Role of thrombolytic therapy in the treatment of patients with unstable angina

Thrombolytic therapy (TT) was performed in 39 of 81 patients with unstable angina pectoris (UAP) resistant to conventional treatment. TT was found to improve prognosis of UAP, to quicken UAP stabilization. Predictors of UAP unfavorable course were discovered. TT is indicated in patients suffering from resistant UAP with markers of poor prognosis.     

Transcutaneous electrical nerve stimulation in unstable angina pectoris

BACKGROUND: Silent ischemia is a strong predictor of unfavorable outcome in unstable angina pectoris. Dynamic continuous vector cardiography provides online detection of ischemic episodes. Transcutaneous electrical nerve stimulation (TENS) has been reported to have antianginal effects in patients with severe coronary artery disease and this is associated with a reduction in myocardial ischemia. The aim of the present study was to investigate the applicability of TENS in patients with unstable angina in the coronary care unit and the effects on vector cardiographic and biochemical markers of ischemia. METHODS: Thirty patients (14 in the TENS group and 16 in a placebo group) were included in a single-blind, placebo-controlled study after being admitted to the coronary care unit. Continuous vector cardiography, leakage of cardiac enzymes and consumption of analgesics were recorded for 24 h. RESULTS: TENS was well tolerated and did not interfere with standard treatment, although vectorcardiographic recording during actual stimulation was disturbed. There was a reduction in the number of silent ischemic ST change vector magnitude episodes (P = 0.02) and their duration (P = 0.01) in the TENS-treated group, and a nonsignificant reduction in the total number of ST change vector magnitude (painful plus silent) episodes (P = 0.09) and their duration (P = 0.05) and in leakage of cardiac enzymes (P = 0.12). There were no detectable differences in terms of episodes of pain leading to stimulation or consumption of analgesics. CONCLUSIONS: TENS seems to be a safe additional treatment in unstable angina pectoris and may reduce the number of ischemic events, by mechanisms apparently unrelated to the reduction of pain.     

Diuretic therapy and angina pectoris

Two boys (9 and 14 years old) participated in an evaluation of treatment for stuttering. Habit reversal procedures (awareness training, regulated breathing, and social support) were combined with teaching positive attitudes to parents. During treatment, stuttering frequencies decreased, speech rates increased, and speech naturalness ratings increased. These changes occurred in the clinic, the child's home, and the child's school. After treatment, stuttering remained low in the clinic and at home, but increased stuttering was found at school.     

Thrombolytic therapy for unstable angina

Thrombolytic therapy for unstable angina has not gained acceptance as a primary treatment for unstable angina (UA) despite the evidence showing a reduction in mortality when these agents are given for myocardial infarction. The purpose of this review is to examine the clinical value of thrombolytic therapy for UA. The multiple lines of evidence supporting intracoronary thrombus formation as a key mechanism in the pathogenesis of UA are reviewed. Studies examining the effect of thrombolytic therapy on angiographic endpoints have shown little effect on the extent of luminal narrowing, but do reveal a decrease in angiographically detected thrombus. Twelve randomized, controlled trials of thrombolytic agents in 611 UA patients with predefined clinical endpoints have been published. These trials varied widely in design and adjunctive therapy both in treated and control grops. Review of these trials show a tendency to fewer clinical events such as death, infarction, and need for revascularization in treated patients, with a corresponding increase in bleeding complications. Clinical efficacy of thrombolytic therapy cannot be excluded by the available data, perhaps in part because of insufficient numbers of patients treated. Determination of the net clinical value of thrombolytic therapy must await larger and more definitive trials.     

