The contribution of gastroesophageal reflux to chest pain in patients with coronary artery disease.

Objective: To describe the effectiveness of investigating and treating the cause of refractory chest pain in patients with coronary artery disease who are receiving optimal antianginal therapy.

Design: Cohort study.

Setting: Tertiary referral center.

Excluding heart disease in the patient with chest pain.

Angina pectoris is chest discomfort associated with myocardial ischemia. When coronary blood flow is inadequate to meet myocardial tissue demand, lactate accumulates, resulting in diastolic and systolic left ventricular dysfunction. This leads to ST-segment abnormalities and eventually to angina pectoris.

The prevalence of abnormal esophageal test results in patients with cardiovascular disease and unexplained chest pain.

The purpose of our study was to assess the prevalence of esophageal test abnormalities in patients with known cardiovascular disease and persistent chest pain. We performed a retrospective review of symptoms, manometry, and provocative test results performed on patients with undiagnosed chest pain. The 220 patients with angiographically determined cardiac disease and persistent chest pain were divided into three groups: coronary artery disease (125 patients), mitral valve prolapse (38 patients), and coronary bypass/angioplasty (57 patients).

Acute Epstein-Barr virus myocarditis simulating myocardial infarction with cardiogenic shock.

We have reported the case of a 38-year-old white woman with substernal chest pain, hypotension, and ECG changes suggesting acute anterior myocardial infarction. Cardiac catheterization revealed no coronary artery pathology, but severe global hypokinesia was noted on left ventriculogram and endomyocardial biopsy revealed myocytic degeneration and mononuclear cell infiltration consistent with acute viral myocarditis. Viral serologies confirmed a recent Epstein-Barr virus infection.

Cardiac transplantation in a patient with muscular dystrophy and cardiomyopathy.

A 17-year-old boy with muscular dystrophy developed a cardiomyopathy. His brother died of a cardiomyopathy, and muscle enzyme levels were elevated in asymptomatic family members. Examination revealed cardiomegaly, hepatomegaly, proximal muscle atrophy and weakness, and calf hypertrophy.

Diastolic mitral regurgitation in acute but not chronic aortic regurgitation: implications regarding the mechanism of mitral closure.

In acute aortic regurgitation, left ventricular pressure rises rapidly during diastole, which produces presystolic mitral valve closure. This does not occur in chronic aortic regurgitation. Since normal, nonregurgitant mitral valve closure may depend on properly coordinated atrial and ventricular contractions, we hypothesized that abnormal mitral valve closure occurring before systole in acute aortic regurgitation may produce diastolic mitral regurgitation detectable by Doppler echocardiography.

Short- and long-acting angiotensin-converting enzyme inhibitors: a randomized trial of lisinopril versus captopril in the treatment of congestive heart failure. The Multicenter Lisinopril-Captopril Congestive Heart Failure Study Group.

A randomized, parallel, double-blind study was performed with lisinopril, a long-acting angiotensin-converting enzyme inhibitor, versus captopril, a shorter-acting angiotensin-converting enzyme inhibitor, in the treatment of congestive heart failure. All patients were in New York Heart Association class II, III or IV and had remained symptomatic despite therapy with digoxin and diuretics. After a 4 to 14 day placebo baseline period, patients were randomized to receive either lisinopril, 5 mg orally once per day (n = 94), or captopril, 12.

Long-term follow-up of symptomatic status of patients with noncardiac chest pain: is diagnosis of esophageal etiology helpful?

Questionnaires were sent to 119 patients with noncardiac chest pain, all of whom had previous detailed esophageal evaluations in which 63 were diagnosed as having pain from the esophagus. Mean follow-up period was 21.8 months.

A double-blind comparison of lisinopril with captopril in patients with symptomatic congestive heart failure.

Angiotensin-converting enzyme (ACE) inhibition with captopril is accepted therapy for the treatment of symptomatic congestive heart failure. In this trial, we compared the new ACE inhibitor, lisinopril, to captopril during a 12-week randomized double-blind study. One hundred twenty-nine patients with New York Heart Association class II, III, or IV congestive heart failure were randomized to receive either lisinopril 5 mg/day (n = 64) or captopril 37.

Edrophonium: a useful provocative test for esophageal chest pain.

Esophageal motility disorders may be an important cause of noncardiac chest pain. To improve our diagnostic yield, we studied the use of edrophonium as a provocative test for inducing esophageal chest pain in 50 symptomatic patients without coronary artery disease and in 25 age-matched controls. Edrophonium (80 micrograms/kg of body weight, intravenous bolus) induced chest pain in 15 (30%) patients and in no controls.

Spasm of the aortocoronary venous graft.

Two cases of spasm of the coronary artery bypass graft are reported, and the angiographic and clinical findings are discussed. Few previous reports of this entity were found in a search of the literature. The therapeutic implications are also presented.

Venous thrombosis as a cause of superior vena cava syndrome. Rapid response to streptokinase.

Venous thrombosis, resulting in superior vena cava syndrome, developed in a patient with two permanent transvenous pacemaker wires. Therapy with streptokinase resulted in prompt relief of the obstruction, with no complications. In properly selected patients, streptokinase may be the treatment of choice for this potentially life-threatening problem.

Coronary artery thrombus: rapid resolution shown by serial coronary arteriography.

Resolution of a coronary artery thrombus within two weeks was demonstrated by serial coronary arteriography in a man with atherosclerotic coronary artery disease. This observation indicates that subtotal coronary artery thrombosis does not invariably progress to complete occlusion of the affected vessel and that the resolution of coronary artery thrombus can occur rapidly.

Comparison of Tc-99m pyrosphosphate and Tc-99m hydroxymethylene diphosphonate in acute myocardial infarction: concise communication.

A clinical comparison between a new bone seeking radiopharmaceutical, Tc-99m hydroxymethylene diphosphonate (TcHMDP) and the standard agent, Tc-99m pyrophosphate (TcPPi), was performed in 18 patients with acute myocardial infarction. Each patient was imaged initially with either TcHMDP or TcPPi, and imaged 24 hr later with the other tracer. All 18 patients had images positive for acute myocardial infarction with TcPPi, whereas 16 of 18 patients (89%) had positive studies with TcHMDP.

Comparison of Tc-99m pyrophosphate and Tc-99m methylene diphosphonate in acute myocardial infarction: concise communication.

This study compared Tc-99m pyrophosphate (PPi) and Tc-99m methylene diphosphonate (MDP) for myocardial infarct imaging in 24 patients with diagnosed acute myocardial infarction. The radiopharmaceuticals were administered randomly and interpreted without knowledge of the sequence used. Twenty-three patients (96%) had positive Tc-99m PPi scintigrams, but only 17 (71%) had a positive Tc-99m MDP study (P less than 0.

Uterine blood flow and its distribution after chronic estrogen and progesterone administration.

The rates and distributions of uterine blood flow (UBF) were measured in conscious castrated ewes during estradiol, progesterone, and combined-hormone regimens. Supplemental progesterone decreased the magnitude of UBF observed on estradiol alone. Progesterone favored distribution of UBF to the uterine caruncles and estradiol favored distribution to the myometrium and uterine cervix.