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)

A 39-year-old woman with long-standing anorexia nervosa was admitted to our hospital because of extreme weakness and cachexia. During a hyperalimentation therapy, she developed chest pain, revealing the electrocardiogram and cardiac enzymes a myocardial infarction of the inferior wall. We suggest that anorexia nervosa does not 'protect' against coronary atherosclerosis, and that some of the cases of sudden death could be related to myocardial ischemia.
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PMID:Anorexia nervosa and myocardial infarction. 796 Feb 53

The incidence of perioperative myocardial infarction with noncardiac surgery varies by the type of procedure and the prevalence of coronary atherosclerosis in the study population. Incidence is < or = 1% with minor procedures and may exceed 10% with vascular operations. The case fatality rate continues to be 30% to 50%. Pathogenesis is not understood completely. Diagnosis is sometimes problematic, because less than 50% of patients complain of chest pain. In addition, a high frequency of notable but apparently innocent postoperative electrocardiograph changes limits the diagnostic use of the electrocardiogram. Fortunately, the creatine kinase MB isoenzyme retains its sensitivity and specificity for acute infarction in perioperative patients. Different approaches to preoperative risk assessment have been developed, including a summative cardiac risk index and a stratification system based on the likelihood that the most powerful risk factor (coronary artery disease) is present. Although many interventions have been recommended to lower perceived risk, none has been tested in a randomized controlled trial, and their comparative efficacy and safety is unknown.
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PMID:Perioperative myocardial infarction with noncardiac surgery. 801 Mar 37

Intravascular ultrasound imaging (IVUS) was performed to elucidate the discrepancy between clinical history and angiographic findings and to measure the diameter and area of the lumen of the normal left coronary artery in 55 patients who presented with chest pain but had normal coronary angiograms. The left coronary artery (LCA) was scanned with a 4.8F, 20 MHz mechanically rotated ultrasound catheter at 413 sites. Atherosclerotic lesions were identified at 72 (17%) sites in 25 patients. The mean (SD) (range) plaque area was 5.55 (3.56) mm2 (2-26 mm2) and it occupied 28.8 (9.6)% (13-70%) of the coronary cross sectional area. Calcification was detected at 24 (33%) atherosclerotic sites in nine patients. The correlation coefficients for the lumen dimensions measured at normal sites by IVUS and by angiography were r = 0.93 (SEE = 0.43) mm for lumen diameter and r = 0.89 (SEE = 4.27) mm2 for lumen area (both p < 0.001). 16 of the 30 patients in whom no atherosclerotic plaques were detected in the LCA lumen by IVUS had no risk factors of coronary artery disease. The cross sectional area of 90 consecutive images of left main coronary artery (LMCA), proximal left anterior descending coronary artery (proximal LAD), and mid LAD was measured in these 16 subjects. The mean (SEM) areas at end diastole were LMCA 17.33 (7.98) mm2; proximal LAD 13.56 (5.85) mm2; mid LAD 9.75 (4.67) mm2. During the cardiac cycle the cross sectional area changed by 10.2 (4.0)% in the LMCA, by 8.3 (4.7)% in the proximal LAD, and by 9.8 (4.0)% in the mid LAD. In 11 patients with plagues the change in cross sectional area in plague segments (5.8(3.1)%) was significantly lower than in the segments from patients without plagues (p < 0.001). Lumen area reached a maximum in early diastole rather than in late diastole. IVUS can imagine atherosclerotic lesions that are angiographically silent; it also provides detailed information about plague characteristics. The variation in coronary cross sectional area during the cardiac cycle should not be ignored during quantitative analysis. Maximum dimensions in normal segments are reached in early diastole. Further studies are needed to clarify the clinical significance of atherosclerosis detected by IVUS in patients presenting with chest pain but normal coronary angiography.
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PMID:Intravascular ultrasound imaging of angiographically normal coronary arteries: a prospective study in vivo. 804 42

