance in recent infarction of varying magnitude. With only 3 years' experience in determining long-term benefits, it seems rational to repeatedly redefine indications for surgery, but currently not to operate on every patient with “significant” coronary disease.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID

摘要:

With the advent of direct bypass surgery, the dramatic clinical responses in some patients has been followed by enormous enthusiasm in many centers. Surgical technics have advanced to such a point that nearly all patients with obstructive coronary disease could have the obstructions bypassed to one or many areas. Criteria for evaluating surgery include mortality, operative infarction rate, patency of grafts, clinical response, and stress testing. Many reports fail to correlate results with angiographic studies of vein function and with completeness of revascularization. When cine studies are performed, a good correlation exists between patent veins and relief of angina and improved stress response. Different patterns of response to stress, sometimes independent of relief of angina, are obtained depending on the completeness of revascularization. Predictable relief of angina is found if revascularization is complete. At times dramatic, but much less predictable, relief of failure (improved ventricular function) follows revascularization. Angina is a valuable aid in selecting some patients for surgery. Stress testing (bicycle ergometry) can now define general groups of patients who are likely, and who are not likely, to show improved myocardial response to stress after surgery. These studies also demonstrate the need for the surgeon to provide complete revascularization whenever possible. The criteria for selection for surgery of patients with symptoms of gross heart failure remain unclear. While revascularization technics could be technically applied to nearly all coronary patients, present methods are unable accurately to define who really needs the surgery and, equally important, which hearts will respond once revascularization is completed.

ISSN:0009-7322    

出版商:OVID    

年代:1972

数据来源: OVID