[Taking history in diagnosing coronary artery disease in the 21st century--wasting time or a valuable diagnostic tool?]. / Badanie podmiotowe w rozpoznawaniu choroby wiencowej w XXI wieku--strata czasu czy tez moze wartosciowa metoda diagnostyczna?

UNLABELLED: The relation of chest pain characteristics and other features of the history of disease to coronary angiograms was assessed in 551 patients with chest pain regarded as definite or probable stable angina pectoris. A standardised questionnaire was used to record demographic details and chest pain characteristics of interviewed patients. The differentiation between typical, atypical or nonanginal pain was based on classification proposed by Diamond. The indications for catheterization in each patient were determined at the discretion of the attending physician. All patients underwent diagnostic coronary angiography (clinically important coronary artery disease was defined as > 50 per cent narrowing of the diameter of at least one major vessel or > or = 50 per cent of the left main coronary artery). CONCLUSION: Chest pain characteristics remains an effective tool for estimating probability of coronary artery disease.

[Side effects during dobutamine stress echocardiography: analysis of 582 studies]. / Objawy niepozadane echokardiograficznej próby dobutaminowej--analiza 582 badan.

The purpose of the study was to assess the safety, adverse effects and complications of the dobutamine stress echocardiography (ED). 582 patients without previous infarction were prospectively studied with ED. There were 196 female and 368 male, age varied from 27 to 74 years, mean 52. Dobutamine was given in stepwise increasing doses from 5 to 40 mcg/kg/min. Mean maximal dose achieved was 33 mcg/kg/min. Atropine was added in 253 (43%) cases. Significant coronary artery disease was present in 323 patients (53%). There were no death, no myocardial infarction or episodes of sustained ventricular tachycardia as a result of ED. The test was terminated when following conditions were revealed: target heart rate (28.9%), maximal established dose achieved (25.3%), left ventricular asynergy (19.6%), angina pectoris (10.8%), increase of systolic blood pressure above 220 mm Hg (2.6%), hypotension (7.6%), nonsustained ventricular tachycardia (1.7%). The most common non-cardiac side effects were skin tingling (19.8%), atypical chest pain(16.3%), palpitations (13.9%) and headache (7.9%). The most side effects were usually well tolerated, without the need for test cessation. The ED was terminated only in 4 (0.6%) patients because of non-cardiac side effects including nausea (0.3%) and headache (0.3%). We conclude that ED may be safely performed in routine clinical practice. Side effects were rare and usually minor. Most severe ischemic pain was relieved by test interruption and sublingual nitro-glycerine or short acting beta-blocker administration.

Prediction of lethal or life-threatening cardio-circulatory events in patients who apparently are not at risk : a preliminary retrospective echocardiographic study.

Major cardio-circulatory events, defined as circulatory death, myocardial infarction, unstable angina, or stroke, sometimes occur unexpectedly in patients who apparently have no evident increase in risk (absence of overt heart failure, hypertrophy, uncontrolled or severe hypertension, previous or present myocardial infarction, angina, myocarditis, infectious or any other pericardial, valvular or great vessel disease, heart malformation, significant arrhythmia or conduction disturbances). To investigate whether 2D-guided M-mode echocardiographic variables have predictive value in such patients, a retrospective analysis of 1,965 cases was performed. Twenty-one patients were found who on the day of echocardiographic examination fulfilled the above criteria, but suffered major cardio-circulatory events during the first following year (1 yr group), 12 during the second year (2 yr group), and 16 during the third year (3 yr group). Twenty-eight patients who fulfilled the same criteria, but were followed-up free of major cardio-circulatory events for 935 +/- 144 days constituted the control group. Multivariate analysis of variance (MANOVA) of echocardiographic data was used to select the final set of 11 variables from 30 measurements and calculations which enabled satisfactory discrimination between the four groups (Hotelling T2 = 3.979, Fisher F = 7.596 > Ftab = 1.585). Extension of MANOVA with the leave-one-out method revealed that none of 28 control patients was predicted to be at risk of major cardio-circulatory events in the next year, and only one of 21 patients from the 1 yr group was misdiagnosed as not being at risk. Patients at risk were older, had slightly greater body size (particularly weight), and slightly increased diastolic diameter and volume of the left ventricle. The left ventricular mass, mean wall thickness, and estimated cross-sectional area indexes were also slightly increased. The peak systolic stress was slightly increased and contractility index (BPS/ESVI) was slightly decreased. Our preliminary results suggest that easily obtained echocardiographic measurements and calculations contain clinically useful predictive information.