Clinical and angiographic features and prognostic significance of early postinfarction angina with and without electrocardiographic signs of transient ischemia

Article Abstract:

Angina is a symptom of heart ischemia (low tissue oxygen levels related to poor blood flow) that often occurs soon after a heart attack and can negatively influence patient outcome. Aggressive treatment, including surgery, is often recommended. The actual incidence of angina varies widely because, among other reasons, criteria have ranged from chest pain to changes observable by electrocardiogram (ECG). Some research suggests that angina without ECG changes may have no implications for outcome. In this study 449 patients (70 female) who had heart attacks were followed and studied for incidence of angina and ECG changes. Of these patients, 164 had early angina after hospital admission, and 79 of these patients had transient ECG changes that accompanied the chest pain. Compared with patients who did not experience angina, those with angina but without ECG changes were older, had frequently experienced angina previously, and had lower blood levels of an enzyme indicative of heart damage. These patients also had more atherosclerotic involvement of coronary arteries. Patients without ECG changes had fewer risk factors, were less likely to have had a previous heart attack, and fewer coronary vessels were involved. They also had good collateral (alternate) circulation around constricted arteries. The frequency of angina and the number of constricted vessels increased by group, with the lowest rates among those without angina and the highest rates among those with ECG changes. Survival during an average follow-up of 14 months was significantly related to group, with 83 percent of the group with ECG changes, 90 percent of the group without angina, and 96 percent of the group with non-ECG angina surviving for 24 months; survival without recurrent nonfatal heart attack was 67, 80, and 78 percent for these groups, respectively. These results indicate that of the patients who experience angina early after a heart attack, those without ECG changes have a more favorable prognosis, although overall prognosis is better for patients without angina. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Heart attack, Electrocardiography, Angina pectoris

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Regression of coronary atherosclerosis: an achievable goal? Review of results from recent clinical trials

Article Abstract:

A review is presented of the medical literature concerning the reversal of atherosclerosis (''hardening'' of the arteries; deposition of fatty plaque on the walls of blood vessels). It is well established that high levels of fats in the blood, particularly cholesterol, contribute to the development of this disorder and that the reduction of blood cholesterol levels can help prevent the formation of plaques that block the arteries. Both clinical results (decreases in the rates of heart attacks and death from heart attack) and results from objective tests support this finding. Angiography is a technique in which blood vessels are viewed by X-ray after a substance has been injected to make them more opaque to these rays. The use of computers aids greatly in obtaining precise measurements of the degree to which arteries of the heart may be blocked by atherosclerotic plaques. With these measurements in hand, it is possible to compare the degree of atherosclerosis in a patient before and after a program of therapy for high blood cholesterol. In one study involving patients who underwent coronary artery bypass grafting (the insertion of a grafted vessel to bypass a blocked coronary artery), lowering cholesterol levels prevented the atherosclerotic plaques from growing worse and prevented new plaques from appearing. In another study involving patients who were members of families in which atherosclerosis occurred as an inherited trait, drug therapy to lower blood cholesterol resulted in a measurable decrease in the size of the atherosclerotic plaques. This change was reflected in a decrease in heart attacks as well. Newer studies, completed only recently, seem to indicate similar trends. When patients with very high blood cholesterol levels are treated with drugs that lower these levels, a regression of atherosclerotic plaques can be documented by angiography. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Risk factors, Development and progression, Atherosclerosis, Hypercholesterolemia

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Acute pulmonary edema caused by prolonged myocardial stunning after dipyridamole-thallium imaging

Article Abstract:

Dipyridamole-thallium imaging is used to evaluate coronary artery disease (diminished supply of oxygen to the heart muscle) in patients who are unable to tolerate the more common exercise stress testing, such as those who are easily fatigued or who are post-myocardial infarction (heart attack). Two-dimensional images are obtained by a scintillation camera after the radionuclide thallium is administered to the patient; these images can reveal the degree and severity of stenosis or narrowing in the coronary arteries. Dipyridamole-thallium imaging procedures have infrequently been associated with a drop in blood pressure or ischemia (decrease in oxygen in the heart muscle); administration of appropriate medications relieves these side effects. This case describes a 65-year-old woman who had a one-year history of recurrent pulmonary edema (abnormal accumulation of fluid in lung tissue) but no cardiac symptoms, who experienced myocardial stunning and acute pulmonary edema during dipyridamole-thallium imaging. Prior to the imaging procedure the patient's blood pressure was 150/90 Hg and heart rate was 72 beats per minute. After intravenous infusion with dipyridamole, which dilates coronary arteries, and thallium (radionuclide), the patient developed shortness of breath. Her vital signs increased to a blood pressure of 170/90 Hg and a heart rate of 100 beats per minute. Her condition progressed to severe pulmonary edema which was treated; two hours later the pulmonary congestion resolved. A comparison of images later revealed a region of ischemia in a stenotic region of the left anterior descending coronary artery and a stunned left ventricle (the heart's main pumping chamber), indicating the ischemic mechanism of the patient's pulmonary edema.

Diagnosis, Causes of, Heart diseases, Heart, Dipyridamole, Pulmonary edema

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