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 amounts of narrowing of the 4 major (left main, left anterior descending, left circumflex and right) epicardial coronary arteries by atherosclerotic plaques were compared in 4 subsets of coronary patients. Of the 129 patients studied at necropsy, an average of 2.7 of the 4 arteries was narrowed greater than 75% in cross-sectional area at some point (0.7/4 in controls), and the group with unstable angina pectoris (3.2/4) had more narrowing than did the groups with sudden coronary death (2.8/4), acute myocardial infarction (2.7/4) and healed myocardial infarction (2.3/4). Each of the 4 major epicardial coronary arteries was divided into 5-mm long segments and a histologic section was prepared and stained by the Movat method of each of the 6,461 segments in the 129 patients and in the 1,849 segments in the 40 control subjects. In the 129 patients, 35% of the 5-mm segments were narrowed 75 to 100% in cross-sectional area (3% in controls) and the group with unstable angina had the highest percent (48%) of segments severely narrowed compared to the groups with sudden coronary death (36%), acute myocardial infarction (34%) and healed myocardial infarction (31%). Thus, of the 4 subsets of patients with fatal coronary artery disease studied at necropsy, those with unstable angina pectoris had the most severe and extensive coronary atherosclerosis.
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PMID:Qualitative and quantitative comparison of amounts of narrowing by atherosclerotic plaques in the major epicardial coronary arteries at necropsy in sudden coronary death, transmural acute myocardial infarction, transmural healed myocardial infarction and unstable angina pectoris. 275 76

One hundred and fifty patients with coronary artery disease (CAD) who refused bypass grafting were followed prospectively from 2 to 8 years. Mean age was 57 +/- 8 (standard deviation) years. Ejection fraction averaged 70 +/- 14%. Eight percent of patients had 1-vessel CAD and 92% had multiple-vessel CAD. Medical treatment included propranolol, nifedipine, isosorbide dinitrate, dipyridamole and aspirin. Annual mortality was 0% for 1- and 2-vessel CAD and 1.3% for left main equivalent disease, 3-vessel and left main CAD. Treatment significantly reduced the incidence of stable and unstable angina. Fifty-two patients (34%) had a second hemodynamic study 4.2 +/- 1.3 years after initial evaluation. Stenosis progression or new significant obstructions (greater than or equal to 70%) in previously normal coronary arteries occurred in 61% of 123 arteries studied, whereas new occlusions were observed in 12% of the arteries. Nonfatal acute myocardial infarction incidence was 8%. No significant changes occurred in ejection fraction. In conclusion, proper medical treatment in selected patients with advanced CAD but preserved ventricular function is associated with good long-term survival and remission of symptoms, although progression of coronary atherosclerosis does occur in some patients.
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PMID:Two- to eight-year survival rates in patients who refused coronary artery bypass grafting. 278 55

From July 1984 to December 1987, intra-aortic balloon pumping (IABP) was attempted percutaneously to 22 patients at the ages of 37-78 with cardiogenic shock or medically refractory heart failure complicating acute myocardial infarction (CS/MRHF-AMI). There was only one failure because of severe bilateral iliofemoral atherosclerosis. Of the 21 patients undergoing IABP, 17 were in cardiogenic shock and 13 of them showed reversal of shock syndrome after 10 to 48 hours of IABP. Cardiac index increased from 1.91 +/- 0.43 to 2.45 +/- 0.43 L/min/M2 (P less than 0.005), spontaneous systolic arterial pressure rose from 79 +/- 10 to 114 +/- 19 mmHg (P = 0.0001), heart rate dropped from 111 +/- 26 to 85 +/- 13 beats/min (P = 0.0001), pulmonary artery wedge pressure decreased from 29 +/- 5 to 16 +/- 3 mmHg (P = 0.0001), and urine output increased from 7 +/- 10 to 79 +/- 22 ml/h (P = 0.0001). Twelve patients, including 4 shock-free, were subsequently weaned from balloon assistance. Of these patients, 8 (5 shock and 3 nonshock) were discharged from the hospital and followed-up for a mean period of 23 months (4 to 38 months). Of the surviving patients, 4 underwent surgical reperfusion and/or infarctectomy during balloon support (n = 1) or after weaning from IABP (n = 3). All of the 10 patients who underwent coronary angiogram were found a severe left anterior descending artery lesion. The main complication was leg ischemia, which was observed in 7 patients: 3 needed removal or replacement of balloon catheter and one required surgical removal of the thrombus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical experience with percutaneous intra-aortic balloon pumping in cardiogenic shock complicating acute myocardial infarction. 280 84

Coronary heart disease (CHD) mortality has been decreasing continuously in all age-sex groups in Japan since 1976. An earlier increase in the 1950s was largely due to a change in the diagnostic method. Hypertension was a more important risk factor than hyperlipidaemia for ischaemic heart disease (IHD) in Japan. Increasing availability of a variety of foods supplying balanced nutrition, opportunities for health screening linked to detection and treatment of high blood pressure with little financial constraint, plus health insurance and health education have improved the cardiovascular health of the people, though these effects have not been evaluated objectively. These changes resulted in less advanced coronary atherosclerosis and less CHD despite a high frequency of smoking in men. Improving technology in the treatment of acute myocardial infarction (MI) may also have contributed to the decline in mortality.
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PMID:Changing CHD mortality and its causes in Japan during 1955-1985. 280 96

Elevated plasma homocysteine and lipid levels are risk factors for atherosclerosis. The plasma levels of homocysteine, determined in acid hydrolyzates of plasma, were found to be correlated with total cholesterol (r = 0.47, P less than 0.001), triglycerides (r = 0.40, P less than 0.01), and body mass index (r = 0.42, P less than 0.01) in 52 males, aged 30-60. A group of 12 male survivors of acute myocardial infarction was given pyridoxine, folate, cobalamin, choline, riboflavin, and troxerutin for 21 days. The plasma concentrations of homocysteine and alpha-amino adipic acid declined to 68% (P less than 0.001) and 57% (P less than 0.001) of the pretreatment values, and the cholesterol, triglycerides, and LDL apo B declined to 79% (P less than 0.001), 68% (P less than 0.01), and 63% (P less than 0.001) of the pretreatment values, respectively. The results suggest a new strategy for control of the metabolic abnormalities in atherosclerosis through the use of naturally occurring, non-toxic nutrients which minimize homocysteine accumulation.
Atherosclerosis 1989 Jan
PMID:Reduction of plasma lipid and homocysteine levels by pyridoxine, folate, cobalamin, choline, riboflavin, and troxerutin in atherosclerosis. 293 Jun 11

Percutaneous transluminal coronary angioplasty (PTCA) is indicated for many patients with symptomatic coronary atherosclerosis. It can be safely used in patients with unstable angina pectoris, multivessel coronary disease (in selected instances), multiple stenoses in single vessels, stenoses in coronary artery bypass grafts, and recent total coronary occlusion. PTCA may be useful in reestablishing coronary flow after acute myocardial infarction with coronary occlusion and in association with thrombolytic therapy for acute myocardial infarction. The primary success rate of PTCA in experienced hands should be approximately 90%. If restenosis occurs after successful PTCA, a second procedure can be used to dilate the segment with restenosis and the success rate is high. Acute coronary events are the major complications of PTCA. Less than 5% of patients need emergency coronary surgery. Mortality for PTCA is less than 1%. Complications of PTCA diminish with increasing operator experience. PTCA is not indicated for patients with long-standing complete coronary occlusions, diffuse atherosclerotic coronary stenoses without discrete stenotic segments, multiple sites of total occlusions, or "skip" areas in vessels served by bridging collaterals. Patients with main left coronary stenoses and stenoses involving both sides of large-vessel bifurcations are not considered for PTCA in most centers. The choice for or against PTCA should be made after careful assessment of the risk/benefit ratio of PTCA vs coronary bypass surgery.
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PMID:Percutaneous transluminal coronary angioplasty: role in the treatment of coronary artery disease. 293 84

