Transmural myocardial infarction in young women taking oral contraceptives. Evidence of reduced regional coronary flow in spite of normal coronary arteries.

Engel, H.-J.; Hundeshagen, H.; Lichtlen, Paul R.

doi:10.1136/hrt.39.5.477

Cited by 30 publications

(5 citation statements)

References 32 publications

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“…Finally, the observation of a significant decrease in regional flow in patients with myocardial infarction, yet normal or almost normal coronary arteries (Table VII) further supports this view (14,26). In the 9 patients, mostly women, admitted to the hospital for coronary angiography several months after myocardial infarction, flow in akinetic areas was significantly decreased by 44%, this reduction being of the same order of magnitude as in patients with high-grade obstructions, i.e.…”

Section: Mbf In'hypokinetc" LV Areas In Relation To Lv Wall Motionmentioning

confidence: 57%

Clinical Application and Results of the Assessment of Coronary Blood Flow by the Regional Precordial Xenon Residue Detection Technique

Lichtlen¹,

Engel²,

Hundeshagen³

1978

Nuklearmedizin

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Methodological and technical aspects as well as application and results of the precordial Xenon-residue-detection technique are critically reviewed. The results concern mainly normal flow in various regions of the heart esp. in the free wall of the right and left ventricle, poststenotic flow in patients with coronary artery disease in relation to the degree of proximal nar-rowings as well as wall motion of the corresponding LV segment, bypassgraft flow and flow after drug interventions esp. nitrates, betablockers, the calcium-antagonist Nifedipine and the coronary dilator Dipyridamole. In spite of its serious limitations (high affinity of Xenon for fatty tissue, geometrical problems in the assessment of flow and its relation to anatomy, gas exchange in situations of high flow etc.), the technique is found to be a usefull investigatory tool. Due to its technical display and the related high costs routine application is, however, prohibitive.

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Section: Mbf In'hypokinetc" LV Areas In Relation To Lv Wall Motionmentioning

confidence: 57%

Clinical Application and Results of the Assessment of Coronary Blood Flow by the Regional Precordial Xenon Residue Detection Technique

Lichtlen¹,

Engel²,

Hundeshagen³

1978

Nuklearmedizin

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“…84,85,91,92 It has been hypothesized that myocardial infarction during OC use is a separate disease entity, as completely normal coronary angiographies have been found in women with thrombotic coronary occlusions. 93,94 This suggests that the effect of OCs, also on arterial disease, is thrombotic rather than atherogenic and is in accordance with an immediate, reversible, noncumulative effect. If this hypothesis is true, the theoretically beneficial effect of the third generation on the lipid profile may not lead to a lower risk of myocardial infarction.…”

Section: Risk and Risk Factorsmentioning

confidence: 70%

Venous and Arterial Thrombosis during Oral Contraceptive Use: Risks and Risk Factors

Tanis¹,

Rosendaal²

2003

Seminars in Vascular Medicine

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Since the introduction of oral contraceptives, their use has been associated with an increased risk of both venous and arterial thrombosis. Pulmonary embolism, myocardial infarction, and stroke are serious disorders with a considerable risk of mortality. Because worldwide over 100 million women use oral contraceptives, issues of drug safety are of great importance. The risk of venous thrombosis during low-dose oral contraceptive use is three- to sixfold increased compared with that of nonusers. The association is not only attributed to the estrogen component of the pill: the risk is twice as high for desogestrel and gestodene (third generation) containing oral contraceptives as for levonorgestrel (second generation) containing oral contraceptives. The risk of venous thrombosis is highest in the first year of use and in women with genetic or acquired risk factors for thrombosis. Both venous or arterial thrombosis are unrelated to duration of use or past use of combined oral contraceptives. The risk of myocardial infarction and stroke during low-dose oral contraceptive use is two- to fivefold increased relative to that of nonusers. The risk of arterial thrombosis induced by oral contraceptive use is more pronounced in smokers and women with hypertension, diabetes, and hypercholesterolemia. All types of thrombosis have strongly age-dependent incidences, and therefore in absolute figures the risks and effects of risk factors increase with age. The lowering of the estrogen dose in combined oral contraceptives from 50 microg to 20-30 microg in the last decade did not clearly reduce the risk of venous thrombosis, myocardial infarction, stroke, or peripheral arterial disease. For stroke and peripheral arterial disease no difference in risk was found between second and third generation oral contraceptives. For myocardial infarction study results are conflicting, and a small benefit of third- over second-generation oral contraceptives cannot be ruled out. However, this is unlikely to counterbalance the adverse effect of third generation contraceptives on venous thrombosis.

