Abstract:
OBJECTIVE:To investigate the effects of spinal cord stimulation on myocardial ischaemia, coronary blood flow, and myocardial oxygen consumption in angina pectoris induced by atrial pacing. DESIGN:The heart was paced to angina during a control phase and treatment with spinal cord stimulation. Blood samples were drawn from a peripheral artery and the coronary sinus. SETTING:Multidisciplinary pain centre, department of medicine, Ostra Hospital, and Wallenberg Research Laboratory, Sahlgrenska Hospital, Gothenburg, Sweden. SUBJECTS:Twenty patients with intractable angina pectoris, all with a spinal cord stimulator implanted before the study. RESULTS:Spinal cord stimulation increased patients' tolerance to pacing (p < 0.001). At the pacing rate comparable to that producing angina during the control recording, myocardial lactate production during control session turned into extraction (p = 0.003) and, on the electrocardiogram, ST segment depression decreased, time to ST depression increased, and time to recovery from ST depression decreased (p = 0.01; p < 0.05, and p < 0.05, respectively). Spinal cord stimulation also reduced coronary sinus blood flow (p = 0.01) and myocardial oxygen consumption (p = 0.02). At the maximum pacing rate during treatment, all patients experienced anginal pain. Myocardial lactate extraction reverted to production (p < 0.01) and the magnitude and duration of ST segment depression increased to the same values as during control pacing, indicating that myocardial ischaemia during treatment with spinal cord stimulation gives rise to anginal pain. CONCLUSIONS:Spinal cord stimulation has an anti-anginal and anti-ischaemic effect in severe coronary artery disease. These effects seem to be secondary to a decrease in myocardial oxygen consumption. Furthermore, myocardial ischemia during treatment gives rise to anginal pain. Thus, spinal cord stimulation does not deprive the patient of a warning signal.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Mannheimer C,Eliasson T,Andersson B,Bergh CH,Augustinsson LE,Emanuelsson H,Waagstein Fdoi
10.1136/bmj.307.6902.477subject
Has Abstractpub_date
1993-08-21 00:00:00pages
477-80issue
6902eissn
0959-8138issn
1756-1833journal_volume
307pub_type
杂志文章abstract:OBJECTIVE:To examine doctors' perspectives about their experiences with handheld computers in clinical practice. DESIGN:Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. SETTING:Six practice settings across the United States and two additional focus group sessi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
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更新日期:2004-05-15 00:00:00
abstract::A random sample of 133 elderly patients who had an unplanned readmission to a district general hospital within 28 days of discharge from hospital was studied and compared with a matched control sample of patients who were not readmitted. The total group was drawn from all specialties in the hospital, and by interviewi...
journal_title:BMJ (Clinical research ed.)
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更新日期:1988-09-24 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:1990-01-20 00:00:00
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更新日期:1998-12-12 00:00:00
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更新日期:2006-06-24 00:00:00
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doi:10.1136/bmj.c1898
更新日期:2010-05-11 00:00:00
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更新日期:1997-07-05 00:00:00
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doi:10.1136/bmj.39465.451748.AD
更新日期:2008-03-15 00:00:00
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journal_title:BMJ (Clinical research ed.)
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更新日期:1998-02-14 00:00:00
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更新日期:2005-07-16 00:00:00
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pub_type: 杂志文章
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更新日期:1997-07-26 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.301.6745.203
更新日期:1990-07-28 00:00:00
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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更新日期:2001-05-12 00:00:00
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doi:10.1136/bmj.327.7413.480
更新日期:2003-08-30 00:00:00
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更新日期:2008-09-02 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.311.7000.283
更新日期:1995-07-29 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:1998-07-04 00:00:00
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更新日期:2007-08-18 00:00:00
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更新日期:2003-07-05 00:00:00
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更新日期:2000-07-15 00:00:00
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更新日期:2005-04-09 00:00:00
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更新日期:1997-03-22 00:00:00
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更新日期:2004-06-19 00:00:00
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更新日期:1997-08-23 00:00:00
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更新日期:2012-03-02 00:00:00
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pub_type: 杂志文章
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更新日期:1988-09-03 00:00:00
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更新日期:2007-09-29 00:00:00
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更新日期:2002-06-29 00:00:00