Thesis (M.S.)--Medical College of Ohio, 2005. / In partial fulfillment of the requirements for the degree of Master of Science in Nursing. Major advisor: Jane C. Evans. Includes abstract. Document formatted into pages: vi, 53 p. Title from title page of PDF document. Title at ETD Web Site : Prodromal signs and symptoms of women with acute coronary syndrome . Bibliography: pages 48-52.

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El documento digital no refiere asesor / Determina si el resultado positivo de la ergometría o del ecoestrés con dobutamina son suficientes para la identificación de lesiones coronarias significativas en pacientes con angina estable sometidos a cinecoronariografía, atendidos en el Instituto Nacional Cardiovascular durante el periodo enero 2013 - enero 2014. El estudio es de tipo observacional, analítico-comparativo, retrospectivo de corte transversal. Se estudió a pacientes mayores de 18 años de edad con diagnóstico de angina estable evaluados con ergometría, ecoestrés con dobutamina y cinecoronariografía (Gold estándar) durante el periodo enero 2013 - enero 2014. La muestra estuvo conformada por 200 pacientes que cumplieron con los criterios de inclusión y ninguno de exclusión. Para el análisis descriptivo se empleó medidas de tendencia central y de dispersión, así como, frecuencias absolutas y relativas. Para el análisis bivariado se empleó la prueba del chi-cuadrado, con nivel de confianza del 95%, además para evaluar el valor diagnóstico de ambas pruebas se utilizó los indicadores de Sensibilidad (S), Especificidad (E), Valor Predictivo Positivo (VPP) y Valor Predictivo Negativo (VPN). Entre las características clínico-epidemiológicas de pacientes con angina estable se observó que el 80% de los pacientes eran de sexo masculino y sus características clinicas más frecuentes fueron: hipertensión arterial (74,5%), consumo de tabaco (55%), dislipidemia (49%) y en menor frecuencia se observó diabetes (20,5%) y obesidad (13%). En la prueba de ergometría el 79,5% de los pacientes tuvieron resultado positivo para la identificación de lesión coronaria significativa, además se encontró clase funcional I en el 45.7% de los pacientes y el 34,3% tuvieron angina limitante. En los resultados del ecoestrés con dobutamina en el 77% de los pacientes se identificaron lesión coronaria significativa, donde se encontró una media de 3.9 segmentos alterados y las lesiones coronarias más frecuentes se observaron en la arteria coronaria descendente anterior (68,6%), seguido de la coronaria derecha (60%) y circunfleja(51,4%). Respecto a la identificación de lesiones coronarias significativas según la prueba de ergometría se evidenció una asociación significativa (p=0.036), con buena sensibilidad del 83%, especificidad 33%, VPP 83% y el VPN 32%; así también se encontró relación significativa entre la identificación de lesiones coronarias y la prueba de ecoestrés con dobutamina (p=0.016), obteniendo también una buena sensibilidad del 86%, especificidad 58%, VPP 89% y el VPN 50%. Se concluye que el resultado positivo de la ergometría y del ecoestrés con dobutamina son suficientes para la identificación de lesiones coronarias significativas en pacientes con angina estable debido a la buena sensibilidad que presentan ambas pruebas. / Trabajo de investigación

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Spinal cord stimulation (SCS) inhibits substance P (SP) release and decreases the expression of the transient receptor potential vanilloid 1 (TRPV1) in the spinal cord at thoracic 4 (T4) during cardiac ischemia in rat models (. Ding et al., 2007). We hypothesized that activation of TRPV1 in the T4 spinal cord segment by intermittent occlusion of the left anterior descending coronary artery (CoAO) mediates spinal cord SP release. Experiments were conducted in urethane-anesthetized Sprague-Dawley male rats using SP antibody-coated microprobes to measure SP release at the central terminal endings of cardiac ischemic-sensitive afferent neurons (CISAN) in the spinal T4 dorsal horns. Vehicle, capsaicin (CAP; TRPV1 agonist) and capsazepine (CZP; TRPV1 antagonist) were injected into the left T4 prior to stimulation of CISAN by intermittent CoAO (with or without upper cervical SCS). CAP induced endogenous SP release from laminae I and II in the T4 spinal cord above baseline. Conversely, CZP injections significantly inhibited SP release from laminae I-VII in the T4 spinal cord segment below baseline. CZP also attenuated CoAO-induced SP release, while T4 injections of CZP with SCS completely restored SP release to basal levels during CoAO activation. CAP increased the number of c-Fos (a marker for CISAN activation) positive T4 dorsal horn neurons compared to sham-operated animals, while CZP (alone or during CoAO and SCS. +. CoAO) significantly reduced the number of c-Fos positive neurons. These results suggest that spinal release of the putative nociceptive transmitter SP occurs, at least in part, via a TRPV1 mechanism.

