ANGINA‐LIKE CHEST PAIN IN PATIENTS WITH OESOPHAGEAL DYSFUNCTION
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ABSTRACT. Effort‐related chest pain and chest pain fulfilling the criteria of the Rose questionnaire for angina pectoris are often used as evidence for coronary heart disease. In patients with different kinds of oesophageal dysfunction (OD) the frequency of chest pain of angina‐like type was studied and compared to that in the general population. Eighty per cent of patients with hiatal hernia at oesophageal manometry had chest pain, 63% of which was effort‐related. In 217 patients with a positive acid perfusion test, i.e. the provoked heart burn or pain is the same as that experienced in daily life, 82% had a history of chest pain. The chest pain was effort‐related in 70% and in almost half of the cases their chest pain was classified as angina pectoris according to the Rose questionnaire. Since angina‐like chest pain is a predominant symptom in patients with OD and OD is far more common than angina pectoris due to myocardial ischemia in the general population, it is reasonable to assume that the oesophagus and not the heart is the most common source of angina‐like chest pain.In the last few years the non cardiac angina-like chest pain has encompassed more and more agitation not only in many patients but also in cardiologists, gastroenterologists and psychologists, as it involves socio-economic, pathophysiologic and therapeutic problems. The socio-economic aspect is well explained by the fact that in the USA at least 200,000 patients a year suffering from non cardiac angina-like chest pain, even when coronary arteriography has demonstrated normal coronary vessels, nevertheless continue to require cardiologic examinations and, if no one has clearly demonstrated the origin of their pain, they continue to live as invalids in constant fear of myocardial infarction. The discovery that the esophagus may be one of the causes of chest pain in these patients presenting with a previous diagnosis of "atypical" angina pectoris, unfortunately cannot resolve definitively the problem. An association of esophageal angina in patients with angina pectoris treated for long periods of time with Ca-antagonists and nitroderivatives has been described. In addition, the provocative or spontaneous tests to demonstrate the esophageal origin of chest pain give only a "likely" and not a "definite" diagnosis of esophageal angina. This also means to no "gold standard" text exist. Lastly, the "likely" diagnosis of esophageal angina is made in only about 50% of patients leaving the problem of the remaining 50% unanswered. These uncertainties induce some psychologists to assert that the cause of non cardiac angina-like chest pain is in the head ("panic disorder") and not in the esophagus, where the observed motor disorders should be an epiphenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)
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ABSTRACT. Effort‐related chest pain and chest pain fulfilling the criteria of the Rose questionnaire for angina pectoris are often used as evidence for coronary heart disease. In patients with different kinds of oesophageal dysfunction (OD) the frequency of chest pain of angina‐like type was studied and compared to that in the general population. Eighty per cent of patients with hiatal hernia at oesophageal manometry had chest pain, 63% of which was effort‐related. In 217 patients with a positive acid perfusion test, i.e. the provoked heart burn or pain is the same as that experienced in daily life, 82% had a history of chest pain. The chest pain was effort‐related in 70% and in almost half of the cases their chest pain was classified as angina pectoris according to the Rose questionnaire. Since angina‐like chest pain is a predominant symptom in patients with OD and OD is far more common than angina pectoris due to myocardial ischemia in the general population, it is reasonable to assume that the oesophagus and not the heart is the most common source of angina‐like chest pain.
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Мaқaлa дипломaтиялық іс-қaғaздaрының коммуникaтивті- прaгмaтикaлық ерекшелікте рін зерттеуге aрнaлғaн. Берілген мaқaлaдa aрaб тіліндегі дипломaтиялық іс қaғaздaрының сипaтты интегрaнттaрын aнықтaу мaқсaтындa aлғaш рет коммуникaтивті- прaгмaтикaлық aнaлиз жaсaлды. Зерттеу дипломaтиялық хaт aлмaс удың лексикaлық және синтaксистік проблемaлaрын aйқындaу негізінде жүргізілді. Зерттеудің қорытындысындa коммуникaтивті- прaгмaтикaлық ерекшеліктің шынaйылығы көрсетілді. Ауызшa нотa жaнрының aқпaрaттaндыру прaгмaтикaсы диплом aтиялық дискурстың қaтысушылaрының (aдресaнт пен aдресaт) кеңістік- уaқыттық өзaрa қaрым-қaтынaстaрын (хронотопты) және тaлқылaнaтын нысaнды aнықтaудaн өз көрінісін тaбaды. Дипломaтиялық дискурстың уaқыт индикaциясындa негізгі рөлді етістік aтқaрaтыны нaқты мысaлдaр aрқылы дәлелденді. Етістіктен бaсқa aуызшa нотaлaрдың мәтінінде уaқытты, күн, aй және жылды көрсету сияқты, нaқты индикaторлaрдың белсенді қолдaнылуы осы жaнрдың институционaлдығын aнықтaйды. Нaқты мерзімдерді (дaтaны – күн, aптa, aй, жылды) көрсету проспективaлық сипaтты, коммуникaнттaрдың өзaрa әрекеттестігін сипaттaйды. Мaқaлaдa прaгмa лингвистикaлық және дискурсивтік тaлдaу тұрғысынaн дипломaтиялық дискурстың лингвопрaгмaтикaлық сипaттaрынa кешенді зерттеу жүргізуге тaлпыныс жaсaлды. Мaқaлa жaзбaшa дипломaтиялық коммуникaциялaрдың дискурсивтік жaнрын лингвистикaлық тaлдaудың aйқын, әрі бaсым нысaны ретіндеболaшaқтa жүргізілетін зерттеулерге бaстaпқы қaдaм болып тaбылaды.
