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Angina pectoris in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Wilbert S. Aronow, William H. Frishman
Angina pectoris is a clinical syndrome reflecting inadequate oxygen supply for myocardial metabolic demands with resultant ischemia. Depending on the underlying pathophysiology, the patient will present with stable or unstable angina. The goals of therapy in elderly patients with angina (ischemic syndromes) are to (1) relieve the acute symptoms and stabilize the acute pathophysiological process; (2) minimize the frequency and severity of recurrent anginal attacks; and (3) prevent progression, plus cause regression of the underlying pathophysiological process. Therapeutic measures are directed at modifying the underlying pathophysiology with therapeutic agents and reducing myocardial ischemia by (1) reducing myocardial oxygen demand and (2) increasing coronary blood flow.
Coronary artery disease and regional left ventricular function
Published in Andrew R. Houghton, MAKING SENSE of Echocardiography, 2013
An acute coronary syndrome occurs when an atherosclerotic plaque ruptures, exposing the lipid-rich core to the bloodstream. This leads to the rapid formation of a thrombus which acutely obstructs flow down the coronary artery. If this leads to necrosis of a portion of myocardium, cardiac markers (e.g. troponins) will be released into the circulation, and the detection of these markers is one of the key diagnostic features of a myocardial infarction. Unstable symptoms without a rise in cardiac markers is termed unstable angina.
Ischemic Heart Disease
Published in P. Chopra, R. Ray, A. Saxena, Illustrated Textbook of Cardiovascular Pathology, 2013
Unstable angina refers to progressively increasing cardiac pain at rest which often is of prolonged duration. This type of angina has a great risk of developing myocardial infarction and therefore is also termed as "preinfarction angina". Rupture of an atheromatous plaque with thrombus formation leads to occlusion of the lumen. Myocardial ischemia results which manifests as pain. The ischemia is generally short lived and therefore does not cause necrosis of the myocardium. Angiographic studies done in unstable angina have shown stenotic lesions in the coronary artery with irregular outlines (ruptured atheromatous plaque) with an intraluminal filling defect (thrombus) demonstrated in a large number of cases. If the occlusion is complete and persistent, myocardial infarction will occur.
Effects of cigarette smoking on older chinese men treated with clopidogrel monotherapy or aspirin monotherapy: a prospective study
Published in Platelets, 2020
Yulun Cai, Weihao Xu, Hongbin Liu, Fan Wang, Lei Duan, Huiying Li, Man Li, Yuerui Li, Lina Han, Hunan Xiao
Cardiovascular and cerebrovascular disease outcomes were evaluated for an average follow-up of 23 months. The primary endpoint was the composite of adverse clinical events, including death, myocardial infarction, stroke, transient ischemic attack (TIA), and unstable angina. Death was defined as death from all causes. Myocardial infarction was defined using the European Society of Cardiology/American College of Cardiology criteria [16]. Stroke was defined as an acute neurological vascular event lasting more than 24h. TIA was defined as an acute neurological vascular event lasting less than 24h. Unstable angina was defined according to the American College of Cardiology Foundation/American Heart Association criteria [17]. The follow-up was completed in all patients by reviewing their medical records and by telephone interviews. Emphasis was placed on the occurrence of the primary endpoint.
Comparison between two different protocols of lower limb constraint-induced movement therapy following stroke: a randomised controlled trial protocol
Published in European Journal of Physiotherapy, 2020
Naima Aliyu Umar, Auwal Abdullahi
The study participants will be stroke patients attending physiotherapy departments at Murtala Muhammad specialists’ hospital, Kano and Muhammad Abdullahi Wase specialists’ hospital, Kano. Participants to be included in the study will be stroke patients who have asymmetrical stance, ability to stand and walk with minimal assistance, and no significant cognitive impairment indicated by a score of ≥24 on mini-mental state examination (MMSE). In addition, patients must have at least 15° of knee flexion in the affected limb and aged 18 years and above. However, participants will be excluded from the study if they have cardiopulmonary diseases which could hinder their ability to participate in the rehabilitation programme in this study. Cardiorespiratory fitness has moderate to high and low to moderate contribution to walking endurance in sub-acute and chronic stroke patients, respectively [26–29]. The conditions include but not limited to unstable angina, uncontrolled-abnormal heart rhythms, symptomatic heart failure and severe shortness of breath. Similarly, patients with severe pain that may interfere with training and those with hemineglect indicated by a cut-off of <44 on the star cancellation test will be excluded from the study. Participants will be recruited consecutively by a trained therapist in each of the study sites.
Off-pump Coronary Artery Bypass through Ministernotomy in Patients with Diabetes Mellitus
Published in Structural Heart, 2020
Khusan Khalikulov, Abrol Mansurov, Saidorifhon Murtazaev
Methods: We have performed 40 operations off-pump coronary artery bypass. All operations were performed through ministernotomy using myocardial stabilizer. The age of patients varies from 32 to 60 years old. All patients were male. Unstable angina was diagnosed in 15 (37.5%) patients, and the rest of 25 (62.5%) patients had different class of stable angina. Arterial hypertension was present in 38 patients, coronary insufficiency in 11 patients. 34 patients had myocardial infarction in the anamnesis. ECG data revealed ischemia in 25 patients. Echo: left ventricle ejection fraction under 40% in patients, under 50% in 22 patients and the rest of patients had 55%. Blood glucose level was varied from 8 to 15 mmol/L and average mean composed of 11.2 mmol/L. Angiography data revealed single-vessel disease in 25 cases and the other 15 patients had double-vessel disease.