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)

Sudden coronary death is a syndrome caused by different mechanisms, all of which should be separately considered with respect to preventive measures. Ventricular fibrillation, tachycardia, and complete atrioventricular block were repeatedly observed during ischemic episodes caused by spasm in both the presence and absence of anginal pain. Spasm is, therefore, a potential cause of sudden coronary death. In "variant" angina, which is a reasonably reliable indicator of coronary spasm, arrhythmias occur in about 25% of patients and tend to recur in the same patient. The severity of coronary atherosclerosis in patients who develop severe arrhythmias is quite variable and not dissimilar from patient who do not. Mortality is considerably higher in patients with severe disease, but fibrillation and death can occur also in patients with angiographically normal arteries. In these patients acute and long-term treatment with nitrates and slow channel blockers appears to give remarkable results. Prevention of arrhythmias in patients in whom arrhythmias are secondary to acute ischemic episodes caused by vasospasm should be attempted by preventing vasospasm.
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PMID:Role of coronary arterial spasm in sudden coronary ischemic death. 704 39

Scanning electron microscopy was used to study the microrelief of the intima of coronary arteries in 11 cases of sudden death due to acute coronary insufficiency. In areas of macroscopically intact intima and in zones of minimal atherosclerotic lesions in patients dying of acute coronary insufficiency there were disorganization of intima microrelief with zones of flattening of folds of the first order, the appearance of microplaques with ulceration, dystrophic calcification which reflect early manifestations of coronary artery atherosclerosis. Another group of lesions (diendothelization of the intima with initial signs of parietal thrombus formation) characterizes the functional state of the vessel and serves an indirect criterion of acutely developing spasm of the coronary artery.
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PMID:[Microrelief of the coronary artery intima in sudden death]. 706 19

In the last decade, increasing information has become available to the effect that an increase in coronary artery tone and coronary artery spasm play an important role in patients with various ischemic heart disease syndromes. Coronary spasm may be superimposed on a coronary vessel already severely obstructed by atherosclerosis. Conversely, spasm may occur in an artery that is only minimally involved with atherosclerosis. The majority of patients studied in the United States with both stable and unstable angina pectoris have underlying severe organic obstructive coronary artery disease. There has now emerged a considerable amount of information from several centers showing that the calcium-channel blockers or calcium-flux antagonists are highly effective in the treatment of stable and unstable angina pectoris. This report focuses on the uses and limitations of one of these agents, nifedipine, in patients with unstable angina and provides a sequential approach to their management.
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PMID:Inpatient treatment of unstable angina: clinical perspective and sequential management. 711 12

In a 55-year-old man, attacks of spontaneous angina were associated with dizziness and syncope. Holter ECG monitoring disclosed evidence of sinus node dysfunction. Dizziness and syncope were corrected by a permanent ventricular demand pacemaker. Coronary cineangiography showed spontaneous, severe, diffuse spasm in a dominant left coronary artery and localized spasm in a nondominant right coronary artery. The patient died of pump failure shortly after cardiac catheterization. An autopsy disclosed only minimal coronary atherosclerosis. This patient's condition shows that (1) coronary spasm may cause sinus node dysfunction, dizziness, and syncope, (2) severe spasm that involves all the coronary artery branches may be fatal, and (3) severe spasm occur in minimally diseased coronary arteries confirmed by pathologic examination.
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PMID:Coronary artery spasm with sinus node dysfunction and syncope. 711 92

Recently it has been recognized that coronary vasospasm plays a significant role in precipitating myocardial ischemic pain in a significant minority of individuals with coronary atherosclerosis (approximately 27-35% of patients with angina pectoris at rest). In these individuals normal physiological vasoconstrictor stimuli appear to trigger a spasm of the large epicardial coronary vessels; evidence suggests that it may be caused by the release of increased amounts of calcium from augmented sarcolemmal storage sites. The calcium entry blockers are remarkably effective in preventing coronary spasm by reducing intracellular calcium, but by different mechanisms. Verapamil appears to reduce intracellular and, more specifically, sarcolemmal calcium stores directly. Diltiazem appears to reduce intracellular calcium by stimulating the sarcolemmal sodium-potassium pump and reducing intracellular sodium, and by this mechanism. potentiating passive sodium-calcium exchange. The effects of the calcium entry blockers on myocardial contractility, cardiac pacemaker and conduction tissue, and regional vascular smooth muscle are also different. This makes some of these agents more suitable than others for therapy of other clinical problems such as chronic stable angina pectoris, supraventricular tachycardia, hypertension, hypertropic cardiomyopathy, and protection of the ischemic myocardium during cardiac surgery.
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PMID:Clinical use of calcium entry blockers. 730 98