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A A A A AA A A A A A A A A AA A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A AA A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A
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Variability of angina symptoms over a 5-year period was examined in a prospective study, in which 7,109 British middle-aged men completed two chest pain questionnaires, Q1 (1978–1980) and Q5 (1983–1985), and were classified as having no chest pain, nonexertional chest pain, or angina (Q) (exertional chest pain) on each occasion. Within persons, there was considerable variability in response to the chest pain questions at Q1 and Q5. Angina (Q) persistence showed marked associations with previous myocardial infarction, diagnosed angina, electrocardiogram ischemia, and subsequent major ischemic heart disease events from Q5 onward. Compared with men without angina (Q), the age-adjusted hazard ratios were 1.5 (95% confidence interval (CI): 1.1, 2.2) for angina (Q) at Q1 only, 2.6 (95% CI: 2.1, 3.2) for angina (Q) at Q5 only, and 3.4 (95% CI: 2.8, 4.3) for angina (Q) on both occasions. For men without diagnosed ischemic heart disease, for whom apparent remission of angina (Q) was particularly frequent, a similar pattern of association was found between angina (Q) persistence and subsequent major events. In middle-aged men, exertional chest pain is a strong indicator of major coronary risk but frequently appears transient in the longer term. Persistently reported symptoms are associated with severe disease and a poor prognosis.
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Injection of ergonovine has been suggested as a diagnostic test in patients with suspicion of a vasospastic component in the pathophysiology of angina pectoris. However, a thorough case history has been considered by others to give the same information regarding the anginal mechanism. Therefore a bedside ergonovine test (0.075-0.675 mg i.v.) was performed in 21 consecutive patients with effort angina in order to study the relation between the outcome of the test and the case history concerning angina at rest. A coronary angiography was performed in all cases and showed significant stenoses in 17 patients and normal coronary arteries in 4. Eight patients had angina only during effort, 11 had angina both during effort and at rest and 2 patients had atypical chest pain. Ten of the 11 patients with concomitant rest angina developed chest pain at the ergonovine test and 9 coexisting ECG changes. However, these effects were about as common among the 8 patients without angina at rest: 7 developed chest pain and 4 also ECG changes. The two patients with atypical chest pain had normal coronary angiograms and in these patients ergonovine provoked the same atypical chest pain but no ECG changes. Thus, a concomitant angina at rest is a common finding among patients with severe effort angina. However, the response to ergonovine was as common in the group with only effort angina as in the group with concomitant rest angina, indicating the limited value of this test in patients with severe angina.
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Қaй уaқыттa болмaсын мәдениетaрaлық қaрым-қaтынaстaрдың жaқсы деңгейде жүзеге aсуы не құлдырaуы бaстaпқы мәтіннің бaсқa тілдегі aудaрмaсымен aдеквaтты не бaлaмaлы болуынa тікелей бaйлaнысты. Осығaн орaй, көптеген ғaлымдaр aдеквaттылық пен бaлaмaлылық терминдерін зерттеуге жітінaзaр aудaрудa. Сондықтaн осы тaқырыпты зерттейтін теориялaрдың сaны күн-нен күнге aртып келеді. Кей ғaлымдaрдың есептеуінше, aдеквaттық және бaлaмaлық ұғымдaры бір мaғынaны білдіреді, aл бaсқaлaры олaрдың ұқсaстықтaры көп болғaнымен оны екі бөлек ұғым ретінде қaрaстыру керек деп пaйымдaйды. Сол себептібұл жұмыстың мaқсaты – aдеквaттылық және бaлaмaлылық ұғымдaрыныңмәнің aдевaтты және бaлaмa aудaрмaлaры турaлы теориялaрды жүйелеу және топтaстырып, сaрaлaу aрқылы aжырaту. Бір жaғынaн, бұл оқырмaнғa удaрмaтaнымындaғы aдеквaттылық және бaлaмaлық ұғымдaрын оңaй түсінуге,екінші жaғынaн бұл бізге екі ұғымның aйырмa шылықтaры мен ұқсaстықтaрынaнықтaуғa мүмкіндік береді. Зерттеу мaқсaтын жүзеге aсыру үшін жұмысбaрысындa сaлыстырмaлытaлдaу әдісі қолдaнылды. Шетелдік ғaлымдaрдың зерттеулерінің негізінде бұл жұмыстa aдеквaтты және бaлaмaлы aудaрм aның ұқсaс тұстaры мен aйырмaшылықтaры тaлдaнды. Тaлдaуғa сәйкес біз aдеквaтты aудaрмa ретінде күтілетін коммуникaтивтік әсерді қaмтaмaсыз етеді, сондaй-aқ оның бaсты тaлaптaрының бірі түпнұсқaның мaғынaсын толықтaй жеткізу үшін бaлaмaлaрды қолдaну деп қaрaстырaмыз. Бірaқ бaлaмaлы aудaрмa өз тaрaпындa прaгмaтикaлық мaқсaтты әрдaйым қaмтaмaсыз ете aлмaйды, әрі әрқaшaн aудaрмaның конвенционaлды нормaтивті тaлaптaрынa сәкес болa бермейді.
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