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

Acute coronary syndrome (ACS) is often associated with the rupture of vulnerable atherosclerotic plaque, coronary thrombus formation, and abrupt limitation of blood flow, leading to adverse outcomes. Passivation of vulnerable plaque represents a therapeutic concept that has the potential to prevent or limit the magnitude of a new rupture in order to reduce the recurrence or severity of events. Plaque passivation can be defined as a process by which the structure or content of the atherosclerotic plaque is changed to reduce the risk of subsequent rupture and thrombosis. This may be achieved by using strategies that address different components of the plaque or the endothelium. The following factors can affect the susceptibility of plaque to rupture: macrophage infiltration; accumulation of inflammatory cells; paracrine secretion of enzymes that may cause degradation of the fibrous cap of coronary plaque; shear stress; circadian rhythm variation in stress hormone release; and infectious agents. The use of pharmacologic agents to reduce plaque vulnerability by passivation has been explored. Clinical studies demonstrate that lipid-modifying agents (e.g., statins), antiplatelet agents (acetylsalicylic acid, thienopyridines, thianopyridines, glycoprotein IIb/IIIa inhibitors), and antithrombotic agents (unfractionated heparin and low-molecular-weight heparin) can reduce the occurrence of acute coronary events in ACS patients. In addition, angiographic studies suggest that statins may also promote regression of atherosclerosis. Angiotensin-converting enzyme inhibitors, niacin, and calcium antagonists may also contribute to plaque passivation. This article reviews atherosclerotic plaque development and vulnerability and discusses some clinical studies highlighting the role of plaque passivation in the management of ACS patients.
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PMID:Pharmacologic plaque passivation for the reduction of recurrent cardiac events in acute coronary syndromes. 1264 37

Acute coronary syndrome occurred in 2 young adults who had a history of Kawasaki disease (KD), but few other coronary risk factors. The first patient was a 27-year-old male with acute myocardial infarction without stenosis detected by coronary arteriography 4 years earlier. Emergency coronary arteriography showed occlusion of the right coronary artery. Aspiration-thrombectomy and rescue balloon angioplasty were successfully performed. The second patient was a 32-year-old male with unstable angina. Right coronary arteriography showed total occlusion with severe calcification. Left coronary arteriography showed 99% stenosis at the proximal site of the circumflex artery, and a directional coronary atherectomy was performed. Histological examination of a specimen from this site revealed a lipid core, macrophages, and smooth muscle cells. Restenosis was not observed on follow-up coronary arteriography after 5-6 months in either case. The coronary stenosis in each case was probably caused by accelerated atherosclerosis at the site without aneurysm as it seemed to be 'normal' on arteriography. Conventional catheter intervention was effective treatment. The sequelae of KD should be recognized as independent coronary risk factors.
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PMID:Successful catheter interventional therapy for acute coronary syndrome secondary to kawasaki disease in young adults. 1265 71

Ischemic heart disease is one of the leading causes of death in Japan. Acute coronary syndrome (ACS) most commonly begins with atherosclerotic plaque rupture and intracoronary thrombus formation. Therefore, the primary goal of treatment of acute coronary occlusion is the achievement of early and complete reperfusion. To achieve this goal, detection of atherosclerosis and/or myocardial necrosis by imaging and serologic tests is important. Original diagnosis of acute myocardial infarction (AMI) was made from typical symptoms, characteristic rises in serum enzyme levels, and an atypical electrocardiographic pattern. Increasingly sensitive and specific tests have been developed in recent years and have been rapidly adopted into clinical practice. Rapid developments in technology in the field of serum biomarkers have redefined the diagnosis of AMI. The new ESC/ACC criteria place increased emphasis on cardiac biomarkers, especially troponins. However, the electrocardiogram still remains significant in the diagnosis of AMI and the ability to identify high risk subgroups by admission electrocardiogram is necessary to estimate the severity of AMI. Current practice guidelines recognize the importance of promptly restoring normal epicardial blood flow, but blood flow to the ischemic tissue may still be impeded after relief of the occlusion; a phenomenon known as no reflow. Myocardial scintigraphy is one of the methods for defining coronary microvascular injury in the acute phase of AMI. Prompt assessment of coronary perfusion and detection of coronary microvascular injury may aid in making decisions concerning the use of drugs to improve microvascular function and left ventricular function after primary coronary angioplasty.
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PMID:[Ischemic heart disease]. 1596 7

