Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The present article deals with the pathophysiological role of serotonin in cardiovascular disease and in other disorders that are accompanied by cardiovascular pathophysiological events. The distribution of serotonin over various organs and tissues and the presence of several types of 5-HT receptors would suggest a rather important physiological role of serotonin. However, a modest serotonergic role could only be shown for the microcirculation and for the regional circulation of the brain and the intestinal wall. An important pathological role of serotonin in the carcinoid syndrome, in migraine, and in peripheral vascular disease is beyond debate, although many details remain to be established. The possibility that serotonergic mechanisms contribute to Raynaud's phenomenon and other vasospastic disorders is the subject of present discussions, although firm evidence for this view is not widely available. An involvement of peripheral serotonin in the genesis and maintenance of essential hypertension seems very unlikely, although vascular damage due to hypertension is probably enhanced by serotonin released from aggregating platelets. This ancillary process is, in particular, to be anticipated in older patients, with vascular walls predamaged by atherosclerosis. For this reason, pharmacological blockade of 5-HT2 receptors may be of potential therapeutic benefit in this category of patient. Finally, the involvement of central serotonergic mechanisms in hypertensive disease cannot be ruled out.
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PMID:Pathophysiological relevance of serotonin. 244 63

Pulsatile blood flow within the normal carotid sinus involves at least two distinct components. That near the flow divider is laminar and antegrade, whereas a boundary layer separation zone in the posterolateral aspect exhibits transient blood flow reversal. It is now possible to document these flow velocity components using pulsed Doppler ultrasound methods. When atherosclerosis develops, it preferentially involves the posterolateral bulb region, obliterating the normal configuration of the sinus with consequent loss of the flow separation zone. It was therefore hypothesized that if flow separation could be detected, it should be predictive of a normal angiogram. To assess this, we evaluated 20 symptomatic patients and two with only bruits found by duplex scanning to have flow separation in either one or both carotid bulbs and who also underwent cerebral angiography. Initial diagnoses were stroke in seven, reversible ischemic neurologic deficit in one, transient ischemic attack in 12, and bruit in two. Flow separation was bilateral in 13 patients (59%). There were 15 patients with symptoms in the territory of a carotid bulb exhibiting flow separation. By angiography, of the 35 bulbs with boundary layer separation, 27 (77%) were normal, with the remainder showing lesions that reduced the diameter of the vessel by 20% or less. Final diagnoses of the 15 patients with symptoms ipsilateral to a carotid sinus exhibiting flow separation were fibromuscular disease in two, lacunar stroke in three, dissection in two, subclavian steal in one, cardiogenic embolus in three, migraine in one, hyperventilation syndrome in one, kink of the mid-internal carotid artery in one, and no diagnosis in one.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnostic significance of flow separation in the carotid bulb. 264 91

Duplex scanning of the extracranial carotid vessels is a highly reliable medical investigation for identifying atherosclerotic or other pathology in this vascular region. The introduction of this technique into hospital practice has posed the problem of when it is indicated. The present study has shown that almost half the examinations carried out (45.2%) were requested on the basis of what were defined as "general" symptoms (vertigo, lipothymia, migraine, etc.); this group showed a low prevalence of atheromatous plaques. 22.7% of the examinations were requested as a control in the presence of atherosclerosis in another vascular region (coronaries, arteries of the lower extremities, etc.) and in these patients the prevalence of carotid stenosis was high or very high. Patients examined subsequently to a neurological episode came to 15.3% of the total. There was a high prevalence of carotid atheromatous lesions. Numerous controls were requested in subjects with type 2A and 2B hyperlipoproteinaemia (6.7% of the total) with a prevalence of atheromatous lesions higher than the homogeneous-for-age group. A limited number of patients (2%) underwent the study following visual disturbances of presumable ischaemic origin. The prevalence of carotid stenoses in these subjects is high. Patients who underwent carotid TEA (8.1%) represent a special group in whom intervention brings a general improvement although the percentage of vessel restenosis exceeds 20%.
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PMID:[Clinical indications for performing Doppler ultrasonography of the extracranial carotid vessels. A series of 805 subjects]. 267 95

Many studies have been done to try to define new therapeutic uses for calcium antagonists, in diseases in which calcium plays a role. Positive results have been obtained in the prevention of acute attacks of idiopathic Raynaud's disease and migraine, and in effort-induced asthma. Some activity could be demonstrated in selected groups of patients with pulmonary hypertension, manic-depressive illness, untractable epilepsy, various functional gynecological or digestive disorders, and in drug-induced nephrotoxicity. A possible effect on the prevention of resistance to anti-cancer drugs could be of major interest. Their antiplatelet effect, and their possible effect against atherosclerosis, which remains to be confirmed, their lack of side-effects in asthmatics and of interference with glucose regulation increase their usefulness in patients with hypertension or ischemic heart disease, especially when other diseases are present.
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PMID:[Use of calcium inhibitors excluding cardiac pathology and arterial hypertension]. 267 79

