BACKGROUND: The diagnostic significance of ECG ergonovine test and the incidence of vasospastic angina in patients with chest pain are still uncertain. METHODS: From May 1998 to June 1999, 133 consecutive patients with chest pain were admitted for diagnostic coronary angiography. ECG ergonovine provocation tests were performed in 64 patients who have a clinical history suggesting vasospatic angina, including 27 of 28 patients with vasospastic angina documented electrocardiographically, or who's coronary angiographic findings could not be explained by their clinical history. Ergonovine was administered intravenously in incremental dose of 0.05, 0.1, 0.2, 0.3, 0.4 mg up to total cumulative dosage of 1.0mg during coronary angiography(41 cases), in the exercise laboratory(21 cases) or both(2 cases). RESULTS: Of 133 patients with chest pain, vasospastic angina was documented in 32(24%), unstable angina in 52(34%), stable angina in 10(8%), and others in 39(29%). Angiography demonstrated coronary spasm in 4 additional patients as well as 22 patients with vasospastic angina documented electrocardiographically, but ergonovine tests in the exercise laboratory showed positive response in 5 of 6 patients with vasospastic angina documented. Among the 25 patients with coronary spasm proved angiographically during ergonovine test, ECG findings at the time of coronary spasm were ST segment elevation in 21(84%), depression in 1(4%) and no change in 3(12%) patients, who had branch vessel spasm, 3 vessel spasm or incomplete spasm on coronary angiogram. Of the 31 patients with vasospastic angina who underwent ergonovine tests, positive response occurred in 24(77%) after a cumulative dose of < or = 0.4mg and in additional 3(10%) after the higher dose of >0.4mg. However the other 4(13%) had no ECG changes even after the higher dose(>0.4mg) of ergonovine. CONCLUSION: This results suggest that vasospastic angina appear to be a common cause of chest pain, and ECG ergonovine test with high dose can improve diagnostic sensitivity but cannot detect some patients with vasospastic angina.
Angina, Stable ; Angina, Unstable ; Angiography ; Chest Pain ; Coronary Angiography ; Depression ; Electrocardiography* ; Ergonovine* ; Humans ; Incidence ; Spasm

BACKGROUND AND OBJECTIVES: Plasma adiponectin, which decreases the progression of atherosclerosis and insulin resistance, as well as suppressing lipid accumulation in macrophages, is decreased in patients with acute myocardial infarction and unstable angina pectoris; however, the correlation between plasma adiponectin and vasospastic angina pectoris (VAP) remains to be verified. We compared the plasma adiponectin concentration between patients with VAP and other coronary artery diseases; moreover, we investigated the association between the plasma adiponectin concentration and VAP. SUBJECTS AND METHODS: Following coronary angiography for the evaluation of chest pain, 395 subjects (180 women and 215 men) were divided into 4 groups: acute coronary syndrome (ACS)(n=117), VAP (n=94), stable angina pectoris (SAP)(n=108) and angiographically normal coronary artery (n=76). The acetylcholine provocation test was used to confirm VAP, and plasma adiponectin concentrations were measured in all participants. RESULTS: The plasma adiponectin concentrations in patients with VAP and ACS were significantly lower than that of the normal coronary artery group (6.6+/-5.4 vs. 5.2+/-4.0 vs. 9.0+/-6.2 microgram/mL, p<0.001, respectively). A multivariate analysis indicated that plasma adiponectin [odd ratio (OR) 0.744, 95% confidence interval (CI) 0.645 to 0.858, p=0.001], smoking (OR 2.054, 95% CI 1.027 to 4.106, p=0.042) and age (OR 0.966, 95% CI 0.935 to 0.997, p=0.031) were independently correlated in patients diagnosed with VAP. CONCLUSION: Our results suggest that a decreased plasma adiponectin concentration may be associated with VAP.
Acetylcholine ; Acute Coronary Syndrome ; Adiponectin* ; Angina Pectoris ; Angina, Stable ; Angina, Unstable ; Atherosclerosis ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Female ; Humans ; Insulin Resistance ; Macrophages ; Multivariate Analysis ; Myocardial Infarction ; Plasma* ; Smoke ; Smoking