The incidence of coronary artery disease (CAD) has dramatically increased in India during the recent years. There are two facets of CAD: stable CAD and unstable CAD which includes patients with acute coronary syndrome (unstable angina, non-ST elevation myocardial infarction, ST elevation myocardial infarction). The treatment of stable CAD (stable angina) includes anti-anginal medication, medication to modify atherosclerosis and aggressive treatment of causative risk factors. Those patients with stable CAD who have symptoms refractory to medical treatment usually require coronary angiography to be followed by either percutaneous or surgical revascularization. Percutaneous coronary revascularization using drug eluting stents has been a major revolution during the last five years for symptomatic relief of angina in symptomatic CAD and can be applied to large subsets of patients. Off-pump surgical revascularization using arterial grafts is a major advance and bypass surgery continues to remain treatment of choice in diabetics with multi-vessel CAD, left main CAD and in patients with multivessel disease and impaired ventricles. Acute coronary syndromes are usually caused by plaque rupture with resultant thrombus and present as unstable angina, non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI). It is now increasingly realized that these patients (particularly the one with high risk) are best managed in advanced cardiac care centres with facilities for cardiac catheterization laboratory, percutaneous coronary interventions and coronary bypass surgery. In both, NSTEMI and STEMI aggressive medical management involving nitrates, ACE inhibitors, beta-blockers, dual anti-platelet agents, heparin and statins are recommended. High risk patients with NSTE-ACS require use of glycoprotein IIa / IIIb inhibitors along with early invasive approach involving coronary angiography, angioplasty using drug eluting stent and in some patients bypass surgery. Early reperfusion is key to management of patients presenting with STEMI. If facilities are available, primary percutaneous coronary intervention (angioplasty with stenting) is treatment of choice for patients with STEMI. In our country, thrombolysis still remains the most frequently utilized reperfusion therapy and all efforts should be devoted to provide this therapy at the earliest. All high risk patients with STEMI (including cardiogenic shock) are best treated in higher centres and these patients should be promptly transported to such centres. Early coronary angiography is recommended for majority of patients following thrombolysis for risk stratification and further treatment. In acute coronary syndromes there is drift towards early invasive treatment and this is reflected in marked increase in cardiac care (catheterization laboratories and cardiac surgery centers) facilities throughout India. All patients with CAD require life-long supervised treatment which includes medication, control of risk factors and lifestyle modification. Avoidance of smoking, heart healthy diet, proper exercise, ideal weight management are important for all the patients. Statins, ACE inhibitors, beta-blockers, antiplatelet agents have a great role to play in treatment and prevention and these drugs should be utilized under medical supervision. It is important that the medical profession play an important role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection and management of cardiac disorders. The American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), Society for Cardiovascular Angiography and Interventions (SCAI) and several other societies engage in production of guidelines in the area of cardiovascular diseases from time to time. These guidelines attempt to define practices that meet the needs of most patients in most circumstances. The aim of the guidelines is to improve the patient care. The ultimate judgement regarding the care of the particular patient is to be made by the clinician / healthcare provider keeping in mind all the circumstances. The incidence and prevalence of coronary artery disease (CAD) has increased tremendously in India during the last two decades and this change is largely attributable to lifestyle changes. There has also been a rapid progress in the treatment of CAD with proliferation of specialized cardiac care units, intensive care units, cardiac catheterization laboratories and facilities for bypass surgery. It is estimated that there are over 400 catheterization laboratories currently in India and nearly half of them are located in six major cities. The increase in disease and availability of facilities has resulted in a dramatic change and the focus is shifting from only medical treatment to invasive treatment. This document is an expert consensus document which has been prepared by going through the available guidelines and other relevant literature on the subject. The experts have performed a formal review of the literature and have weighed the strength of evidence for or against a particular therapy as it can be applied in Indian scenario. The consensus document deals with the management of ischemic heart disease (IHD) under following sections: 1) Stable Angina 2) Non ST Elevation Acute Coronary Syndrome (NSTE-ACS) 3) ST Elevation Acute Coronary Syndrome (STE-ACS) or Acute Myocardial Infarction (AMI).
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PMID:API expert consensus document on management of ischemic heart disease. 1721 32

Acute coronary syndromes (ACSs) are the most common cause of hospital admission in patients with coronary artery disease (CAD). The term ACS refers to a spectrum of acute life-threatening disorders that includes: unstable angina (UA), non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). The pathophysiology is similar: coronary atherosclerosis plaque rupture and subsequent thrombus formation. Such plaques usually are lesions with <50% stenosis severity prior to ACS, but are lipid-rich soft plaques (vulnerable plaques). The clinical presentation depends on the degree of partial (UA/NSTEMI) or complete lumen obstruction of the culprit coronary artery (STEMI). This article reviews the UA/NSTEMI ACS, since these two entities are closely related and usually, it is not possible to distinguish them upon presentation at the emergency department (ED). It presents the latest advancement on the pathophysiology, clinical presentations, diagnosis, risk stratification and management. It emphasizes on the selection of the optimal management approach which includes early invasive versus initial conservative strategies. Besides, it discusses the different approaches being used in the light of the information provided by the latest clinical trials. Although, at the present time, the optimal management approach remains unsettled, ACSs are usually managed using an early invasive strategy in tertiary care hospitals in the USA. The application of clinical practice guidelines developed by the American College of Cardiology and the American Heart Association (ACC/AHA) has confirmed definite improvement of patient care. Part of the information presented in this article, particularly in its management, is based on these guidelines (3). Evidence base scientific data insists upon using aggressive medical therapy (statins, anti-platelets, beta blockers [BBs], angiotensin converting enzyme inhibitors [ACE-Is], and control of coronary risk factors) as well as mechanical reperfusion, whether by percutaneous coronary intervention (PCI) or by coronary artery bypass graft (CABG). These approaches are considered complementary rather than as opposing strategies.
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PMID:Unstable angina and non ST elevation acute coronary syndromes. 1906 75

Acute coronary syndrome most commonly begins with atherosclerotic plaque rupture and intracoronary thrombus formation. Therefore, the primary goal of treatment for acute coronary syndrome is the achievement of early and complete reperfusion. The diagnosis of acute myocardial infarction (AMI) is made from typical symptoms, characteristic rises in serum enzyme levels, and changes in the electrocardiographic pattern. Although rapid developments in technology in the field of serum biomarkers have redefined the diagnosis of AMI, the electrocardiogram still remains significant in the diagnosis of AMI. Moreover, the identification of high-risk subgroups based on the admission electrocardiogram is essential to estimate the severity of AMI. Pulmonary embolism is an another thromboembolic disorder leading to mortality worldwide. The relationship between deep vein thrombosis and pulmonary embolism has been emphasized. The early detection of free-floating deep venous thrombosis by venous ultrasonography of the lower extremities is critical to prevent pulmonary embolism. For the detection of atherosclerosis, the identification of myocardial necrosis and thrombi by imaging tests is important. This paper reports the clinical usefulness of various noninvasive diagnostic approaches in cardiovascular disease.
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PMID:[Clinical significance of physiological function testing in cardiovascular disease]. 2007 24

Acute coronary syndrome (ACS) describes a spectrum of symptoms arising from the development of atherosclerosis. The degree of myocardial ischaemia depends on plaque stability and the extent of vessel occlusion. This article examines underlying pathophysiological processes and reviews current guidance and principles of managing ACS through symptom control, reducing mortality and maximizing secondary prevention. Nurses have a vital role in all aspects of delivering this care and meeting National Service Framework Standards for Coronary Heart Diseases (CHD) (2000). A clear understanding of the pathophysiological basis for ACS will reinforce clinical work, particularly in the recognition, monitoring and early management.
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PMID:Current guidance on the management of acute coronary syndrome. 2008 76