Bacterial endocarditis may present with acute chest pain due to coronary embolization and mimics acute myocardial infarction secondary to coronary atherosclerosis. We present the first case report of coronary embolization secondary to aortic valve endocarditis treated with standard doses of streptokinase and aspirin. The patient survived but sustained a large myocardial infarction and a major gastrointestinal bleed. Infective endocarditis should be considered in all patients presenting with acute chest pain. When myocardial infarction is due to coronary embolism from endocarditic valves standard thrombolysis regimes should be avoided.
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PMID:Acute coronary embolism complicating aortic valve endocarditis treated with streptokinase and aspirin. A case report. 808 59

Over a seven year period, 8.6% of 990 patients subjected to coronary arteriography because of angina pectoris were found to have normal coronary arteries (NCA). The subsequent histories of these patients were compared to those of a group of patients (N = 112) with coronary atherosclerosis (CAD). On average 44 months after coronary arteriography, 2.4% (NCA) had died versus 20.5% (CAD) (p < 0.001). Myocardial infarction had occurred in 0% (NCA) versus 12.8% (CAD) of the survivors (p < 0.001). Chest pain was unchanged or had worsened in 58.2% (NCA) versus 21.1% (CAD) (p < 0.001). Of the NCA patients, 33.3% had ischaemia during exercise-ECG. Three patients developed ischaemia during hyperventilation test. Eighty % (NCA) versus 63.9% (CAD) gave up work due to chest pain (p < 0.05). Further, 55.7% (NCA) versus 34.6% (CAD) had reduced daily activities (p < 0.01); similarly, the frequency of divorce was higher in the NCA group (10.2%) than in the CAD group (1.3%) (p < 0.05).
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PMID:[Syndrome X. Somatic and social prognosis of patients with angina pectoris and normal coronary arteriography]. 806 3

Between November 1992 and April 1993, 864 coronary angiographies were performed at our institution. In 14 patients (1.6%), no significant coronary disease (> 50% stenosis) was found despite documented myocardial infarction. Of these, 2 patients (0.2%), aged 46 and 33 years, had perfectly smooth coronary arteries at angiography. The most commonly postulated mechanism of myocardial infarction in such patients is coronary spasm with superimposed thrombosis. The same risk factors as those operative in atherosclerotic coronary artery disease are thought to play a role in this setting. The prognosis is good. In one of the patients with < 50% stenosis of coronary vessels, a history of cocaine abuse could be elicited as the possible causal factor of acute myocardial infarction. Cocaine-induced coronary spasm can lead to arrhythmias, myocardial infarction or accelerated coronary atherosclerosis even in patients with normal coronary arteries. Myocarditis must be considered in the differential diagnosis of acute myocardial infarction in young patients with chest pain, typical electrocardiographic and enzymatic changes but without risk factors.
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PMID:[Myocardial infarct in patients with normal coronary arteries]. 818 2

Familial hypercholesterolemia is a disorder of lipid metabolism associated with a highly increased risk for cardiovascular disease. Since in such patients even combined drug therapy often fails to decrease low-density lipoprotein (LDL) cholesterol levels sufficiently, extracorporeal LDL elimination has been developed. We treated eight adult patients with LDL immunoadsorption using antibodies against apolipoprotein B without additional lipid-lowering drug therapy for 3 years; this procedure was performed at weekly intervals. By one treatment session, LDL cholesterol and lipoprotein(a) levels were decreased by 55%. Under regular treatment, mean LDL cholesterol levels of 165 mg/dL between two consecutive treatment sessions could be reached, compared with 522 +/- 24 mg/dL before any treatment. As high-density lipoprotein (HDL) cholesterol levels increased under regular treatment, the LDL/HDL cholesterol ratio decreased from 13.4 to 3.4. Positive influences on plasma and whole-blood viscosity as well as on erythrocyte aggregation also seem to be beneficial with regard to retarding atherosclerosis. Very-low-density lipoprotein (VLDL) levels were reduced by approximately 50% after treatment, accompanied by a marked increase of lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) activity. The effects of LDL apheresis on hemostasis, complement activation transport proteins, and hematological parameters were found to be small. In addition, no side effects amounting to any major clinical relevance occurred in any of the patients. After 3 years of LDL apheresis, a decrease in the frequency of anginal chest pain and ST segment depression on exercise testing and a marked reduction of tendon xanthoma size were observed.
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PMID:Three-year treatment of familial heterozygous hypercholesterolemia by extracorporeal low-density lipoprotein immunoadsorption with polyclonal apolipoprotein B antibodies. 834 99