We report 133 cases of strokes in patients aged 9-45 (male: 68, female: 65), mean age: 33.5 years. There were 112 arterial infarcts (84%), 9 venous infarcts (7%), 12 hemorrhages (9%). Among the arterial infarcts, 23 (20.5%) were due to a dissecting aneurysm, 17 (15%) to atherosclerosis, 13 (12%) to cardiac embolism. Echocardiography with contrast was performed in 69 patients showing a patent foramen ovale in 15. Mitral valve prolapse was present in 8, among which 5 had in addition a patent foramen ovale. Among 16 migrainous patients there were 7 dissecting aneurysms and 3 patent foramen ovale. Twenty two of 65 women were taking oral contraceptives at the time of the stroke. Strokes in patients taking oral contraceptives or during the puerperium accounted for 43% of the strokes in women. Ten cases (9%) have had no explanation. Venous infarctions were mainly due to puerperium and oral contraceptives. Hemorrhages were mainly due to arterial hypertension. No cause was found in 4/12 cases. The most useful investigations were angiography and echocardiography with contrast. This study confirms that extensive and early investigations are necessary in strokes in the young and particularly in women taking oral contraceptives, migraine patients and patients with mitral valve prolapse.
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PMID:[Cerebral vascular accidents in young subjects. A study of 133 patients 9 to 45 years of age]. 279 9

A group of 350 migraineurs (87 male, 263 female) and 300 controls without migraine (104 male, 196 female) were questioned about occurrence, in parents, of the atherosclerosis-related diseases (ASRD) of diabetes mellitus (DM), hypertension (HBP), myocardial infarction (MI), and stroke as well as about recurrent severe headache (RSHA). Occurrence of DM, HBP, MI and stroke was compared for mothers and fathers of migraine vs. those of control subjects and no significant differences were found. The mothers and fathers were pooled and resegregated by presence or absence of RSHA and then occurrence of DM, HBP, MI and stroke again compared. For mothers there was increased occurrence of stroke and DM in the RSHA group but the differences were not significant. For RSHA fathers there was increased incidence of MI (p less than .10) and HBP (p less than .01). Aggregate occurrence of all ASRD was evaluated for RSHA vs. no-RSHA parents. ASRD occurred more frequently in the RSHA than in the no-RSHA parents (p less than .05). Breakdown by age showed that this occurred at all ages in men (p less than .05) but in women the difference was significant only under age 60 (p less than .05). This study suggests that RSHA, which is primarily migraine, may be a risk factor or a marker for occurrence of ASRD.
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PMID:Headache as a risk factor in atherosclerosis-related diseases. 292 74

The major antihypertensive mechanism of calcium antagonists is by decreasing the systemic vascular resistance, modified by the counter-regulatory responses of the baroreflexes and the renin-angiotensin-aldosterone system. In severe hypertension, the concept that calcium overload of the vascular myocyte could precipitate or aggravate peripheral vasoconstriction provides a logical basis for the use of these agents as first choice therapy; nifedipine, especially, has been well tested. As monotherapy for mild to moderate hypertension each of the three first-generation agents compares well with beta-blockers. Calcium antagonists may have a special role in the therapy of certain patient groups (elderly, black) or in those subjects whose life style involves intense physical or mental exertion (hemodynamics better maintained than with beta-blockade) or in patients with early end-organ damage such as left ventricular hypertrophy or renal insufficiency. However, the goal blood pressure may not be reached during monotherapy so that drug combinations may be required. Further indications for these compounds are as follows. Verapamil and diltiazem are frequently used in supraventricular tachycardias including acute and chronic atrial fibrillation. In the arrhythmias of the Wolff-Parkinson-White syndrome, there is the potential danger of provocation of anterograde conduction. Further indications for calcium antagonists, still under evaluation, include congestive heart failure (controversial), hypertrophic cardiomyopathy (verapamil), primary pulmonary hypertension (high doses required), Raynaud's phenomenon (nifedipine and diltiazem effective), peripheral vascular disease (proof not yet documented), cerebral insufficiency and subarachnoid hemorrhage (nimodipine promising), migraine, exertional bronchospasm, renal disease, atherosclerosis (experimental), and primary aldosteronism (nifedipine inhibits aldosterone release). Second-generation agents include dihydropyridines, such as nitrendipine, nicardipine, felodipine, amlodipine, nisoldipine, nimodipine, and isradipine. From these will be selected agents that are longer acting and provide higher vascular selectivity. New preparations of existing agents include slow-release formulations of nifedipine, verapamil, and diltiazem. Minor side effects include those caused by vasodilation (flushing and headaches), constipation (verapamil), and ankle edema. Serious side effects are rare and result from improper use of these agents, as when intravenous verapamil is given to patients with sinus or atrioventricular nodal depression from drugs or disease, or nifedipine to patients with aortic stenosis. The potential of a marked negative inotropic effect is usually offset by afterload reduction, especially in the case of nifedipine. Yet caution is required when calcium antagonists, especially verapamil, are given to patients with myocardial failure unless caused by hypertensive heart disease. Drug interactions of calcium antagonists occur with other cardiovascular agents such as alpha-adrenergic blockers, beta-adrenergic blockers, digoxin, quinidine, and disopyramide.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Calcium channel antagonists. Part III: Use and comparative efficacy in hypertension and supraventricular arrhythmias. Minor indications. 315 29