Acute coronary syndrome (ACS) is a clinical syndrome caused by acute myocardial ischemia and a severe stage of coronary atherosclerosis heart disease. The aim of this study was to clarify whether ramipril was a therapeutic agent against monocyte chemoattractant protein 1 (MCP-1), interleukin 18 (IL-18), and interleukin 10 (IL-10) in elderly patients with ACS. A total of 190 subjects including 72 elderly patients with ACS (78.1% male, mean age 67.12 +/- 5.06 years), 60 elderly patients with stable angina pectoris (76.9% male, mean age 68.00 +/- 4.52 years), and 58 healthy volunteers (77.8% male, mean age 65.96 +/- 4.18 years) were recruited into the study. Serum MCP-1, IL-10, and IL-18 were determined in 132 elderly patients by enzyme-linked immunosorbent assay (ELISA) before and after treatment with low doses of ramipril (2.5-5 mg/day), and were determined in 58 healthy volunteers. The levels of serum MCP-1 and IL-18 were much higher in elderly patients with ACS than those in elderly patients with SAP and healthy volunteers. After treating with ramipril, the levels of MCP-1 and IL-18 were decreased in elderly patients with ACS. Moreover, ramipril significantly increased serum IL-10 in elderly patients with ACS. Ramipril plays an important role in elderly patients with ACS. With decreasing MCP-1 and IL-18, it can ameliorate cytokine-associated cardiac damage. This study may provide a new recognition of angiotensin-converting enzyme inhibitor for the treatment of ACS.
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PMID:Effects of ramipril on serum monocyte chemoattractant protein 1, interleukin-18, and interleukin-10 in elderly patients with acute coronary syndrome. 2033 66

Acute coronary syndrome (ACS) are the result of a sudden imbalance between myocardial demand for oxygen and its supply. The most common reason (90%) is the sudden reduction of coronary artery lumen by clot formation on a damaged atherosclerotic plaque. Among the uncommon causes, such as spasm, obstruction, inflammation or trauma of the coronary arteries, carbon monoxide poisoning could be the cause of ACS. Carbon monoxide intoxication can lead to ACS both healthy and non-critical restricted coronary artery The paper presents three cases of acute carbon monoxide poisoning complicated by acute coronary syndrome, troponino - positive. Case I: patient 60 years old, smoker, with symptoms of peripheral atherosclerosis of the lower limbs, Case II: patient 50 years old without signs of atherosclerotic disease. Case III: patients aged 20 previously healthy.
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PMID:[Troponin positive acute coronary syndromes in the course of acute carbon monoxide poisoning as the factor exposing primary coronary heart disease previously undiagnosed]. 2201 Apr 52

Compared to other statins, pitavastatin is a highly potent 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitor and an efficient hepatocyte low-density lipoprotein-cholesterol (LDL-C) receptor inducer. Its characteristic structure (heptenoate as the basic structure, a core quinoline ring and side chains that include fluorophenyl and cyclopropyl moieties) provides improved pharmacokinetics and significant LDL-C-lowering efficacy at low doses. Unlike other statins, the cyclopropyl group on the pitavastatin molecule appears to divert the drug away from metabolism by cytochrome P450 (CYP) 3 A4 and allows only a small degree of clinically insignificant metabolism by CYP2C9. As a result, pitavastatin is minimally metabolized; most of the bioavailable fraction of an oral dose is excreted unchanged in the bile and is reabsorbed by the small intestine ready for enterohepatic recirculation. This process probably accounts for pitavastatin's increased bioavailability relative to most other statins and contributes to its prolonged duration of action. In addition to its potent LDL-C-lowering efficacy, a number of pleiotropic benefits that might lead to a reduction in residual risk have been suggested in vitro. These include beneficial effects on endothelial function, stabilisation of the coronary plaque, anti-inflammatory effects and anti-oxidation. With regard to the clinical safety and efficacy of pitavastatin, the Phase IV Collaborative study of Hypercholesterolemia drug Intervention and their Benefits for Atherosclerosis prevention (CHIBA study) showed similar changes in lipid profile with pitavastatin and atorvastatin in Japanese patients with hypercholesterolemia. However, a subgroup analysis of the CHIBA study showed that pitavastatin produced more significant changes from baseline in LDL-C, TG, and HDL-C in patients with hypercholesterolemia and metabolic syndrome. The clinical usefulness of pitavastatin has been further demonstrated in a number of Japanese patient groups with hypercholesterolemia, including those with insulin resistance, low levels of high-density lipoprotein-cholesterol (HDL-C), high levels of C-reactive protein, and chronic kidney disease. Finally, the Japan Assessment of Pitavastatin and AtorvastatiN in Acute Coronary Syndrome (JAPAN-ACS) study showed that pitavastatin induces plaque regression in patients with ACS, which suggests potential benefits for pitavastatin in reducing CV risk.
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PMID:Pitavastatin: an overview. 2215 81


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