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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of hypertension, hyperlipidemia, and the combination of both on acute and chronic myocardial ischemia were evaluated in a total of 30 male rabbits. After preliminary hypertension and/or hyperlipidemic load by loading of the abdominal aorta and/or cholesterol feeding, acute ischemia was produced by clipping of the left coronary artery. The banding produced elevation of carotid arterial pressure and left ventricular hypertrophy. Cholesterol feeding resulted in severe atheromatous changes in all sizes of coronary arteries. The intimal thickening was due to foam cell accumulation in all arteries examined. Animals pretreated with the combination of hypertension and hyperlipidemia displayed the most severe cardiolmegaly with advanced coronary atherosclerosis and chronic ischemic lesions of the myocardium, i.e., perivascular patchy fibrosis in the subendocardial area. Furthermore, electron microscopic detection of ultrastructural myocardial damage, involving glycogen depletion, sarcoplasmic edema, mitochondrial swelling, and contractile abnormalities, was also most frequent in this group. These changes were quantitated using the ischemic score. These results confirm the hypothesis that fatal ischemic injuries may occur clinically in human hearts with coronary insufficiency due to coexistence of hypertensive cardiomegaly and severe coronary atherosclerosis. They offer a model for further study of these combined effects.
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PMID:An ultrastructural study on ischemic lesions in rabbits' hearts with pressure overload and hyperlipidemia. 315 60

Multiple congenital coronary-left ventricular fistulae (CLVF) are rare (4.5% of all coronaro-cardiac fistulae, the same incidence as isolated CLVF); data obtained from 7 personal and 25 previously reported cases, showed that this anomaly, is diagnosed at coronary angiography performed for anginal chest pains in 2 out of 3 cases; cardiac auscultation was usually normal but the basal ECG was pathological in 3 out of 4 cases; the electrical changes suggested myocardial ischaemia in 20 out of 24 cases. However, exercise stress testing was negative in 47% of cases. Multiple CLVF usually arose from the same artery (59%); the commonest artery involved was the left anterior descending (84% of the single artery fistulae and 100% in cases of multiple CLVF arising from more than one artery). The angiographic appearances of multiple CLVF were constant: images of "intracavitary rain". Associated ventriculographic abnormalities were uncommon but coronary atherosclerosis was observed in 15% of cases. The main differential diagnosis is that of CLVF secondary to intra-left ventricular thrombosis due to the development of neovascularisation of the thrombus from the underlying endocardium. The value of non-invasive investigations (2D echocardiography alone or coupled with pulsed Doppler) has not been shown in this type of coronaro-cardiac fistulae. Surgical correction was attempted in 3 cases, 2 of which had associated cardiac pathology justifying surgery. The presence of unequivocal coronary insufficiency due to CLVF was not demonstrated despite some suggestive clinical and paraclinical indicators.
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PMID:[Multiple congenital coronaro-left ventricular fistulas. Apropos of 7 cases]. 393 22

An observation of adrenergic myocarditis with clinical and electrical signs of coronary failure is reported. The patient had electrical and enzymatic manifestations of acute anteroseptal necrosis, complicated at the acute stage by complete atrioventricular block and fatal vasoplegic circulatory collapse. Post-mortem examination showed obstructive atherosclerosis of the anterior interventricular artery without anatomic signs of infarction. Pathogenesis of this coronary failure is discussed. In this case, functional coronary insufficiency produced by catecholamine release was associated with coronary atherosclerosis.
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PMID:[Early coronary atherosclerosis in a malignant pheochromocytoma. Apropos of a case]. 632 81

Two coronary pulmonary fistulae were demonstrated between the right coronary and left anterior descending arteries and the main pulmonary artery at coronary angiography, in a 66 year old woman with a continuous murmur in the third left intercostal space. This double malformation, though uncommon is not rare (18 previously published cases). It is usually diagnosed late (17 to 76 years) and the presentation is limited in half the cases to a localised continuous murmur, the localisation of which may simulate a patent ductus arteriosus. The hypothesis of a supernumerary coronary artery arising from the main pulmonary artery is suggested by the constancy of the anatomical characteristics of the reported cases. Eight patients presented typical attacks of angina which were due to severe coronary atherosclerosis, affecting two or three main vessels except in one case. Therefore, it is unlikely that these fistulae cause coronary insufficiency by a coronary steal syndrome. However, this mechanism may aggravate symptoms in patients with coronary artery disease and necessitate surgical cure of the fistulae at the same time as coronary bypass surgery. On the other hand, surgery does not seem to be indicated in asymptomatic patients.
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PMID:[Bilateral coronaro-pulmonary fistula. Apropos of a new case with review of the literature]. 642 85

The test involving isometric muscular tension has been proved promising for the non-invasive quantitative evaluation of the severity of coronary insufficiency. Fifty-seven males with coronary stenosing atherosclerosis and 24 normal subjects have been studies. It has been shown that the isometric test is the method of choice in angina at rest and of a low effort as well as in labile angina, whereas tests with increasing exercise are more adequate in angina associated with moderate and hard exercise.
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PMID:[Isometric load in assessing the severity of coronary insufficiency in heart surgery patients]. 674 93

Systematic blood coagulation analyses were conducted in 32 severely hypertensive patients treated with the angiotensin converting enzyme inhibitor captopril. Two hours after the first captopril dose, fibrin monomer complexes had already increased. This rise was even more distinct after 26 h and 1 week. Tests after 6 and 12 months of therapy showed a regression of fibrin monomer complexes to pretreatment values. In several patients with a marked increase in fibrin monomer complexes, the partial thromboplastin time (PTT) became shorter and antiplasmin activity increased. The most pronounced increase in fibrin monomer complexes was seen in patients with a rapid and excessive blood pressure reduction. The concentration of fibrin monomer complexes also rose in 15 healthy normotensive subjects, after a single oral dose of captopril (25 mg). Additionally, the PTT was shortened and antiplasmin significantly rose. An inhibition of fibrinolysis by captopril could be demonstrated by the effect on fibrin plates and thrombus weight after streptokinase. Out of 58 patients with severe hypertension and atherosclerosis treated with captopril, 7 patients suffered vascular complications during antihypertensive therapy: myocardial infarction (n = 2), coronary insufficiency (1), cerebral ischemia (1), renal insufficiency (3). These ischemic lesions may be partly explained by the alterations of coagulation and fibrinolysis under captopril therapy.
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PMID:Effects of the converting enzyme inhibitor captopril on blood coagulation and fibrinolysis in man. 675 Feb 21

Percutaneous transluminal coronary angioplasty, first performed in man in 1977, has been used increasingly in selected patients with angina pectoris due to coronary atherosclerosis. Patients with single-vessel coronary artery disease in whom the stenosis is relatively proximal, noncalcified, discrete, and tapered rather than eccentric are the best candidates for the procedure. Objective evidence of coronary insufficiency documented by scintigraphy or exercise testing allows objective follow-up. Patients must be candidates for coronary artery bypass graft surgery since a complication might require immediate operation. Clinical experience indicates that 60%-85% of patients chosen for coronary angioplasty can have their coronary stenoses successfully dilated. Symptomatic improvement occurs in almost 90% of successful dilatations. Follow-up studies have shown persistent vessel patency for more than 1 year. From 3% to 8% of patients have needed urgent coronary artery bypass graft surgery because of coronary insufficiency developing at the time of angioplasty. Mortality has been less than 1%. The initial favorable experience with coronary angioplasty indicates that it should continue to be evaluated. The limits of patient selection for the procedure and long-term results require further compilation of data.
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PMID:Percutaneous transluminal coronary angioplasty. 677 73

In the purpose of studying their respective predictive value, beside the cardiovascular risk, the concentrations of B and (Apo) A1 apoproteins, cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol were estimated in a group of 110 patients (acute coronary insufficiency : 30 cases; recent myocardial infarction : 50 cases; cerebro-vascular accident : 30 cases) compared with the concentrations of an example group composed of 150 normolipemic subjects, presumed healthy. The concentrations of Apo A1 and HDL-cholesterol remain close in both groups, respectively to 1,6 +/- 0,33 mmol/l and 0,85 +/- 0,18. On the other hand, in the patients group, the concentrations of LDL-cholesterol, triglycerides and cholesterol are very increased in all the patients less than 60 years old; beyond they meet the ones of the control subjects with same age; the concentrations of the Apo B stay high in all the cases. In conclusion, the predictive value of the concentrations of HDL-cholesterol and of the Apo A1 remains very uncertain; it's much lower than the value of the concentrations of Apo B, major protein constituent of the atherogenic lipoproteins which are increased significantly whatever may be the age of the patient who show acute vascular accident linked to the atherosclerosis.
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PMID:[Interpretation of B and A apoproteins dosage in the acute accidents of the cerebral and coronary atherosclerosis. Age influence upon the results (author's transl)]. 678 58

This article deals with the question of whether or not the risk factor concept, a principal aspect of preventive cardiology, has contributed to patient care in coronary heart disease. The risk factors considered are plasma cholesterol, high blood pressure, smoking, diabetes and marked obesity. With the exception of plasma cholesterol and diabetes, all of these factors enhance myocardial oxygen consumption and thus, in the presence of coronary insufficiency, promote myocardial ischemia. Their modification is therefore good general medical practice, even if not related to coronary atherosclerosis. Diabetes needs adequate medical treatment in patients both with and without coronary atherosclerosis. Because of the occasional occurrence of spontaneous regression of coronary atherosclerosis and the morphologic and functional complexity of coronary artery pathology, it has never been and probably never will be demonstrated that lowering plasma cholesterol levels by diet or other means will cause regression of coronary atherosclerosis. It follows that modification or treatment of risk factors is implemented for good medical reasons but does not demonstrably or predictably affect coronary artery disease. It is concluded that the contribution of the risk factor concept to patient care in coronary heart disease has been, and still is, trivial.
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PMID:Contribution of the risk factor concept to patient care in coronary heart disease. 682 30

A retrospective study of autopsies was performed on patients who died of ischaemic heart disease (IHD) in the industrialised Ruhr valley of West Germany. Groups were classified on the basis of the presence or absence of cardiac scar tissue, acute myocardial infarction and cardiac rupture. Severe coronary atherosclerosis was not a constant finding in IHD, and ranged from 57% of acute coronary insufficiency cases in women to 86% of recurrent infarction cases in men. During the period 1970 to 1979 recurrent infarction decreased in frequency, whilst hearts with scar tissue in the absence of fresh infarction (chronic progressive coronary insufficiency) became increasingly common. These two groups accounted for 72% of IHD deaths and were more common in men than in women. However, the incidence of first-time acute myocardial infarction and acute coronary insufficiency was higher in women than in men. The frequency of clinically known diabetes mellitus and/or hypertension was higher in women with IHD than in controls. Systemic hypertension was not commoner in cardiac rupture cases than in other cases of acute myocardial infarction. Cardiac rupture increased markedly in the latter half of the last decade so that since 1974 20% of all acute myocardial infarcts showed cardiac rupture. The incidence of first-time infarction as well as anterior infarction was significantly higher in cases of cardiac rupture than in acute infarction without rupture. The incidence of recent coronary thrombosis was low in recurrent myocardial infarction (23%), higher in first-time infarction (39%) and highest in cardiac rupture (59%). In men, this finding was significantly higher in acute infarction with rupture than in acute infarction without rupture (p less than 0.001). The view of coronary thrombosis as a secondary phenomenon in acute myocardial infarction is supported.
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PMID:Myocardial infarction, cardiac rupture, and coronary insufficiency in the industrialised Ruhr valley. An autopsy study. 685 29


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