Dolichoectasia of intracranial arteries is an infrequent disease with an incidence less than 0.05% in general population. It represents 7% of all intracranial aneurysms. Commonly seen in middle age patients with severe atherosclerosis and hypertension, the affected arteries include the basilar artery, supraclinoid segment of the internal carotid artery, middle, anterior and posterior cerebral arteries; males are more frequently affected. The clinical features of these fusiform aneurysms are divided in three categories: ische-mic, cranial nerve compression and signs from mass effect. Hemorrhage may also occur. Nine patients with symptomatic cerebral blood vessel dolichoectasias are presented. Six of them were males with moderate or severe hypertension. Lesions were confined to the basilar artery in 3 cases, carotid arteries and the middle cerebral artery in 1 case, and both systems were affected in 4 patients. Middle cerebral arteries were affected in 5 cases and the anterior cerebral artery in one. An isolated fusiform aneurysm of the posterior cerebral artery is also presented (case 8) (Table 3). Motor or sensory deficits, ataxia, dementia, hemifacial spasm and parkinsonism were observed. One patient died from cerebro-meningeal hemorrhage (Table 2). All patients were studied with computerized axial tomography of the brain, 5 cases with four vessel cerebral angiography, 4 cases with magnetic resonance imaging (MRI) and case 5 with MRI angiography. Clinical symptoms depend on the affected vascular territory, size of the aneurysm and compression of adjacent structures. The histopathologic findings are atheromatous lesions, disruption of the internal elastic membrane and fibrosis of the muscular wall. The resultant is a diffuse deficiency of the muscular wall and the internal elastic membrane. Recent advances in neuroimaging such as better resolution of CT scan, magnetic resonance images (MRI) and MRI angiography increased the diagnosis of this pathology showing clearly the affected vessels. This avoids the use of conventional or digital subtraction angiography, reserved only for diagnosing suspected saccular aneurysm, evidence of subarachnoid hemorrhage or planning surgical treatment. The treatment of this entity may be medical or surgical. There is evidence suggesting a more favorable outcome with anticoagulation therapy, although antiaggregation is a reasonable alternative. In our experience no difference in clinical outcome was evident. Surgical treatment of this type of aneurysm includes intra- or extracranial occlusion of parent artery, clipping or aneurysm trapping, tourniquet occlusion, and circumferential wrapping with clip reinforcement. Endovascular occlusion has been accomplished with detachable balloon technique or coils. No surgical attempt was done in our cases. The prognosis is variable depending on the patients age, vessels involved and clinical complications.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Dolichoectatic intracranial arteries. Advances in images and therapeutics]. 756 39

There are many causes of left main coronary artery disease, the first of which is atherosclerosis. Other rarer causes may be observed, such as acute and chronic occlusions, spasm and primary and secondary dissection. The prevalence of stenosis of the left main coronary artery at coronary angiography is about 5%. The risk factors are the same as for coronary artery disease. The symptoms are angina, especially unstable angina. The diagnosis is suspected on the finding of an extremely positive exercise stress test, confirmed by coronary angiography. The results of the prospective large scale Veterans Administration trial showed surgery to be the treatment of choice with a 30 months survival of 80% in the surgical group compared with 64% in the medical group. The operative morbidity and mortality is less than 10% at present. Recent studies have reported a medium-term mortality of 4.3 to 10.25% with follow-up periods of 24 and 43 months respectively. The long-term survival and functional improvement are excellent, with values of nearly 80%. Chronic occlusion of the left main stem is rare, 0.01 to 0.7% in coronary angiographic studies. There is no difference in presentation, electrocardiographic or stress test features compared with other severe coronary artery disease. The diagnosis is angiographic and the treatment surgical because of the mediocre natural history with risks of sudden death and severe infarction. Acute occlusion of the left main coronary is rare for generally fatal. The mechanism is acute thrombosis and the clinical presentation is that of extensive infarction usually with cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Left main coronary artery disease]. 764 37

