Dolor torácico atípico: estudio mediante la prueba de provocación del ácido clorhídrico / Atypical chest pain: study by the hydrochloric acid provocation test

El propósito del trabajo es estudiar el origen del dolor torácico (DT) atípico en pacientes con coronariografía normal (CN) y patológica (CP) mediante la prueba de provocación de Bernstein evaluándolo por medio de electrocardiograma (ECG), índice tensión tiempo (ITT) y electromanometría de esófago (EMM). Se estudiaron dos grupos, uno de 16 controles sanos en quienes se hizo manometría determinando la presión de la zona de alta presión (ZAP), presióm de la onda peristálica (PO), duración (DO) y velocidad de propagación (VPO) de la misma y porcentaje de ondas aperistálicas (%Ap). El segundo grupo estaba constituido por 21 pacientes con dolor torácico con coronariografía patológica (10 pacientes). En ellos se determinó en formas simultánea la presencia de DT, ECG, ITT y EMM; luego de un período basal y de la perfución esofática de placebo y ácido clorhídrico 0.1 N. El 61,9% de los pacientes con DT mostraron transtornos basales de la dinámica esofágica tales como aumento de la ZAP, DO, VPO y % Ap. El análisis estadístico global fue significativo en cuanto a la relación FC/ITT. La prueba de provocación del DT por medio de la perfusión de HCI 0.1 fue positiva en 14.2% de los pacientes (AU)

Dolor torácico atípico: estudio mediante la prueba de provocación del ácido clorhídrico / Atypical chest pain: study by the hydrochloric acid provocation test

El propósito del trabajo es estudiar el origen del dolor torácico (DT) atípico en pacientes con coronariografía normal (CN) y patológica (CP) mediante la prueba de provocación de Bernstein evaluándolo por medio de electrocardiograma (ECG), índice tensión tiempo (ITT) y electromanometría de esófago (EMM). Se estudiaron dos grupos, uno de 16 controles sanos en quienes se hizo manometría determinando la presión de la zona de alta presión (ZAP), presióm de la onda peristálica (PO), duración (DO) y velocidad de propagación (VPO) de la misma y porcentaje de ondas aperistálicas (%Ap). El segundo grupo estaba constituido por 21 pacientes con dolor torácico con coronariografía patológica (10 pacientes). En ellos se determinó en formas simultánea la presencia de DT, ECG, ITT y EMM; luego de un período basal y de la perfución esofática de placebo y ácido clorhídrico 0.1 N. El 61,9% de los pacientes con DT mostraron transtornos basales de la dinámica esofágica tales como aumento de la ZAP, DO, VPO y % Ap. El análisis estadístico global fue significativo en cuanto a la relación FC/ITT. La prueba de provocación del DT por medio de la perfusión de HCI 0.1 fue positiva en 14.2% de los pacientes

[Atypical chest pain: study by the hydrochloric acid provocation test]. / Dolor torácico atípico: estudio mediante la prueba de provocación del ácido clorhídrico.

Evaluation by means of gastroenterological and cardiological methods. The purpose of this paper was to study the origin of chest pain (CP) in patients with normal and pathological coronary arteries as characterized by coronary arteriogram (CA). Sixteen normal control individuals (X 27 years -7 females and 9 males) were studied by means of esophageal manometry (EM) with a 3 way catheter perfused by a low compliance capillary system. Twenty-one patients with chest pain were studied and divided according to coronary arteriogram in normal (NC) and pathological arteries (PC). They were simultaneously studied by means of EM, heart rate/pressure product (RPP), and 12 lead ECG monitoring. After a basal period they were given a Bernstein's provocative chest pain test, and after each of its stages we determined in a simultaneous fashion CP, EM, ECG and RPP. In 61.9% of the patients abnormal basal EM was found. It was characterized by increase in HPZ, duration, propagation velocity and pressure of the peristaltic waves: as well as an increase in the percentage of aperistaltic waves. In 14.2% of the patients the Hydrochloric provocative test was positive. The only statistically significant datum was the heart rate/RPP relationship. We conclude that in future studies it would be of interest to combine 24 hour monitoring EM and pH as well as a more sensitive provocation test such as edrophonium chloride.

Dolor torácico atípico: estudio mediante la prueba de provocación del ácido clorhídrico. / [Atypical chest pain: study by the hydrochloric acid provocation test]

Evaluation by means of gastroenterological and cardiological methods. The purpose of this paper was to study the origin of chest pain (CP) in patients with normal and pathological coronary arteries as characterized by coronary arteriogram (CA). Sixteen normal control individuals (X 27 years -7 females and 9 males) were studied by means of esophageal manometry (EM) with a 3 way catheter perfused by a low compliance capillary system. Twenty-one patients with chest pain were studied and divided according to coronary arteriogram in normal (NC) and pathological arteries (PC). They were simultaneously studied by means of EM, heart rate/pressure product (RPP), and 12 lead ECG monitoring. After a basal period they were given a Bernsteins provocative chest pain test, and after each of its stages we determined in a simultaneous fashion CP, EM, ECG and RPP. In 61.9

of the patients abnormal basal EM was found. It was characterized by increase in HPZ, duration, propagation velocity and pressure of the peristaltic waves: as well as an increase in the percentage of aperistaltic waves. In 14.2

of the patients the Hydrochloric provocative test was positive. The only statistically significant datum was the heart rate/RPP relationship. We conclude that in future studies it would be of interest to combine 24 hour monitoring EM and pH as well as a more sensitive provocation test such as edrophonium chloride.

Penbutolol and molsidomine synergism in angina pectoris. A double blind ergometric trial.

In order to test the additional efficacy of the combination of a beta blocker (penbutolol 40 mg single dose) with molsidomine (2 mg single dose), a double blind cross-over trial was performed in 30 patients with stable angina pectoris. Stress tests were done before and 1 h after the beta blocker alone and the combination therapy. Some training effect could be detected on comparing results from the first and second days. Combined therapy showed a better response of resting systolic arterial pressure, resting and maximal diastolic pressure, heart rate gain (from rest to maximal effort) and particularly in the angina severity score. All of these variables changed significantly in comparison to the beta blocker alone, 46 out of 60 post-drug ergometric studies were negative; of the 14 positive tests, 11 followed the beta blocker and only 3 the combined therapy. The combination of a preload reducer molsidomine and a beta blocker may be adequate for patients only partially compensated or with cardiomegaly and/or a depressed ejection fraction.