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

Arteriographic estimates of stenosis severity can fail to reflect the impact of an individual stenosis on delivery of blood to the myocardium. Whether a coronary stenosis is truly flow-limiting can be determined by measuring hyperemic blood flow or coronary flow reserve; however, until recently, the tools needed to measure coronary flow reserve in humans--namely, a method of quantitating coronary blood flow in individual arteries and another method for producing maximal microvascular vasodilation--were not available. Over the last 8 years, our laboratory group has developed a catheter for measuring coronary blood flow velocity in humans, using the Doppler principle, and studied the effects of microvascular vasodilators. These studies have enabled us to measure coronary flow reserve in humans and to characterize some of the effects of focal and diffuse atherosclerosis on the coronary circulation. In addition, we have used flow reserve measurements in the diagnosis of microvascular dysfunction in patients with chest pain and normal coronary arteries and as a means of assessing noninvasive methods for detecting focal coronary artery disease.
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PMID:Assessment of the human coronary circulation using a Doppler catheter. 203 34

Follow-up of bypass patients in the early postoperative phase involves the management of complications such as perioperative myocardial infarction, postoperative arrhythmias, pericarditis, postcardiotomy-syndrome, fever, infection and chest pain. The longterm management has to focus on changes in lifestyle with particular regard to risk factors for coronary atherosclerosis. Diagnostic tools for work-up of postoperative chest pain include stress testing and radionuclide techniques; ultrafast computerized tomography is superior in the evaluation of bypass function to cine-NMR. Conventional angiography is still the only method to reliably visualize graft patency and anastomotic sites. Indications for reoperations can be well defined.
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PMID:[Care of patients following coronary bypass surgery from the internist's viewpoint]. 236 17

It was demonstrated that patients with coronary heart disease with coronary angiographically documented stenosing coronary atherosclerosis and frequent episodes of angina pectoris had significantly higher pain threshold in response to electric skin irritation and greater defense unconditioned flexor reflex R-III threshold than healthy subjects and patients with chest pain of extracoronary genesis.
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PMID:[Decreased thresholds of pain sensation and defense flexor reflex in patients with ischemic heart disease]. 277 81

A 30-year-old man was admitted with severe chest pain and electrocardiographic evidence of myocardial infarction. Subsequent angiography revealed myocardial bridging of the middle third of the left anterior descending coronary artery and no evidence of coronary atherosclerosis. In the absence of other risk factors, circumstantial evidence points to a possible etiological role of myocardial bridging in the ischemic event in our patient.
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PMID:Myocardial infarction associated with a myocardial bridge. 280 14

Decreased oxygen supply rather than increased demand may be the primary pathogenic mechanism of myocardial ischemia in patients with unstable angina. Coronary artery spasm and in vivo platelet aggregation may play an important role in the mechanism by which the magnitude of fixed obstruction secondary to coronary atherosclerosis is transiently exacerbated. In this case report, we describe a patient who developed chest pain accompanied by ischemic ECG changes during coronary arteriography, due to a transient thrombotic aggravation of a fixed, significant coronary stenosis. Percutaneous transluminal coronary angioplasty was performed with relief of the coronary stenosis and of the symptoms.
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PMID:Transient platelet aggregation as a mechanism of unstable angina. Aggressive treatment with coronary angioplasty. 297 56

Acetylcholine (20 to 100 micrograms) was infused directly into coronary arteries in 10 patients with variant angina (group A), 13 subjects without coronary artery disease (group B) and 8 patients with significant organic coronary artery stenosis (greater than or equal to 50%) but without variant angina (group C) during coronary arteriography, to clarify the action of this agent on coronary arteries. Temporary pacing was performed at a demand heart rate of 40 beats/min while bradyarrhythmia developed. Coronary arteriography after administration of acetylcholine showed coronary vasoconstriction in all 10 patients (100%) of group A. Angina accompanied by electrocardiographic ischemic changes in 9 of 10 (90%, 7 ST-segment elevation and 2 depression) was provoked during this test. In the patients of group B, acetylcholine also induced vasoconstriction in 8 of 22 (36%) coronary arterial systems examined, chest pain in 3 (14%) and ST-segment deviation in none (0%). In the patients of group C, acetylcholine induced vasoconstriction in 3 of 9 (33%), chest pain in 2 (22%) and ST-segment depression in 1 (11%). No definite coronary artery dilation induced by acetylcholine was noted. Coronary vasoconstriction (p less than 0.05), electrocardiographic ischemic findings (p less than 0.01) and chest pain (p less than 0.01) were induced significantly more frequently in group A than in both groups B and group C. No significant difference was found between group B and group C. The coronary arteries in the patients with variant angina seem to be more susceptible to acetylcholine than those of patients without variant angina irrespective of the presence of significant atherosclerosis.
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PMID:Supersensitivity of coronary arteries in variant angina to spasm induced by intracoronary acetylcholine. 333 20