A follow-up over a 7-year period demonstrated that 8.6% of all patients subjected to coronary arteriography because of angina pectoris had normal coronary arteries (NCA). The somatic and social prognosis of these patients were evaluated and these were compared to that of an age- and sex-matched group of patients with arteriographically verified coronary atherosclerosis (CAD). On average 44 months after coronary arteriography, 2.4% with NCA had died versus 20.5% with CAD (P < 0.001). Myocardial infarction occurred in 0% (NCA) versus 12.8% (CAD) among survivors (P < 0.001). Coronary revascularization was carried out in 0% (NCA) versus 76.9% (CAD). Chest pain was unchanged or had worsened in 58.2% (NCA) versus 21.1% (CAD) (P < 0.001) and this in the NCA patients was correlated to the occurrence of minimal lesions of the coronary arteries. Of the NCA patients, 33.3% had ischaemia during exercise-ECG. Normalization was seen in 12 patients and newly developed ischaemia in seven patients. Three patients developed ischaemia during hyperventilation test. Eighty percent (NCA) versus 63.9% (CAD) gave up work due to chest pain (P < 0.001). Further, 55.7% (NCA) versus 34.6% (CAD) had reduced daily activities (P < 0.001); similarly, the frequency of divorce was higher in the NCA group (10.2%) than in the CAD group (1.3%) (P < 0.05).
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PMID:Somatic and social prognosis of patients with angina pectoris and normal coronary arteriography: a follow-up study. 840 7

The prevalence of risk factors for atherosclerosis in 488 consecutive patients undergoing cardiac catheterization for the investigation of chest pain was compared with that in 868 subjects from a population sample. The presence and severity of angiographic coronary artery disease (CAD) (defined as mean diameter stenosis > 50%), total and high-density lipoprotein (HDL) cholesterol, triglycerides, history of systemic hypertension, smoking, diabetes mellitus, family history and drug therapy were assessed. Low HDL cholesterol (< 0.9 mmol/liter [35 mg/dl]) was more prevalent in patients with CAD than in the population sample in both men (44% [95% confidence interval 38 to 48] vs 21% [12 to 28]; p < 0.01) and women (12% [9 to 15] vs 1% [0 to 3]; p < 0.01). There were no differences in total cholesterol levels between these 2 groups. Total:HDL cholesterol ratios were significantly greater in patients with CAD. History of systemic hypertension was more prevalent in both men and women with CAD than in the population sample (47% [37 to 57] vs 20% [16 to 25] for men, and 31% [26 to 36] vs 21% [17 to 26] for women; p < 0.01). The prevalence of other risk factors was not significantly different between the 2 groups. In patients with CAD, the severity of disease was inversely correlated with levels of HDL cholesterol in both men and women (p < 0.01), and positively correlated with total cholesterol in men aged < 55 years (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Association of angiographically detected coronary artery disease with low levels of high-density lipoprotein cholesterol and systemic hypertension. 843 34

Vitamin B6 is effective in the treatment of carpal tunnel syndrome and related disorders in patients with vitamin B6 deficiency. Hyperhomocysteinemia, a risk factor for atherosclerosis, is associated with deficiencies of vitamin B6, folate, and cobalamin. Patients who were given vitamin B6 for carpal tunnel syndrome and other degenerative diseases were found to have 27% of the risk of developing acute cardiac chest pain or myocardial infarction, compared with patients who had not taken vitamin B6. Among elderly patients of the author (JE) expiring at home, the average age at death from myocardial infarction was 8 years later in those who had taken vitamin B6, compared with those who had not taken vitamin B6. The preventive effect of vitamin B6 on progression of coronary heart disease may be related to increased formation of pyridoxal phosphate, the coenzyme that is required for catabolism of the atherogenic amino acid, homocysteine.
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PMID:Prevention of myocardial infarction by vitamin B6. 855 75


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