pyrophosphate and Angina--Unstable

Because of recent findings, a reassessment is needed of the concept that rest angina associated with ST-segment depression is due to a spontaneous, transient increase of blood pressure or heart rate, or both, in the presence of critical coronary artery stenosis. Continuous hemodynamic and electrocardiographic recordings done before and during attacks of rest angina and thallium-201 scintigrams done during pain indicate that a transient reduction of flow is the immediate cause of ischemia in most, but not all, instances. Flow reduction, in turn, appears to be due to coronary arterial spasm or platelet aggregation, or both, acting at a site of atherosclerotic narrowing. Therapy for unstable rest angina should include measures to prevent both transient reductions of flow and increases of myocardial oxygen consumption. A combination of long-acting nitrates, a beta-blocker, a calcium-channel blocker, and aspirin or heparin is suggested for this purpose. Intravenous nitroglycerin is useful when angina occurs despite this therapy or when frequent attacks of ischemia are occurring at the time of admission.

Topics: Angina Pectoris; Angina, Unstable; Coronary Angiography; Coronary Disease; Coronary Vasospasm; Diphosphates; Electrocardiography; Hemodynamics; Humans; Krypton; Myocardium; Platelet Aggregation; Radioisotopes; Rest; Rubidium; Technetium; Technetium Tc 99m Pyrophosphate; Thallium

Topics: Angina Pectoris; Angina, Unstable; Animals; Breast Neoplasms; Cardiomyopathies; Coronary Disease; Diagnosis, Differential; Diphosphates; Dogs; Electric Countershock; Humans; Myocardial Infarction; Radionuclide Imaging; Rats; Rib Fractures; Technetium; Technetium Tc 99m Pyrophosphate

Altogether 106 patients with different types of acute CHD (large and small local MI, unstable angina) and stable angina were investigated. Combined assessment of perfusion disorder permits differentiation of necrotic and ischemic myocardial lesions. A degree and type of RP accumulation corresponds to a size of necrotic myocardial lesion determined by means of biochemical markers of necrosis. Parallelism of myoglobin concentration, isoenzyme activity in the blood serum and the results of scintigraphy was revealed. In focal RP accumulation, myoglobin concentration reached maximum values; a moderate increase and decrease up to normal values in the absence of accumulation were observed in diffuse accumulation. Diffuse RP accumulation in patients with stable and unstable types of angina was indicative of transient perfusion disorders resulting from myocardial ischemia.

Topics: Angina Pectoris; Angina, Unstable; Coronary Disease; Diphosphates; Heart; Humans; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Angina Pectoris; Angina, Unstable; Bundle-Branch Block; Diphosphates; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Ambulatory Care; Angina Pectoris; Angina, Unstable; Diphosphates; Heart; Humans; Myoglobin; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Myocardial radiocardiography and scintigraphy with 99mTc-pyrophosphate was performed in 58 patients with stable angina and 60 patients with unstable angina. In patients with stable angina, positive scintigrams were mostly recorded after anginal attacks. Their central hemodynamic parameters deteriorated progressively as angina increased in severity. Patients with unstable angina typically showed myocardial accumulation of the label that was unrelated to anginal attacks and recordable by direct-projection scintigraphy. The assessment of myocardial radiocardiographic and scintigraphic data allows one to differentiate between stable and unstable angina.

Topics: Adult; Angina Pectoris; Angina, Unstable; Cardiac Output; Diagnosis, Differential; Diphosphates; Exercise Test; Female; Heart; Humans; Male; Middle Aged; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Vascular Resistance

Topics: Angina Pectoris; Angina, Unstable; Diphosphates; Female; Heart; Humans; Male; Myocardial Infarction; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

To depict the three-dimensional distribution of 99mTc-pyrophosphate in the heart, emission computed tomography (ECT) was performed, following the conventional planar imaging, in 32 cases with suspected acute myocardial infarction (AMI). There were 23 cases with evidence of AMI, 7 with unstable angina (UA), and 2 with dilated cardiomyopathy (DCM). While the planar images showed discrete cardiac activity in only 11 of the 23 cases (48%) with AMI, the ECT images delineated focal myocardial uptake clearly in 20 of them (87%). On the other hand, the ECT images revealed cardiac blood-pool activity without significant myocardial uptake in all cases with UA and DCM in which the planar images showed diffuse activity. Thus, the ECT imaging of 99mTc-pyrophosphate seems to be a valuable technique for assessing the presence and localization of myocardial necrosis, especially in cases showing diffuse cardiac activity in the planar imaging.

Topics: Adult; Aged; Angina Pectoris; Angina, Unstable; Cardiomyopathies; Diagnosis, Differential; Diphosphates; Female; Heart; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Tomography, X-Ray

Topics: Adult; Aged; Angina, Unstable; Diphosphates; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; Myocardial Infarction; Necrosis; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate