Bronchial asthma causing symptoms suggestive of angina pectoris.

Many patients undergoing pharmacological stress echocardiography for assessing symptoms suggestive of coronary artery disease are found to have a normal test. This study was performed to evaluate whether asthma symptoms simulate angina pectoris. A total 41 consecutive patients who had a negative pharmacological stress echocardiography and had been evaluated for angina pectoris were studied. Patients with previously known coronary artery disease or obstructive lung disease were excluded. Lung function testing was performed and the authors proceeded either with the administration of a bronchodilator or with methacholine challenge testing. A questionnaire was applied to assess the symptoms dyspnoea, chest tightness and substernal burning at the end of the challenge test. In addition, patients were asked if they were experiencing those symptoms that made them seek medical attention. From the 41 patients tested, 26 patients showed a significant bronchial hyperreactivity (mean +/- SD provocative concentration causing a 20% fall in the forced expiratory volume in one second 5.93 +/- 4.50 mg x mL(-1)). A total of 20 patients confirmed having those symptoms that led to cardiac evaluation. It was concluded that symptoms suggestive of angina pectoris might represent bronchial asthma. This should be considered in the differential diagnosis of angina pectoris.

[The role of dobutamine stress echocardiography in the clinical routine of a department of cardiology]. / Der Stellenwert der Dobutamin-Stressechokardiographie im Routinebetrieb einer Kardiologischen Abteilung.

BACKGROUND: The aim of this study was to assess the role of dobutamine stress echocardiography (SE) for diagnosis and therapy of coronary artery disease (CAD) in the routine practice of a cardiological department in which bicycle stress-testing, scintigraphy and coronary angiography are available. METHODS: Between January 1997 and September 1998, 123 patients (79 men, 44 women, 60.1 +/- 9.9 years) underwent SE. SE-indication, SE-result and the consequence of the SE were registered. A telephone follow-up, asking for events and cardiac interventions, took place after at least one year. RESULTS: SE was performed in 57 patients with suspected CAD and in 66 patients with known CAD. The indications were inconclusive bicycle stress-testing or perfusion scintigrams (n = 77), search for hibernation (n = 22), discrepancy between presenting symptoms and results of previous investigations (n = 14) and preoperative risk stratification (n = 10). In the group with suspected CAD, the proportion of female patients was higher (p = 0.001), in the group with known CAD the proportion of male patients was higher (p = 0.002). SE showed an ischemic reaction in 35 patients, hibernation in 24 patients, no ischemic reaction in 56 patients and was inconclusive in 8 patients. The consequence of SE was recommendation for diagnostic coronary angiography (n = 27), revascularisation (n = 10), abstention from any invasive intervention (n = 77), noncardiac surgery (n = 9) and electrophysiological investigation (n = 1). During the investigated period, 955 bicycle stress-tests, 677 Thallium scintigrams and 987 coronary angiograms were carried out. During the follow-up (15 +/- 2.9 months) 4 patients died. In 6 patients cardiac interventions were carried out. No differences were observed regarding events and interventions depending on SE results and consequences. CONCLUSIONS: At a cardiological department SE plays a role if findings are inconclusive and if hibernation or operative risk is looked for. A negative SE result most commonly leads to abstention from invasive intervention. If the SE result is positive, the recommendation for invasive intervention is also influenced by the clinical symptoms and the size of the ischemically reacting myocardium.

[The prognostic value of dobutamine stress echocardiography. A long-term follow-up study]. / Der prognostische Wert der Dobutamin-Stressechokardiographie. Eine Langzeit-Follow-up-Studie.

BACKGROUND AND OBJECTIVE: The prognostic value of dobutamine stress echocardiography in patients with suspected or known coronary heart disease has not exactly been assessed. Purpose of the study was the assessment of the prognostic value of DSE regarding cardiac events, especially in patients with a normal DSE finding. PATIENTS AND METHODS: 316 patients (168 men, 148 women, mean age 61 +/- 10 years), included in this follow-up study, underwent DSE between January 1994 and December 1996 to evaluate clinically suspected or known coronary heart disease. DSE was classified according to resting and stress echocardiography as either "normal-normal (NN)", "normal-ischemic (NI)", "abnormal-normal (AN)", "abnormal-ischemic (AI)" or "inconclusive (C)". Follow-up by telephone took place between June 1997 and April 1998. "Events" were survived myocardial infarction and death. "Interventions" were revascularisation procedures, either percutaneous transluminal coronary angioplasty (PTCA) with or without stenting or aortocoronary bypass surgery. RESULTS: In 161 patients, DSE was NN, NI in 27 patients, AN in 55 patients, AI in 54 patients and C in 19 patients. Mean follow-up duration was 28 months. Events occurred in 23 patients: survived myocardial infarction in 10, death in 13 persons. Interventions were carried out in 50 patients: PTCA with or without stenting in 19, aortocoronary bypass surgery in 31 persons. The event rate was significantly lower in patients with DSE classified as NN (P = 0.03 by log-rank) than in other groups. The intervention rate was significantly lower in the NN-group (P = 0.0001 by log-rank) than in the other groups, too. CONCLUSION: Patients with a normal rest echocardiography and DSE had a good prognosis in a long-term follow-up study.