Acute myocardial infarction was precipitated by hyperventilation in a 65 year old man. His coronary arteriogram in the chronic phase showed almost normal coronary arteries. Injection of acetylcholine (50 micrograms) into the left coronary artery induced spasm of the circumflex artery with chest pain in association with ST-segment elevation in the inferior leads and ST-segment depression in the precordial leads. In this patient there may have been atherosclerosis of the coronary arteries with absent or dysfunctional endothelium, despite an almost normal angiographic appearance. In the absence of endothelium the response of the smooth muscle to acetylcholine is constriction.
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PMID:Possible role of coronary spasm in acute myocardial infarction precipitated by hyperventilation. 334 64

Serum high density lipoprotein (HDL) levels are inversely related to the risk of coronary heart disease. Controversy exists regarding the relative importance of HDL subfractions, and few studies have related subfraction levels to lifestyle factors associated with coronary risk. We examined the relationship of the major subfractions, HDL2 and HDL3, to alcohol consumption, cigarette smoking, physical exercise, body mass index, and socioeconomic status in 88 men and 49 women aged 35-64 years. Body mass index was inversely related to HDL2-cholesterol (C), particularly in men, but had no significant relationship with HDL3-C. Cigarette smoking and degree of physical exercise were not significantly related to either HDL subfraction. Alcohol consumption had a strong positive correlation with HDL3-C in both sexes; this association was statistically significant after controlling for cigarette smoking, body mass index, and serum triglyceride. Minnesota-coded ECG abnormalities and positive responses to the WHO chest pain questionnaire were associated with lower levels of HDL-C and HDL2-C in both sexes, and significantly lowered levels of HDL3-C in men but not women. These findings suggest that HDL3-C, as well as HDL2-C, may be related to coronary risk, and indicate that the protective effects of alcohol consumption may be mediated via this subfraction.
Atherosclerosis 1988 Feb
PMID:The relationship of high density lipoprotein subfractions to alcohol consumption, other lifestyle factors, and coronary heart disease. 334 37

Indexes of left ventricular diastolic filling were measured by pulsed Doppler echocardiography in 21 insulin-dependent diabetic patients and 21 control subjects without clinical evidence of heart disease. No patient had chest pain or electrocardiographic changes during exercise testing. The mean age of patients was 32 years. All patients had a normal ejection fraction. Six (29%) of the 21 diabetic patients had evidence of diastolic dysfunction as assessed by the presence of at least two abnormal variables of mitral inflow velocity. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (1.24 +/- 0.21 versus 1.66 +/- 0.30, p. less than 0.001). Atrial filling velocity was significantly increased in diabetic patients (74.3 +/- 16.7 versus 60.3 +/- 12.2 cm/s, p less than 0.004), whereas early filling velocity was reduced by a nearly significant degree (88.8 +/- 12.6 versus 98.5 +/- 18.8 cm/s, p less than 0.057). The atrial contribution to stroke volume as assessed by area under the late diastolic filling envelope compared to total diastolic area was also significantly increased in diabetic compared with control subjects (35 versus 27%, p less than 0.001). Left ventricular diastolic filling abnormalities in diabetic patients did not correlate with duration of diabetes, retinopathy, nephropathy or peripheral neuropathy. These data suggest that approximately one-third of such patients have subclinical myocardial dysfunction unrelated to accelerated atherosclerosis. Doppler echocardiography may offer a reliable noninvasive means to assess diastolic function and to follow up diabetic patients serially for any deterioration in cardiac status before the appearance of clinical symptoms.
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PMID:Diastolic abnormalities in young asymptomatic diabetic patients assessed by pulsed Doppler echocardiography. 337 97

The term "penetrating aortic ulcer" refers to an ulceration of an atheromatous plaque that extends deeply through the intima and into the aortic media. It may precipitate an intramedial dissection (usually localized) or may rupture into the adventitia to form a pseudoaneurysm. The typical patient with penetrating atheromatous aortic ulcer is elderly and has hypertension, atherosclerosis, and back or chest pain, but pulse deficit, stroke, aortic insufficiency, and compromise of a visceral vessel are not present. Classic aortic dissection and symptomatic thoracic aortic aneurysms are among possibilities in the differential diagnosis. Aortography demonstrates the presence of an aortic ulcer similar in appearance to gastric ulcers seen on barium examination; in addition, an intramural aortic hematoma may be present. Our experience with penetrating aortic ulcers in symptomatic patients indicates that conservative medical therapy leads to recurrence of symptoms and a need for surgical intervention. We present a case that illustrates the salient features of this distinct clinical entity.
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PMID:The penetrating aortic ulcer: pathologic manifestations, diagnosis, and management. 338 11


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