PURPOSE: The purpose of this study is to evaluate the diagnostic value of the Triage(R) Cardiac System (Biosite, USA) for quantitative detection of acute myocardial infarction. METHODS: During a three-month period, we prospectively studied the cases of patients who visited the emergency department (ED) with suspicious acute ischemic chest pain. With the exclusion of patients with stable angina (according to ACC/AHA guideline) and non-cardiogenic chest pain, a total of 20 patients were studied. We evaluated the sensitivity and the specificity of the Triage(R) Cardiac System, and we compared the results with those from an established device (Elecsys(R) 1010, Boehringer Mannheim, Germany) by using a Pearson correlation and the student t-test. RESULTS: The mean operating time of the Triage(R) Cardiac System was faster than that of the established device (16 +/- 1.2 min vs 30+/-0.6 min). The sensitivity and the specificity were same for the two devices. The sensitivity and the specificity of CK-MB were 63.6% and 88.9% respectively, and those of cardiac troponin were 54.5% and 100%. In the evaluation of patients who arrived at the ED after 4 hours of symptom onset, the sensitivity and the specificity were high. The Pearson correlation of CK-MB between the two devices was significant (r=0.970, p<0.01). The CK-MB values of acute myocardial infarction were significantly different with unstable angina (Triage(R) Cardiac System: t = 2.857 p = 0.017; Elecsys(R) 1010: t = 2.804 p = 0.018). CONCLUSION: The Triage(R) Cardiac System is a good diagnostic device for acute myocardial infarction, and its fast reporting of the result and its ease to use in the ED are superior to those of the established device.
Angina, Stable ; Angina, Unstable ; Chest Pain ; Emergency Service, Hospital ; Humans ; Myocardial Infarction* ; Prospective Studies ; Sensitivity and Specificity ; Troponin

BACKGROUND AND OBJECTIVES: Early color M-mode Doppler flow propagation (Vp) has been used to distinguish pseudonormal from normal diastolic filling patterns. However, the role of other indices, including the late diastolic propagation velocity (Ap) and time delay of mitral flow propagation (VpTD and ApTD), is not clear. SUBJECTS AND METHODS: Doppler echocardiographic examinations were performed in 89 patients (60.6+/-9.9 years, male 59.6%), with an ejection fraction > or =40%, who were admitted for diagnostic coronary angiography. The clinical diagnoses on admission were stable angina (41.6%), unstable angina (30.3%), old myocardial infarction (24.7%) and atypical chest pain (3.3%) The diastolic filling patterns, as confirmed by mitral inflow and pulmonary venous flow, were compared with the Ap, VpTD and ApTD indices using color M-mode Doppler echocardiography. RESULTS: The age, left ventricular ejection fraction, left ventricular end diastolic and end systolic dimensions, the left atrial size, and the E'and A'velocities of the mitral annulus tissue Doppler were significantly different between patients with normal and abnormal diastolic filling patterns. In patients with normal filling, impaired relaxation and pseudonormalized filling patterns, the VpTD were 63.1+/-14.9, 85.2+/-25.5 and 107.8+/-36.8 ms (p<0.001), the E/Vp were 1.3+/-0.4, 1.6+/-0.6 and 3.1+/-0.7 (p<0.001), and the E/VpTD were 1.2+/-0.5, 0.7+/-0.2 and 0.9+/-0.4 (p<0.001), respectively. The Ap and ApTD showed significant differences between patients with normal and pseudonormalized filling patterns (Ap 58.3+/-23.5 vs. 36.2+/-15.1, p=0.000; ApTD 47.1+/-19.5 vs. 66.7+/-22.2, p=0.001). The PVa duration, an index that depends on the left ventricular end-diastolic pressure, was the most important independent predictor for ApTD from a multiple regression analysis (R2=71.4%). CONCLUSION: The color M-mode Doppler indices, Ap, VpTD and ApTD, are new diagnostic parameters for diastolic dysfunction.
Angina, Stable ; Angina, Unstable ; Chest Pain ; Coronary Angiography ; Diagnosis ; Diastole ; Echocardiography* ; Echocardiography, Doppler ; Heart Failure ; Humans ; Male ; Myocardial Infarction ; Relaxation ; Stroke Volume

Variant angina pectoris (VAP) is a special type of unstable angina with coronary artery spasm as the main pathogenesis, characterized by resting chest pain, and transient ST segment dynamic changes. The development of acute myocardial infarction is not uncommon. We report a case of a 49-year-old female patient diagnosed with VAP at 2 years before who suddenly suffered severe chest pain. Troponin-I was elevated. Immediate coronary angiography showed near-total occlusion in the proximal left anterior descending artery, which was not fully dilated despite use of intracoronary nitroglycerin. Intravascular ultrasound showed focal significant stenosis with a large amount of plaque at the site of spasm and the lesion was successfully treated with drug-eluting stent placement. Intravascular imaging may be instrumental in high-risk patients with VAP who suffer recurrent chest pain despite intensive anti-spasm medications.
Angina Pectoris, Variant ; Angina, Unstable ; Arteries ; Atherosclerosis* ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Drug-Eluting Stents ; Female ; Humans ; Middle Aged ; Myocardial Infarction* ; Nitroglycerin ; Spasm* ; Troponin I ; Ultrasonics ; Ultrasonography