The association between acute coronary events and acute allergic reactions has been recognized for several years. The first reported case occurred in 1950, during an allergic reaction to penicillin. In 1991, Kounis and Zavras described the syndrome of allergic angina and allergic myocardial infarction, currently known as Kounis syndrome. Two subtypes have been described: type I, which occurs in patients without predisposing factors for coronary artery disease and is caused by coronary artery spasm, and type II, which occurs in patients with angiographic evidence of coronary disease when the allergic events induce plaque erosion or rupture. This syndrome has been reported in association with a variety of medical conditions, environmental exposures, and medication exposures. Entities such as Takotsubo cardiomyopathy, drug-eluted stent thrombosis, and coronary allograft vasculopathy appear to be associated with this syndrome. In this review, we discuss the pathobiology, clinical features, associated entities, and management of Kounis syndrome.

The upper cervical spinal region functions as an intraspinal controller of thoracic spinal reflexes and contributes to neuronal regulation of the ischemic myocardium. Our objective was to determine whether stimulation of the C2 cervical spinal cord (SCS) of rats modified the input signal at the thoracic spinal cord when cardiac ischemia-sensitive (sympathetic) afferents were activated by transient occlusion of the left anterior descending coronary artery (CoAO). Changes in c-Fos expression were used as an index of neuronal activation within the spinal cord and brain stem. The pattern of substance P (SP) release, a putative nociceptive transmitter, was measured using antibody-coated microprobes. Two SCS protocols were used: reactive SCS, applied concurrently with intermittent CoAO and preemptive, sustained SCS starting 15 min before and continuing during the repeated intermittent CoAO. CoAO increased SP release from laminae I and II in the T4 spinal cord above resting levels. Intermittent SCS with CoAO resulted in greater levels of SP release from deeper laminae IV-VII in T4 than CoAO alone. In contrast, SP release from laminae I and II was inhibited when CoAO was applied during preemptive, sustained SCS. Preemptive SCS likewise reduced c-Fos expression in the T4 spinal cord (laminae I-V) and nucleus tractus solitarius but increased expression in the intermediolateral cell column of T4 compared with CoAO alone. These results suggest that preemptive SCS from the high cervical region modulates sensory afferent signaling from the ischemic myocardium.

Antibody-coated microprobes were inserted into the thoracic (T3-4) spinal cord in urethane-anesthetized Sprague-Dawley rats to detect the differences in the release of immunoreactive substance P-like (irSP) substances in response to differential activation of cardiac nociceptive sensory neurons (CNAN). CNAN were stimulated either by intrapericardial infusion of an inflammatory ischemic exudate solution (IES) containing algogenic substances (i.e., 10 mM each of adenosine, bradykinin, prostaglandin E2, and 5-hydroxytryptamine), or by transient occlusion of the left anterior descending coronary artery (CoAO). There was widespread basal release of irSP from the thoracic spinal cord. Stimulation of the CNAN by IES did not alter the pattern of release of irSP. Conversely, CoAO augmented the release of irSP from T3-4 spinal segments from laminae I-VII. This CoAO-induced irSP release was eliminated after thoracic dorsal rhizotomy. These results indicate that heterogeneous activation of cardiac afferents, as with focal coronary artery occlusion, represents an optimum input for activation of the cardiac neuronal hierarchy and for the resultant perception of angina. Excessive stimulation of cardiac nociceptive afferent neurons elicited during regional coronary artery occlusion involves the release of SP in the thoracic spinal cord and suggests that local spinal cord release of SP may be involved in the neural signaling of angina.