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Changing features of anginal pain after PTCA suggest a stenosis on a different artery rather than restenosis
No full textBackground We recently found that patients who had had two myocardial infarctions in different myocardial regions frequently reported different locations of infarct pain, whereas patients who had had two infarcts at the same site had a similar distribution of pain. The aim of this study was to assess whether a different location of anginal pain may help identify patients with a new stenosis on an artery perfusing another myocardial region as opposed to those with restenosis after coronary angioplasty (PTCA). Methods and Results We studied 38 patients (59 +/- 11 years old) who underwent PTCA for single-vessel disease, with recurrence of symptoms requiring repeat coronary angiography during a 3-year follow-up. According to our inclusion criteria, angiography showed either a significant restenosis of the dilated lesion, with no evidence of lesions in the other vessels (n = 26), or a new stenosis in either of the other coronary arteries, with no restenosis in the dilated vessel (n = 12). Before each procedure, patients reported the location and radiation of anginal pain. There was no relation between location of pain and site of the coronary stenosis. However, none of the patients viith restenosis reported a different location of pain after angioplasty, compared with 5 patients with new stenosis (0% versus 42%, P = .002). Radiation of pain involved different areas of the body in 1 patient with restenosis and in 6 with new stenosis (4% versus 50%, P = .002). Overall, location or radiation of pain in a different body area had a specificity of 96% and a sensitivity of 58% in detecting a stenosis an a new artery. Conclusions A different location of anginal pain may distinguish patients with a new coronary stenosis from those with restenosis after PTCA for single-vessel disease. These findings suggest that in individual patients, differences in the location of cardiac pain may be indicative of the occurrence of ischemia in different myocardial regions
Changing features of anginal pain after PTCA suggest a stenosis on a different artery rather than restenosis
No full textUna disfunzione cardiaca biventricolare in pazienti con coronaropatia asintomatica puo’ essere causata da una miocardite piuttosto che da ischemia miocardica.
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Diagnosis of transient acute myocardial ischemia in man by M-mode echocardiography
No full textUnder basal conditions the echocardiographic findings in anginal patients (pts.) without previous myocardial infarction appears usually normal. Consequently, the usefulness of the ultrasounds evaluation in angina pectoris has been commonly considered poor and the utilization of this technique in coronary artery disease has been restricted to the detection of myocardial infarction in its acute phase or to its chronic mechanical alterations. The purpose of this study was to assess the possibility offered by M-mode echocardiography to detect changes caused by transient myocardial ischemia at rest in man, in view of the possible diagnostic application of this technique. The reported results were obtained from 25 ischemic attacks (13 spontaneous and 12 ergonovine induced) with ST segment elevation or pseudonormalization of a basally negative T wave at rest. The semiautomatic computerized analysis of echocardiograms continuously recorded during these attacks showed a reduction of motion and of systolic thickening, accompanied by a diastolic thinning of the wall involved by the ischemia. These changes occur very early: they appear few seconds before ECG changes and are accompanied by a reduction of contraction and relaxation dP/dt and precede the onset of chest pain; moreover, they are followed by an increase in left ventricular internal diameters. In conclusion M-mode echocardiography is a sensitive technique capable to detect transient myocardial ischemia in the course of spontaneous or induced angina with ST segment elevation or positivity of negative T wave. This approach could be helpful in the diagnostic evaluation of patients with atypical chest pain and/or aspecific ECG changes and it can be complementary to other non invasive techniques such dynamic ECG and nuclear cardiology techniques
Correlazione tra livelli plasmatici di brain natriuretic peptide e fase dilatativa nella cardiomiopatia ipertrofica.
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