ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03104.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03105.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03106.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT.A six month survey of 588 patients presenting with chest pain to our emergency room revealed some 85 different diagnoses. The most common ages were the sixties and there were more men than women. Myocardial infarction and reflux esophagitis were more common in men, esophageal spasm equally prevalent in both sexes and psychiatric disorders more common in women. Site, radiation, duration and description were helpful in presumptive diagnosis with a few surprises. The problem was common (3.7% of 15.716 visits to the Emergency Room) and frequently perplexing. Wrong diagnoses abound! An overview of the problem is presented including neural mechanisms in pain perception. Chest pain due to intrathoracic structures, the chest wall, nerve roots and extrathoracic structures are considered.

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03107.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT.Questionnaires aimed at detecting angina pectoris and oesophageal dysfunction (OD) were used in 281 patients with central chest pain of a type which gave suspicion of ischaemic heart disease (IHD). Signs of IHD were found in 208 patients (74%), 172 of whom had a positive angina pectoris questionnaire. The sensitivity of the questionnaire regarding the diagnosis of IHD was 83%, the specificity 48% and the predictive accuracy 82%. OD was found in 137 of the 281 patients (49%). »Do you often have heartburn« was the question which distinguished the OD and non‐OD groups the best (p<0.001). The sensitivity of this question in detecting OD was 34%, the specificity 93% and the predictive accuracy 82%. In conclusion, the diagnostic value of the angina pectoris questionnaire was limited by a low specificity and the diagnostic value of the oesophageal questionnaire by a low sensitivity in these patients with chest pain. Differential diagnosis of chest pain is an important every day problem in clinical medicine. The difficulties in the differentiation between pain of oesophageal and cardiac origin have been emphasized by several authors (4, 5, 6, 7). In the present report the interest has been focused on the use of questionnaires in the differential diagno

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03108.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT.Dyspnea may form a differential diagnostic symptom to chest pain in ischemic heart disease (IHD) but may also precede angina pectoris (AP) as a manifestation of IHD. In the Primary Preventive Trial in Göteborg the occurence of AP and its relation to dyspnea has been studied in a random population sample of men aged 47–54 years at entry to the study and followed for 4 years. In the cross‐sectional study dyspnea was reported in 21% of the total population and in 70% of the angina population. Dyspnea at entry to the study was reported in 36% among cases who developed AP alone during the follow‐up time and in 35% among cases who developed AP associated with myocardial infarction. The dyspnea was not related to smoking habits or to low grade of physical activity. The report of dyspneabeforechest pain in IHD may be due to misinterpretation in early cases. On the other hand it is also known that intermittent left ventricular failure coincident with attacks of myocardial ischemia will give a subjective feeling of dyspnea. According to our study there is a definite association between AP and dyspnea. In some cases dyspnea precedes AP whereas in others the chest pain precedes the dyspnea. The symptom dyspnea also carries important prognostic information

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03109.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT.In patients with stable exertional angina the pain reaction during and after exercise has been classified and analyzed with regard to reproducibility, time relationship between pain and ECG reactions with ST‐depression. The pain reaction has a good reproducibility ‐ at least as good as the ECG reaction ‐ both within the day and from day to day. The pain usually appears a few minutes after the appearance of ST‐depression but there are big individual variations. For any given patient the time relationship between pain‐ and ECG‐reaction is fairly constant but beta‐blockers and myocardial infarction may increase the pain threshold in individual cases. To conclude the analysis of the pain reaction adds valuable information to the exercise test both in patients with ischaemic heart disease and in patients with angina‐like pain

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03110.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT.Patients with effort angina and a history of cold intolerance performed brief sub‐maximal exercise bicycle tests in various room temperatures with separation of inspiration and room air. Exposure to a cold room (−10°C) and inhalation of very cold air (−35°C) in a normal room caused a significant decrease in maximal workload. Heart rate, systolic blood pressure, and rate‐pressure product were significantly higher during exercise when compared with findings in the normal room. The decrease in maximal workload correlated significantly to the increase in heart rate and rate pressure product during exercise in both conditions, and to the increase in systolic blood pressure at exposure to a cold room. Exposure to 10 and 0°C environmental temperature, and inhalation of moderately cold air (−10°C) did not cause any significant changes in maximal workload, heart rate, blood pressure, or rate pressure product during exercise, compared to the findings in the normal room. In conclusion, skin cooling seems to be far more important in its effect on heart load and the working capacity in patients with effort angina than inhalation of moderately cold air; inhalation of very cold air, however, does cause changes in working capacity similar to those of exposure to a cold environment. Increase in heart work during exercise is likely to cause the decrease in working capacity observed both with skin cooling and cold a

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03111.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT.In 27 patients (pts.) with a history of exercise induced angina pectoris coronary heart disease (CHD), hypertrophic or congestive cardiomyopathy and mitral valve prolapse were excluded by coronary and left ventricular angiography and echocardiography. The pts. were divided into two subgroups: 12 pts. with normal (groups A) and 15 pts. with abnormal exercise ECG (group B). All but two pts. showed a positive reaction on nitroglycerin. The results of a retrospective analysis of clinical and hemodynamic findings are reported. No age differences were detected. There was an over‐representation of females in group B (12:3). In group B ST‐depression (0,1 − 0,3 mV) during exercise and angina occured in 4 pts., in the remainder only ST‐depression between 0,1 and 0,3 mV was observed. At submaximal exercise (mean in group A 75 watt, group B 82 watt) in both groups left ventricular enddiastolic pressure (LVEDP) and\ or mean pulmonary artery pressure (PAP) increased to abnormal values. The main difference between the two groups beyond the ST‐segment reaction with exercise was the difference in enddiastolic volume indices (EDVI): 74±15 in group A and 90±16 ml/m2in group B. By these findings exercise induced angina in absence of CHD can occur with two different patterns both showing pathologic LVEDP values with exercise: type A with normal exercise ECG and normal LV volumes, type B with abnormal exercise ECG and borderline or abnormal EDVI, increase of end‐systolic volume index during exercise and constant stroke volume index during rest and exercise. The positive effect of nitroglycerin in both groups can be explained by the reduction of elevated LVEDP during exercise. The etiology of this type of left ventricular compliance disorder is unknown. Long term therapy with isosorbiddinitrate should be discussed in spite of absence of coronary

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03112.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY

摘要:

ABSTRACT.The result of treadmill exercise tests were studied in 158 patients (pts) who were exercised submaximally 1 to 3 month after an acute transmural myocardial infarction. A 4 minute test had initially been performed prior to their discharge, 14 to 20 days after the acute event. Eighty pts had an inferior and 65 an anterior infarction; 13 could not be reliably classified and were not further included. In the inferior infarction group, 10/80 had a positive test characterized by ST changes (9 pts), and anginal pain (4 pts). In the anterior infarction group, 11/65 had a positive test: ST‐changes could be reliably assessed in only 2, while 9 had anginal pain; one had ventricular tachycardia. Fourteen pts underwent coronary arteriography; all showed severe triple vessel disease, and in 8 myocardial revascularization was performed. In pts with a previous anterior myocardial infarction, anginal pain can be a very helpful finding, since ST changes are usually hard to interpre

ISSN:0001-6101    

DOI:10.1111/j.0954-6820.1981.tb03113.x

出版商:Blackwell Publishing Ltd    

年代:1981

数据来源: WILEY