Transmyocardial laser revascularization in stable and unstable angina pectoris]

The importance of urinary tract infection (UTI) in patients with spinal cord injury cannot be understated. Many patients with significant bacteriuria are considered to be colonised rather than infected, and treatment should be reserved for those with clinical symptoms or other signs of infection. Published research on the prevention and management of UTI in patients with spinal cord injury often has limitations due to differences in definitions of UTI, studies on groups using different urinary drainage appliances, the mixture of newly injured and longstanding injured patients and studies being carried out predominantly on male patients. The complications due to UTI and the difficulties in treating established infection mean that prevention is essential. Close urological follow-up is crucial in ensuring that adequate bladder drainage is achieved avoiding the use of long term indwelling urinary catheters if at all possible. For those patients who require long term urinary appliances patient education and strict attention to hygiene and catheter care policies is important. The role of antiseptic/ antibiotics is strictly limited in preventing UTI in patients with spinal cord injury and may even be harmful. Further study into which groups of patients may benefit from the use of antiseptics or antibiotics is urgently required. Continued research into different methods of prevention eg by vaccination, immunotherapy, the use of receptor analogues and bladder interference should also be encouraged.     

Selection of drug therapy in stable angina pectoris

Given a strong match between regions of two sequences, how far can the match be meaningfully extended if gaps are allowed in the resulting alignment? The aim is to avoid searching beyond the point that a useful extension of the alignment is likely to be found. Without loss of generality, we can restrict attention to the suffixes of the sequences that follow the strong match, which leads to the following formal problem. Given two sequences and a fixed X > 0, align initial portions of the sequences subject to the constraint that no section of the alignment scores below -X. Our results indicate that computing an optimal alignment under this constraint is very expensive. However, less rigorous conditions on the alignment can be guaranteed by quite efficient algorithms. One of these variants has been implemented in a new release of the Blast suite of database search programs.     

A new clinical classification for hospital prognosis of unstable angina pectoris

Unstable angina represents a heterogeneous spectrum of clinical entities between chronic stable angina and acute myocardial infarction. To facilitate prognostication of in-hospital outcome, we prospectively tested on a priori unstable angina classification scheme based on information available at the time of acute presentation. Prospective database enrollment at the time of emergency room presentation was performed and patients were classified into 1 of the following categories: class IA, acceleration of previous exertional angina without electrocardiographic (ECG) changes; class IB, acceleration of previous exertional angina with ECG changes; class II, new-onset exertional angina; class III, new-onset rest angina; class IV, protracted rest angina with ECG changes. The study consisted of 1,387 consecutive patients with unstable angina. Baseline demographics and aggregate in-hospital major cardiac event rates were recorded (myocardial infarction, refractory angina, and death). There was a significant increasing trend in cardiac events from class I to IV (p < 0.0001). Class IA patients had the lowest aggregate event rate at 2.7% (p = 0.0005). Paired chi-square tests of adjacent categories showed no differences in event rates for class IB and II (p = 0.3). A significantly higher rate of adverse events was seen for class III patients (20.1%, p < 0.0001). Class IV patients demonstrated the highest rate of in-hospital adverse events (42.8%, p < 0.0001). We conclude that this easily deduced, universally applicable categorization of unstable angina is highly prognostic of in-hospital adverse cardiac events and hence could have potential use for triage decisions regarding hospital admission and intensity of therapy.     

Prognostic implications of detection of troponin I in patients with unstable angina pectoris

In our study, troponin I was not a predictor of cardiac events and a negative troponin I test did not exclude the presence of severe coronary artery disease. A positive troponin I test in patients with unstable angina identified a subgroup with probable, more active coronary disease (with higher levels of C-reactive protein).     

Coronary stenosis progression differs in patients with stable angina pectoris with and without a previous history of unstable angina

OBJECTIVES: To compare the evolution of stenoses responsible for acute coronary events with those not associated with acute coronary syndromes. METHODS AND RESULTS: We prospectively studied angiographic stenosis progression in 190 stable angina patients, with single vessel disease, who were awaiting non-urgent coronary angioplasty. Sixty four patients had a previous history of unstable angina (Group 1) and 126 patients had no history of unstable angina (Group 2). Culprit stenoses were classified as "complex' or "smooth'. At restudy, 8 +/- 4 months after the first angiogram, 12 of 63 culprit stenoses in Group 1 had progressed and seven of 125 in Group 2 (19% vs 6%, P = 0.0044). Thirteen of 68 complex culprit stenoses had progressed, compared with only 6 of 120 smooth culprit stenoses (19% vs 5%, P = 0.003). Coronary events occurred in 12 Group 1 patients and nine Group 2 patients (P = 0.02). CONCLUSIONS: In patients with stable angina, stenoses associated with previous episodes of unstable angina are more likely to progress than stenoses not associated with previous unstable angina. Unstable coronary atherosclerotic plaques, even those that have been clinically stable for more than 3 months, may retain the potential for rapid progression to total occlusion.     