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“…A previous myocardial infarction is practically always attended in men by significant coronary lesions;ff 7' 9 this is also true in women, with a few exceptions.8 23 The patients with a previous myocardial infarction have therefore been excluded from the present study because in such patients the goals of maximal exercise testing are to measure the physical work capacity and to predict the severity and the extent of CAD. 24 28 Complaints of typical AP strongly suggest in men the presence of significant CAD and our data (90% of CAD) confirm those of other larger series.7'9 Reciprocally, in men, CAD is unlikely when the complaints are not characteristic of AP (16% of CAD).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of exercise electrocardiography and thallium myocardial scintigraphy in patients without previous myocardial infarction: a Bayesian approach.

Melin¹,

Piret²,

Vanbutsele³

et al. 1981

Circulation

122

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SUMMARY The clinical value of combining exertional ECG and postexertional thallium (201T1) scintigraphy was assessed in 160 patients (130 men and 30 women) suspected of having coronary artery disease (CAD) who underwent a coronary arteriography. Based on sex and history, the patients were subdivided in two groups with different prevalences of CAD: Group 1 (high prevalence of CAD = 90%) included 98 men with typical angina pectoris (AP) and group 2 (low prevalence of CAD = 18%) included 32 men and 30 women with atypical AP.Compared with the exertional ECG, myocardial scintigraphy was more sensitive (87% vs 74%) and more specific (89% vs 70%) for the diagnosis of CAD. The combination of the ECG and scintigraphic data was useful if both tests gave concordant results: 100% of true positives (n = 67) and 84% of true negatives (n = 43). In case of discordant results (n = 50), no firm diagnostic conclusion could be made due to the many false-positive (27%) and false-negative (25%) scintigrams.These results are easier to interpret when the prevalence of CAD is taken into account. According to Bayes' theorem, abnormal exercise results confirm CAD when the prevalence is high and normal results rule out CAD when the prevalence is low; also, a normal response to exercise has no predictive value when the prevalence is high. When the prevalence is low, an abnormal ECG or thallium has low predictive value but concordant abnormal responses are highly predictive for CAD (100% of true positives).EXERCISE myocardial perfusion scintigraphy with thallium-201 is useful for detecting myocardial ischemia due to coronary artery disease (CAD) and seems more reliable than the exertional ECG. '-5 In symptomatic patients, the characteristics of the complaints are important and, from a well-taken history, one can evaluate the likelihood of CAD.8 12 Several reports on exertional ECG have indicated that the diagnostic information provided by the test was largely determined by the prevalence of the disease within the population.9" [13][14][15][16][17] This study was undertaken to assess the diagnostic value of exercise thallium scintigraphy and its combination with exertional ECG; in order to analyze the influence of the prevalence of CAD, the patients were subdivided in groups according to the information provided by the history. The prevalence of CAD is almost 100% after an acute myocardial infarction, so patients with a history of infarction were excluded. Material One hundred sixty patients, 130 men and 30 women, suspected of CAD but without evidence of a previous myocardial infarction, were studied. They underwent a multistage maximal exercise test 1 to several days before the arteriographic study. These patients were studied because of the presence of chest pain. Before the exercise test, the patients were carefully questioned by the same physician. From the clinical history, the complaints were subjectively judged to be typical or atypical of angina pectoris (AP). As in a previous study,9 this judgment was based on the location, qualit...

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Transmural myocardial infarction in young women taking oral contraceptives. Evidence of reduced regional coronary flow in spite of normal coronary arteries.

Cited by 30 publications

References 32 publications

Clinical Application and Results of the Assessment of Coronary Blood Flow by the Regional Precordial Xenon Residue Detection Technique

Clinical Application and Results of the Assessment of Coronary Blood Flow by the Regional Precordial Xenon Residue Detection Technique

Venous and Arterial Thrombosis during Oral Contraceptive Use: Risks and Risk Factors

Diagnostic value of exercise electrocardiography and thallium myocardial scintigraphy in patients without previous myocardial infarction: a Bayesian approach.

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