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HealthDay News — For people with stable chest pain referred for invasive coronary angiography (ICA), the risk for major adverse cardiovascular events (MACE) is low among those with a low [...]

2023 JUN 22 (NewsRx) -- By a News Reporter-Staff News Editor at Women's Health Weekly -- Women have long searched for remedies for the bothersome hot flashes that often come [...]

Obstetrician-gynecologists are deeply committed to reducing maternal mortality and severe morbidity. Hypertensive diseases of pregnancy, including preeclampsia and eclampsia, are important contributors to both maternal mortality and severe morbidity. Among [...]

Fang Wang, a pharmacist at Pharmakon Pharmaceuticals in Noblesville, was testing samples of drugs made at the company one day in 2014 when she noticed something that alarmed her. A [...]

2020 DEC 26 (NewsRx) -- By a News Reporter-Staff News Editor at Obesity, Fitness & Wellness Week -- Data detailed on heart attack have been presented. According to news reporting [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.07.009 Byline: Todd Hurst (a), Tina H. Olson (b), Lisa E. Olson (c), Christopher P. Appleton (a) Keywords: Cardiac syndrome X; Microvascular angina; Microvascular ischemia; Endothelial dysfunction Abstract: Cardiac syndrome X (CSX), or angina with no flow-limiting stenosis on coronary angiogram, has been regarded as a condition with an excellent prognosis despite variable symptomatic improvement. Newer data show that patients with CSX with endothelial dysfunction have an increased risk for future adverse cardiac events. Current hypotheses of CSX pathophysiology emphasize a dysfunctional vascular endothelium that leads to microvascular ischemia. Treatments that target improving endothelial function, such as statins, angiotensin-converting enzyme inhibitors, estrogen, and lifestyle modification, are promising additions to treatment regimens for CSX. The goal of this article is to provide information for improved diagnosis, risk stratification, and therapy for the population with CSX. Author Affiliation: (a) Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Ariz (b) East College, Arizona State University, Mesa (c) Department of Biology, University of Redlands, Redlands, Calif. Article History: Received 4 July 2005; Revised 11 July 2005; Accepted 11 July 2005

Background: The belief that chest pain relief with nitroglycerin indicates the presence of active coronary artery disease is common. However, this hypothesis has not been tested. Objective: To define the diagnostic and prognostic value of chest pain relief with nitroglycerin. Design: Prospective observational cohort study. Setting: Urban community teaching hospital. Patients: 459 consecutive patients with chest pain admitted through the emergency department who received nitroglycerin from emergency services personnel or an emergency department nurse. Follow-up was obtained by telephone contact at 4 months. Measurements: Chest pain relief was defined as a decrease of at least 50% in patients' self-reported pain within 5 minutes of the initial dose of sublingual or spray nitroglycerin. Active coronary artery disease was defined as any elevated serum enzyme levels, coronary angiography demonstrating a 70% or greater stenosis, or a positive exercise test result. Results: Nitroglycerin relieved chest pain in 39% of patients (181 of 459). In patients with active coronary artery disease as the likely cause of their chest pain, 35% (49 of 141) had chest pain relief with nitroglycerin. In contrast, in patients without active coronary artery disease, 41% (113 of 275) had chest pain relief (P > 0.2). Four-month clinical outcomes were similar in patients with or without chest pain relief with nitroglycerin (P > 0.2). Conclusions: These data suggest that, in a general population admitted for chest pain, relief of pain after nitroglycerin treatment does not predict active coronary artery disease and should not be used to guide diagnosis.

The optimal medical regimen for the treatment of cocaine associated myocardial ischemia has not been defined. While animal and human data demonstrate the risks of beta-adrenergic blockade, studies in the cardiac catheterization laboratory suggest a beneficial role of nitroglycerin. We performed a prospective multicenter observational study to evaluate the clinical safety and efficacy of nitroglycerin in the treatment of cocaine associated chest pain at six municipal hospital centers. Of 246 patients presenting with cocaine associated chest pain, 83 patients were treated with nitroglycerin at the discretion of the treating physician. Relief of chest pain and/or adverse hemodynamic outcome were the primary endpoints. Baseline comparisons of patients treated with nitroglycerin to those not treated with nitroglycerin found that the treated patients were at higher risk of ischemic heart disease. They were older (36 years vs 32 years, p = 0.0008), more likely to have an ischemic electrocardiogram (27% vs 4%, p < 0.0001), to be admitted (94% vs 40%, p < 0.000 1), and to have a discharge diagnosis of ischemic heart disease (41 % vs 9%, p < 0.0001). Nitroglycerin was beneficial in 41 patients (49%; 95% Cl, 38-60%): 37 patients (45%) had relief or reduction in the severity of chest pain and 4 patients 5%) had other beneficial effects. Only one patient had an adverse outcome (transient hypotension in the setting of a right ventricular infarct). Nitroglycerin is safe and possibly effective in the treatment of cocaine associated chest pain. (Key Words: cocaine; myocardial infarction; nitroglycerin; drug abuse; angina; ischemia; human.), INTRODUCTION Over the past decade the increase in recreational cocaine use has led to an increased awareness of its associated medical complications. With 24 million Americans estimated to have used [...]

Psychoactive medications have been used to manage chest pain of presumed esophageal origin, especially in syndromes associated with esophageal motor dysfunction. The rationale for their use is based on (a) the high prevalence of psychiatric disorders reported in patient groups with esophageal symptoms and minor motor dysfunction, (b) recognized psychophysiologic effects on esophageal motor activity, (c) the potential benefits that nerve-modulating drugs may have on the pathogenesis of the syndromes (independent of psychiatric factors), and (d) observations from treatment trials for chronic pain--including irritable bowel syndrome, a disorder that shares some clinical features with functional esophageal chest pain. Although psychiatric factors may have interactive effects on the presentation and course of reflux disease, the use of psychoactive drugs in reflux disease has not been tested. The effects of psychoactive drugs have been systematically explored and documented in only one study. At present, the mechanisms of esophageal symptom reduction resulting from psychopharmacologic treatments are not clear, but reduced sensitivity to visceral stimuli remains one possibility.

Although the recently introduced patches containing nitroglycerin for transdermal absorption have already gained widespread use in the treatment of angina pectoris, convincing evidence as to their efficacy has yet to [...]

A randomized controlled trial is compared by two paramedic administered nalbuphine dosing regimens on patients suffering from chest pain or trauma. The comparison was made on the factors like homogeneity, analgesic efficacy, change in vital signs, side effects and the results showed more effectiveness of rapid dosing of nalbuphine and decrease in the pain.

You are the lab director of a small community hospital of less than 200 beds, meeting with your supervising associate administrator and going through the monthly laboratory statistics. You show [...]

Doctors should not abandon the use of nitroglycerin for identifying patients who may have coronary artery disease. A study published in 2003 found that nitroglycerin relieves chest pain even in patients who do not have coronary artery disease. However, nitroglycerin may still be useful in identifying patients who have typical angina.

When a 46-year-old man presents to the ED with chest pain, the initial electrocardiogram (ECG) shows a ST-segment elevation in the inferior leads. After the ED physician consults with the [...]

ORLANDO -- About 10% of patients who presented to a hospital emergency department with chest pain and suspected acute coronary syndrome had platelets that were nonresponsive to aspirin, in a [...]