RESUMEN
Prognosis in the case of refractory angina pectoris is poor in comparison with stable angina. Patients with refractory angina are more likely to have an acute coronary attack as a result of more diffuse coronary artery lesions and a high prevalence of cardiac risk factors. The quality of life of these patients is also poor. 36 patients 35-70 years of age with chronic stable angina were studied (34-males and 2-females). In all patients the stable angina was diagnoses based on the results of coronary angiography, medical record, ECG, echocardiography, stress-test, blood glucose, coagulation and lipid spectrum tests results. All patients were divided into 2 groups. By coronary angiography in 5 cases severe stenosis (80-95%) and occlusion of left main coronary artery was founded. In 10 cases significant stenosis of main coronary artery was not found and the patients were referred for conventional anti-ischemic therapy. 11 patients were treated by revascularization procedures (4 coronary artery bypass grafting and 7 coronary angioplasty). 15 cases ( 41,6%) were considered as refractory angina pectoris as far as they were suffering from ischemic heart disease and symptoms were present despite optimal medical therapy. They had been considered not suitable for any interventional procedure due to several reasons (distal localization of stenosis, diffuse lesions of arteries, etc.).
Asunto(s)
Angina de Pecho , Adulto , Anciano , Angina de Pecho/complicaciones , Angina de Pecho/diagnóstico , Angina de Pecho/diagnóstico por imagen , Angina de Pecho/tratamiento farmacológico , Angina de Pecho/cirugía , Angioplastia Coronaria con Balón , Enfermedad Crónica , Angiografía Coronaria , Puente de Arteria Coronaria , Estenosis Coronaria/diagnóstico , Ecocardiografía , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Revascularización Miocárdica , Pronóstico , Calidad de Vida , Factores de RiesgoRESUMEN
The effect of left ventricular (LV) contrast ventriculography (VG) on the state of intracardiac hemodynamics during the administration of a contrast medium and 30-40 sec. after it was investigated in 48 CHD patients. It followed retrograde catheterization of the left ventricle by a parallel use of two catheters that permitted recording intraventricular pressure directly during LV VG. The performance of left VG with 76% urografin administered in a dose of 0.6-0.8 ml/kg with the rate of 13-15 ml/s produced no significant change in the state of intracardiac hemodynamics, relaxation and pumping function of the LV in the course of the first three contrasted cardiocycles. Transitory disorder of hemodynamics observed in the patients after contrast VG was restored by itself in 15-20 min.
Asunto(s)
Medios de Contraste , Enfermedad Coronaria/fisiopatología , Diatrizoato de Meglumina , Ventrículos Cardíacos/diagnóstico por imagen , Hemodinámica/efectos de los fármacos , Humanos , RadiografíaRESUMEN
The effect of left ventricular (LV) contrast ventriculography (VG) on the state of intracardiac hemodynamics during the administration of a contrast medium and 30-40 sec. after it was investigated in 48 CHD patients. It followed retrograde catheterization of the left ventricle by a parallel use of two catheters that permitted recording intraventricular pressure directly during LV VG. The performance of left VG with 76% urografin administered in a dose of 0.6-0.8 ml/kg with the rate of 13-15 ml/s produced no significant change in the state of intracardiac hemodynamics, relaxation and pumping function of the LV in the course of the first three contrasted cardiocycles. Transitory disorder of hemodynamics observed in the patients after contrast VG was restored by itself in 15-20 min.
Asunto(s)
Diatrizoato de Meglumina , Hemodinámica/fisiología , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/fisiopatología , Ventriculografía con Radionúclidos/métodos , Medios de Contraste , Diatrizoato de Meglumina/farmacología , Hemodinámica/efectos de los fármacos , Humanos , Función Ventricular Izquierda/efectos de los fármacosAsunto(s)
Enfermedad Coronaria/tratamiento farmacológico , Diástole/efectos de los fármacos , Contracción Miocárdica/efectos de los fármacos , Nifedipino/farmacología , Nitroglicerina/farmacología , Administración Sublingual , Enfermedad Coronaria/fisiopatología , Electrocardiografía , Humanos , Nifedipino/administración & dosificación , Nitroglicerina/administración & dosificaciónRESUMEN
Left ventricular relaxation was studied in 105 patients with coronary heart disease (CHD), 42 with mitral and aortic valvular diseases, and 14 with congestive cardiomyopathy. To assess the left ventricular relaxation, the values of dP/dt and T time constants for isovolumic exponential fall in intraventricular pressure were defined in the patients. Depressed left ventricular relaxation was found in the majority of the patients with CHD whatever the status of global and segmental pumping function of the left ventricle. Abnormal left ventricular relaxation turned out to be a characteristic feature in patients with congestive cardiomyopathy and valvular diseases that contributed to the generation of left ventricular overload by its pressure and volume. In CHD patients, depressed relaxation was accompanied by lower volume and slower early diastolic filling of the left ventricle.
Asunto(s)
Cardiomiopatía Dilatada/fisiopatología , Enfermedad Coronaria/fisiopatología , Insuficiencia de la Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/fisiopatología , Contracción Miocárdica/fisiología , Gasto Cardíaco Bajo/etiología , Ventrículos Cardíacos/fisiopatología , HumanosRESUMEN
The practicability of the diagnosis of "ischemic cardiomyopathy (ICMP)" was examined on the basis of clinical and angiocardiographic data in 32 coronary patients with left-ventricular diffuse hypo- and akinesia, and its angiocardiographic markers were identified. The ICMP patients show a typical clinical picture, its major signs being congestive circulatory insufficiency, cardiomegaly and electrocardiographic evidence of large-focal scarry changes. The ICMP diagnosis is based on considerably increased ventriculographic volumetric parameters, and diffuse hypo- and akinesia of the left ventricle with the ejection fraction falling below 30% in patients with coronarographically-documented coronary arterial lesions.