Left ventricular diverticulum is rare cardiac malformation;fewer than 30 cases have been reported in the world. We present a case of left ventricular diverticulum with chest pain suggested unstable angina. Myocardial rupture of this case was occured during cardiac catherization. patient was recovered and discharged. Relevant literature was also reviewed.
Angina, Unstable ; Chest Pain ; Diverticulum* ; Humans ; Rupture

BACKGROUND: Troponin T(TnT), a 37 kDa polypeptide subunit of contractile protein, is part of the troponin complect in striated muscle, where it binds to tropomyosin. TnT is not usually found in circulating blood, but increase in serum by cytoplasmic damage. Because the amino acid sequence is unique to cardiac muscle, one can immunologically differentiate skeletal muscle and cardiac protein isoforms. METHODS: We evaluated serum cardiac TnT (ELISA, Troponin-T, Boehringer Mannheim, Germany) versos CK-MB mass (IMX CK-MB, Abbott Laboratories, USA) in 46 cases (173 samples) of acute myocardial infarction, 28 cases (94 samples) of ansi na pectoris, 23 cases (62 samples) of other cardiac disease, and 32 cases of non-cardiac disease from September 1994-June 1996. RESULTS: TnT was detected in serum(cutoff value 0.20 ng/ml) within 6 hours after onset of chest pain, slightly earlier than CK-MB mass (cutoff value 5.0 ng/ml). Sensitivity of TnT (81%) is not statistically different from CK-MB mass (84%) within 24 hour of cutest pain but more sensitive after 24-72 hours of symptom, Specificity (79.5%) and positive predictive value (70.7%) of TnT were superior to that of CK-MB mass within 24 fours of cutest pain, and persistent to 6 days, which was longer than that of Cl4-MB mass. More patients show increment of TnT in unstable angina pectoris(40.0%) than stable angina pectoris(15.4%), No difference in detection rate of TnT between angina pectoris(28.6%) and other cardiac disease patients(34.8%). Only 3.1 % of non-cardiac disease patients show TnT increment. CONCLUSIONS: We concluded that TnT Is not detected In most of non-cardiac disease patients, and is an early and later marker with very wide diagnostic time win-dow. Also, TnT can be used as a valuable masker for ischemic myocardial damage in any underlying causes.
Amino Acid Sequence ; Angina, Stable ; Angina, Unstable ; Chest Pain ; Cytoplasm ; Heart Diseases ; Humans ; Muscle, Skeletal ; Muscle, Striated ; Myocardial Infarction* ; Myocardial Ischemia* ; Myocardium ; Protein Isoforms ; Sensitivity and Specificity ; Trinitrotoluene ; Tropomyosin ; Troponin T* ; Troponin*

To assess the likelihood of procedural success in patients with multivessel coronary artery disease, 46 consecutive patients (male 34, female 12, mean age 60+/-9 years) umderwent single or multiple site angioplasty. The clinical diagnosis of unstable angina was in 20(44%), stable angina in 10 and acute or old myocardial infarction in 16. Coronary angiographic findings of 2 vessel disease was in 38(83%), triple vessel disease in 8. Left ventricular function was generally well preserved (mean ejection fraction 65+/-12%, range 30-82%) and mean 2.0 stenosis per patient angic, lasty had attempted. Single vessel angioplasty (SVA) was performed in 13 and multivessel angioplasty (MVA) in 33. Procedural success was achieved in 79(86%) out of total 92 stenoses. Sixty-six(88%) out of 75 stenoses in MVA and 13(76%) out of 17 stenoses in SVA had procedural success respectively. According to angiographic morphology of lesions, procedural success of type A stenoses was 17/17(100%), type B stenoses 57/66(86%) and type C stenoses was 5/9(33%). In 13 failures included inability to pass the guide wire cross the lesion in 7, inability to guide the griding catheter in 2 and inability to dilate lesions in 4. Before and after angioplasty, treadmill test (modified Bruce protocol)could be performed in 29 patients. Total duration of exercise and maximal double product improved significantly from 8.5+/-2.3 minute 5188+/-2403 to 12.2+1.3 min., 23,062+/-4111 respectively (p<0.001). 17 out of 24 patients who had positive treadmill test before angioplasty showed negative conversion after procedure. Complications included dissection in 29, prolongd chest pain in 5, acute closure in 3, cardiac tamponade in 1 and ventricular fibrillation due to side branch oclusion in 1. Thus, coronary angioplasty in selected paients with multivessel coronary artery disease might be useful and have relatively good immediate results, but the long-term efficacies with other forms of treatment must be evaluated prospectively.
Angina, Stable ; Angina, Unstable ; Angioplasty* ; Cardiac Tamponade ; Catheters ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis ; Exercise Test ; Female ; Humans ; Myocardial Infarction ; Ventricular Fibrillation ; Ventricular Function, Left