Longterm potassium therapy in angina pectoris (author's transl)

The effect of a two month potassium therapy on maximum performance was systematically investigated in 12 patients with overt angina pectoris. The patients received 40 mEq potassium daily by mouth. The average maximum performance increased by 85% after 8 weeks' administration of potassium. The rise in the performance curve fell after 6 weeks to attain a steady state after 8 weeks. In particular it must be emphasized that the heart rate was reduced under maximum capacity in spite of considerable increase in performance. Furthermore, a comparison of heart rates after 8 weeks' potassium administration showed that in each case for the same level of performance the heart rate was 15% less than before potassium. The results of the investigation support longterm therapy with potassium in angina pectoris.     

银杏达莫注射液治疗不稳定心绞痛疗效观察

目的:评价银杏达莫注射液治治疗不稳定心绞痛的疗效及耐受性.方法:67例不稳定心绞痛患者随机分成治疗组(34例)和对照组(33例),对照组常规应用阿司匹林、β-阻断剂、口服硝酸脂类、他汀类药物、极化液等;治疗组在常规治疗基础上加用银杏达莫注射液,共治疗15天,对治疗组和对照组不稳定心绞痛发作情况进行比对.结果:治疗组、对照组的心绞痛改善总有效率88.23%、69.69%,两组比较差异有显著性(P<0.05).结论:银杏达莫注射液治疗不稳定心绞痛疗效确切.     

Conservative therapy of angina pectoris using nifedipine (Adalat)

35 patients with angina pectoris or previous myocardial infarction were treated for the period of 6 weeks with a new calcium-antagonist (4-2'-Nitrophenyl-2,6-Dimethyl 1,4-dihydro-pyridin-3,5-dicarbon acid dimethylester) Adalat. The attacks of angina pectoris decreased by 75 percent, the need for nitroglycerin decreased by 84 percent. Examination at rest and under exercise before and during the treatment with Adalat showed when registered by electrocardiogram and by the mean pulmonary-capillary pressure a better tolerance under exercise during treatment as well as a decrease of the PCPm in rest and under exercise after 6 week-therapy with Adalat. No improvement during the period of treatment was seen in 2 patients, who suffered from a severe diffuse type of coronary artery disease.     

Diagnosis of coronary vasospasm in patients with clinical presentation of unstable angina pectoris using ergonovine echocardiography

Although coronary vasospasm can contribute to the development of unstable angina, the definite diagnostic method has not been established. The purpose of this study was to determine if ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) after angiographic confirmation of insignificant fixed disease would be useful and safe in detecting coronary vasospasm in patients with unstable angina. After control of chest pain with medications in patients admitted to the coronary care unit under the tentative diagnosis of unstable angina, diagnostic coronary angiography was performed. All patients with normal or insignificant fixed disease underwent ergonovine echocardiography after discontinuation of medications for 4+/-1 days. Among 208 consecutive patients enrolled for this study, 75% (156 of 208) showed significant fixed disease in the angiography. Ergonovine echocardiography was performed in 52 patients with insignificant disease, and coronary vasospasm was documented in 33 (63%, 33 of 52). No serious procedure-related arrhythmia or myocardial infarction occurred. Esophageal motility disorder and hypertrophic cardiomyopathy were diagnosed in 6 and 3 patients, respectively. Chest pain of undetermined etiology was the final diagnosis at discharge in 10 patients (5%, 10 of 208); among them chest pain redeveloped in 2 patients, and repeated ergonovine echocardiography revealed positive results. Our data suggest that among patients with the clinical presentation of unstable angina, coronary vasospasm is the main cause of myocardial ischemia in a considerable number of patients with a normal or near-normal angiogram, and ergonovine echocardiography after confirmation of absence of significant fixed disease is useful and safe for noninvasive diagnosis of coronary vasospasm in this setting.