Sudden, transient loss of vision in one eye (amaurosis fugax) is associated frequently with atherosclerosis of the internal carotid artery in adults and may herald a stroke. Thus, cerebral angiography is often performed. Amaurosis fugax in children is uncommon and an underlying cause is rarely demonstrated. Recurrent episodes of amaurosis fugax occurred in five adolescents. A characteristic evolution and pattern of visual loss, consistent with choroidal ischemia as the underlying mechanism, was described by four of them. Although none of the episodes were accompanied by headache, four patients had a history of common migraine at other times or a family history of migraine. These episodes of visual loss may represent a migraine variant, and cerebral angiography is not indicated in adolescents with such a history.
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PMID:Amaurosis fugax in teenagers. A migraine variant. 334 21

Amaurosis fugax is a term used to describe transient monocular visual loss due to atherosclerosis of the ipsilateral internal carotid artery. It is differentiated from other causes of transient monocular blindness, especially retinal migraine. It is said that amaurosis fugax episodes are short in duration and only occasionally include "positive" visual phenomena such as scintillations. Monocular migraine is more prolonged and often accompanied by scintillations. We studied 37 patients with amaurosis fugax and angiographic evidence of carotid atherosclerosis ipsilateral to the symptomatic eye. Nearly one-third of the patients had long attacks or positive visual phenomena. In many patients, transient monocular visual loss due to carotid atherosclerosis cannot be differentiated from retinal migraine based on clinical symptoms alone.
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PMID:Symptoms of amaurosis fugax in atherosclerotic carotid artery disease. 357 86

The charts of patients between the ages of 15-40 years admitted to the Foothills or Calgary General Hospitals in Alberta, Canada between January 1, 1976 and December 31, 1981 and discharged with a diagnosis of reversible ischemic neurological deficits (RIND) or transient ischemic attacks (TIA) were reviewed. A basic work-up was done in almost every instance. 76 patients ranging in age from 16 to 40 years were identified -- 30 male and 46 female. 12 patients (16%) had angiographic evidence of atherosclerosis at a site appropriate to their symptoms, and atheroslerosis was therefore assumed to be the cause of the occlusive cerebrovascular event. 11 (14.5%) were believed to have cardiac sources for emboli and 4 (5%) were thought to have emoblized from intracranial aneurysms. 6 (8%) had a stroke or RIND associated with complicated migraine. 12 patients were pregnant or taking oral contraceptives (OCs) at the time of their illness and in 7 (15% of the female group) this was apparently the only significant coincident risk factor. 11 (14.5%) had other causes for their ischemic episodes, and in 25 instances (33%) no cause was identified. 56 patients (73.5%) had a cranial tomography (CT) scan, 55 (72.5%) had cerebral angiography, and 44 (58%) underwent echocardiography. Only 23 (30%) had all 3 tests. Of 12 patients with atherosclerosis, 7 were male and 5 female. These persons tended to be at the upper end of the age range for the study with a mean age of 36 years. Almost all had 1 or more risk factors for atherosclerosis, such as hypertension, diabetes mellitus, hyperlipidemia, obesity, or smoking. 11 patients had an identified cardiac source for an embolous. 55 patients (72.5%) in this series had cerebral angiograms and 4 of these demonstrated intracranial aneurysms. In 7 females with no direct discernible cause for an ischemic event, 6 were using OCs and 1 was pregnant. A variety of other causes were detected in 11 patients. A total of 25 individuals had no cause identified for their illness. Occlusive cerebrovascular disease is not uncommon in young adults. OCs are seldom implicated, and a high yield of identifiable treatable lesions justifies extending conventional screening investigations to include echocardiography and cerebral angiography.
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PMID:Occlusive cerebrovascular disease in young adults. 673 11


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