Since the introduction of PTCA by Gruntzig in 1977, this is now widely used in some subsets of patients with coronary artery disease and is an effective alternative to surgery for many patients. In the 3 years from June 1983 to June 1985, PTCA was attempted in 33 patients with coronary artery disease at the Severance Hospital. There were 26 men and 7 women, whose mean age was 51 years(31-68year). Seven patients had a previous myocardial infarction. Thirty one of 33 patiens presented with chest pain. Twenty four patients had unstable angina and 7 stable angina. the median duration of angina was 5 months(1-120months). 29 had one vessel disease. One had left main disease, 1 two-and 2 three-vessel disease. PTCA was attempted on lesions located in the left anterior descending artery in 26 patients, right coronary artery in1. Successful dilation(stenosis opened by 20% or more of the normal luminal diameter)was achieved in 24 patients(73%). Seventy seven of the stenosis of the LAD and 75% of the RCA was succesfully dilated, whereas PTCA was failed in all 2 patients with a stenosis of the LCX. One patients with a stenosis of the left main artery was succesfully dilated. The mean degree of stenosis was reduced from 77+/-2% to 34+/-2%(P<0.001). The mean pressure gradient was diminished from 53+/-8mmHg to 18+/-6mmHg(P<0.001). Acute coronary occlusion occured in 4 patients(12%). Three of them developed acute myocardial infarction. Emergency coronary bypass operation was done in 2 patients, but one died on the day of operation. Follow-up clinical assessment in the hospital after successful angioplasty indicated freedom from angina in the most of successfully dilated patietns. Eleven patients who underwent successful dilation had basesline and follow-up(within 2 weeks after PTCA) transmill tests. Nine of 11 patients with a positive treadmill test before PTCA obtained negative results after successful angioplasty. Mean exercise duration increased from 316+/-46sec to 601+/-34sec(P<0.001). Eight patients have developed recurrence of angina(recurrence rate;33%) during follow-up period of 3 to 36 months(medial;10 months). In 6 of these cases, restenosis has been documented angiographically within 3 months of dilatation. Four asymptomatic patients have had follow-up angiography. In all patients, the dilated segments was unchanged or improved. Repeat PTCA was attempted in 5 patients with a success rate of 80% without any complications. This initial expierence with PTCA indicates that it is an effective method of relieving coronary stenosis and ischemic symptoms in selected patients. But it carries an inherent risk of serious complications. Also restenosis is a persistent problem with PTCA. Repeat PTCA can be done with a high success and a low complication rate.
Angina, Stable ; Angina, Unstable ; Angiography ; Angioplasty ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Occlusion ; Coronary Stenosis* ; Coronary Vessels* ; Dilatation ; Emergencies ; Exercise Test ; Female ; Follow-Up Studies ; Freedom ; Humans ; Male ; Myocardial Infarction ; Phenobarbital ; Recurrence

PTCA has been widely applied in patients with symptomatic coronary artery disease since 1977. The PTCA was performed on a total of 25 patients (19 men and 6 women) from Feburary 1988 to January 1990 at Inje University Baik Hospital. Their mean age was 51.4+/-10.1 years. The 20 patients had unstable angina, and 5 patients had stable angina. The 6 patients had a previous myocardial infarction. The 17 patients had one vessel disease, 6 patients had two vessel disease and 2 patients had three vessel disease. Primary success was achieved in 24 of 25 patients. The mean degree of stenosis was reduced from 80.7+/-2.9% to 16.2+/-3.3% (p<0.01). After PTCA, pain was relieved or subsided in all patients. In 6 patients, mild chest pain has reccured during the short term follow up. Repeat PTCA was performed in 2 of 6 patients successfully. Complications occurred in 3 patients ; coronary artery spasm, ventricular fibrillation and femoral artery hematoma in each patients.
Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon, Coronary* ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease* ; Coronary Vessels* ; Femoral Artery ; Follow-Up Studies ; Hematoma ; Humans ; Male ; Myocardial Infarction ; Spasm ; Ventricular Fibrillation