Several lines of evidence have clearly established the role of lipoproteins as risk factors for the development of atherosclerosis. Epidemiologic studies from different countries have found that about one third of myocardial infarction survivors under 60 years of age are hyperlipidemic. The acute stress reaction occurring in the first hours following an acute myocardial infarction causes distinct changes in the patient's metabolic profile, these changes include a significant reduction of total cholesterol and cholesterol associated with low density lipoproteins and a usually mild elevation of blood glucose. With the purpose of establishing the prevalence and severity of lipoprotein disorders found in myocardial infarction survivors living in Mexico city we conducted a prospective study of 106 consecutive admissions to the coronary care unit at the National Institute of Cardiology with the fully proven diagnosis of acute myocardial infarction, we included only patients younger than 60 years of age that could be sampled within the first 72 hours of the appearance of typical symptoms, at this time the coronary risk factor profile was assessed and blood samples were drawn (acute sample). After three months of the diagnosis we sampled 81 of the original 106 patients (chronic sample). The comparison of these 81 patients showed remarkable differences in the lipid values obtained on each sample. The mean value for total cholesterol in the acute sample was 225 mg/dl whereas the corresponding value for the chronic sample was 240.5 mg/dl (p less than 0.005). This difference was also highly significant for the low density fraction. On the basis of the chronic sample analysis we estimated a prevalence of hyperlipoproteinemia of 35.8%. (II: 18.5%, III: 2.5%, IV: 14.8%), an additional subgroup of 10 patients (12.3%) had the hypo-HDL phenotype raising the number of subjects at risk for atherosclerosis to as high as 48.1% considering only the lipoproteins. The prevalence figures for the rest of the risk factors were as follows: 70.3% for tobacco smoking, 35.8% for Systemic Arterial Hypertension, 33.4% for Obesity and 30.8% for Diabetes Mellitus. Among the group of 81 patients, 17 were known diabetics, eight additional cases of Diabetes Mellitus were diagnosed at the chronic phase (two with fasting hyperglycemia and six with diagnostic oral glucose tolerance tests). The "acute plase" glycemia for these eight subjects was significantly higher (mean: 98.4 mg/dl) than the corresponding value for the non diabetic patients (mean: 83.4 mg/dl p less than 0.002), the seventeen known diabetics had a mean glycemia of 150.6 mg/dl in the acute sample.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Metabolic disorders in survivors of myocardial infarct]. 296 58

We report a case of an aneurysm of a coronary artery in a 29-year-old male with an acute myocardial infarction. The patient had no risk factors for atherosclerosis and his medical history revealed only repeated episodes of quartian malaria three years before. Coronary arteriography showed aneurysmal dilatation of the proximal part of the left anterior descending coronary artery with thrombus formation at the site of the dilatation. The right coronary artery and the left circumflex artery were free from disease. To the best of our knowledge, this is the first presentation of coronary arterial aneurysm probably related to quartian malaria.
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PMID:Coronary arterial aneurysm: possible relation with malaria? 306 56

The use and type of antithrombotic therapy for patients with cardiac disease are described based on an understanding of the pathophysiologic mechanisms involved, the risk of thromboembolism, and the evidence from prospective and, if necessary, retrospective clinical trials. The indications and intensity of anticoagulant therapy in patients with valvular heart disease and prosthetic valves are first discussed. We recommend that the prothrombin time be reported as a ratio and standardized using the International Normalized Ratio. The pivotal role of platelets and the clotting system in the initiation and progression of atherosclerosis and the acute coronary syndromes is described. There is no evidence to date that antiplatelet therapy is of value in primary prevention or in patients with stable angina, but the value of aspirin in patients with unstable angina was clearly shown in two well-designed studies. Adequate prophylactic therapy to prevent the thrombotic complications of acute myocardial infarction (i.e., venous thrombosis and intracardiac thrombosis) is described, and the available data on the prevention of coronary reocclusion after thrombolysis reviewed. There is now convincing evidence from studies in animals and in patients that vascular injury during aortocoronary vein bypass graft surgery requires antitihrombotic therapy starting before the procedure to minimize acute platelet thrombus deposition and prevent occlusion. Restenosis after arterial angioplasty appears to be related to acute platelet thrombus deposition on the site of deep arterial injury. Therapeutic interventions should probably involve both anticoagulants and platelet inhibitor therapy. Implications derived from recent animal studies are discussed.
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PMID:Antithrombotic therapy for patients with cardiac disease. 307 28

High density lipoprotein (HDL) cholesterol, apolipoprotein A-I (apo A-I), gamma-glutamyl-transferase, testosterone and oestradiol were determined in plasma in non-diabetic males who had survived an acute myocardial infarction (AMI) before the age of 60. They also had serum levels of cholesterol below 7.0 mmol/l 1 year after the AMI. On the basis of diastolic blood pressure they were subdivided into 2 groups with diastolic blood pressures below 90 mm Hg (n = 39), and with or above 95 mm Hg (n = 21) and then compared with an age-matched male non-diabetic reference group (n = 32). There were no significant differences in the levels of HDL cholesterol, gamma-glutamyl-transferase, and sex hormones between the AMI groups and the reference group. Reduced plasma levels of apo A-I were found in the AMI groups.
Atherosclerosis 1986 Jan
PMID:Low serum apolipoprotein A-I in acute myocardial infarction survivors with normal HDL cholesterol. 308 Oct 12


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