Coronary vasospasm is manifested by either focal or diffuse pattern in clinical settings. To examine the differences in vessel wall morphologic appearance between the sites of focal and diffuse vasospasm, we studied 29 patients with chest pain at rest, during exertion, or both by intravascular ultrasound. By angiography, focal vasospasm with diameter reduction of 90% +/- 3% (mean +/- SD) was provoked by intracoronary ergonovine (0.01 to 0.04 mg) in 15 patients. Diffuse vasospasm with diameter reduction of 79% +/- 5% (NS) was provoked in seven patients, and the remaining seven patients served as the control group. By ultrasonography, a significantly thickened intimal leading edge with sonolucent zone was observed in 55 sites from 22 coronary arteries with either focal or diffuse vasospasms (0.61 +/- 0.32 mm), although these sites were normal or minimally narrowed by angiography. Seven segments from the control group exhibited a thin intimal leading edge with sonolucent zone (0.23 +/- 0.08 mm, p < 0.01). When the thickness of the intimal leading edge with sonolucent zone was compared between the abnormal sites with focal and diffuse vasospasm, this was significantly greater at focal spasm, 1.01 +/- 0.35 mm (n = 15), than that at diffuse spasm, 0.46 +/- 0.13 mm (n = 40, p < 0.01). At the sites with diffuse spasm, some of the lesions lay scattered along the coronary vessels, although the lesions were localized at the sites of focal vasospasm. These results indicate that atherosclerosis is present at sites with both focal and diffuse vasospasm even in the absence of angiographically significant coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of vessel wall morphologic appearance at sites of focal and diffuse coronary vasospasm by intravascular ultrasound. 766 Oct 58

In 21 patients with T3, T4 pharyngo-laryngeal cancer circumferential resection with immediate reconstruction using a free revascularized jejunal autograft was performed. In 13 cases the jejunal reconstruction was successful. In patients previously not irradiated the rate of success was 75% and in irradiated ones 37.5%. Five patients survived more than 5 years: one more than 7, two more than 6 and one more than 5. One patient with an unsuccessful jejunal graft and with subsequent skin reconstruction survived more than 6 years. The causes of failure were:-irreversible spasm of the arteries in 2 cases, skinking of the vessels resulting in flap necrosis in flap necrosis in 2 cases, -necrosis due to widespread atherosclerosis of the cervical arteries in 3 cases and of an unknown cause in 1 case. The cause of death was: widespread metastases in 12 cases, C.V.A. in 1 case, road traffic accident in 1 case, complications of the ileus in 1 case and carotid artery haemorrhage in 1 case. One of the successful patients was irradiated postoperatively, because the pathology report stated there was incomplete resection, and survived more than 6 years with no disturbance of swallowing. In general 10 patients died in the first year, 4 in the second, 1 in the third and 1 in the fourth--without any signs of recurrence. The five year survival of 24% in the presented group is relatively high in comparison with the generally accessible data for T3, T4 hypopharyngeal carcinoma treated by any of the usual methods.
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PMID:[The latest results of the advanced hypopharyngeal cancer surgery with immediate reconstruction using the free jejunal autograft]. 797 Jul 59

Aim of this study was to analyze the cardiovascular response to graded physical exercise in patients who have undergone cardiac transplantation and to assess the ability of exercise stress testing in early detection of coronary artery disease. We studied 114 transplanted subjects (100 men and 14 women, mean age 46.6 +/- 11.3 years), who performed exercise stress testing 6 months after bypass and then every 6 (+/- 1) months during a 5-year follow-up. Variations of hearth rate (HR), systolic blood pressure (SBP), heart rate-pressure product (RPP) values and exercise stress tolerance were studied both in basal and maximum workload conditions. Mean HR values at basal conditions (103.9 +/- 11.3 b/min at 6 months and 89 +/- 12.7 b/min at 60 months, p < 0.05) and maximum workload tolerance (67.7 +/- 20.4 W at 6 months and 100 +/- 17 W at 60 months, p < 0.05) were significantly different at the beginning and at the end of follow-up. SBP values both at basal conditions and at peak exercise had always been constant. Exercise was stopped for leg muscle fatigue in 92% and dyspnea in 7% of the subjects; isolated T-wave and ST segment changes were found in 29.8% and in 10.5% of the patients respectively, whereas 11.4% exhibited both ST-T variations. Angiographic examination (performed in 80/114 patients) showed significant coronary disease (stenosis > 50%) in 8, coronary atherosclerosis (CAD) of minor degree in 4 and provoked spasm in 2 subjects. In this subgroup exercise stress testing induced ischemic ECG changes (ST segment depression > or = 1 mm) without angina in 1 patient, ST-T segment variations only in 5 and no electrocardiographic alterations (negative tests) in 2 patients. Four subjects with CAD and 1 with coronary spasm induced by angiography showed isolated ST segment and T-wave changes. Our work demonstrated that exercise stress testing plays a relevant role in the study of the denervated heart response to dynamic exercise. The rise in workload tolerated, observed in our population, seems to be related to time elapsed from surgery, improvement in clinical conditions, psychological stability and patient's confidence in his own abilities. The tolerance to exercise 6 months after graft seems to predict the quality of performance in the following tests. Our angiographic results reveal a low sensitivity of the exercise stress test in detecting CAD in this population according to traditional electrocardiographic criteria for myocardial ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The ergometric test after a heart transplant: its usefulness and limits]. 808 12


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