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

Six highly trained marathon runners developed myocardial infarction. One of the two cases of clinically diagnosed myocardial infarction was fatal, and there were four cases of angiographically-proven infarction. Two athletes had significant arterial disease of two major coronary arteries, a third had stenosis of the anterior descending and the fourth of the right coronary artery. All these athletes had warning symptoms. Three of them completed marathon races despite symptoms, one athlete running more than 20 miles after the onset of exertional discomfort to complete the 56 mile Comrades Marathon. In spite of developing chest pain, another athlete who died had continued training for three weeks, including a 40 mile run. Two other athletes also continued to train with chest pain. We conclude that the marathon runners studied were not immune to coronary heart disease, nor to coronary atherosclerosis and that high levels of physical fitness did not guarantee the absence of significant cardiovascular disease. In addition, the relationship of exercise and myocardial infarction was complex because two athletes developed myocardial infarction during marathon running in the absence of complete coronary artery occlusion. We stress that marathon runners, like other sportsmen, should be warned of the serious significance of the development of exertional symptoms. Our conclusions do not reflect on the possible value of exercise in the prevention of coronary heart disease. Rather we refute exaggerated claims that marathon running provides complete immunity from coronary heart disease.
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PMID:Coronary heart disease in marathon runners. 27 Sep 40

The relation of self-reported chest discomfort to the presence of atherosclerosis was examined, taking age and gender differences into account. Sixteen practicing cardiologists independently rated the items of a self-report questionnaire of angina pectoris (AP) symptoms according to their adjudged likelihood of being associated with coronary artery disease (CAD). Inpatients' (130 male and 82 female) responses to this questionnaire were obtained on the day prior to coronary angiography and scored according to their reporting of 12 symptoms endorsed by all 16 cardiologists, 25 symptoms endorsed by at least 90% of the cardiologists, and responses to items used in the Rose questionnaire, a brief survey tool for diagnosis of chest pain. Finally, patients' angiographic results were rated for presence of 75% or more CAD of one or more coronary arteries. Surprisingly, more symptoms were reported by patients without significant CAD, regardless of age or gender.
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PMID:Self-report of chest pain symptoms and coronary artery disease in patients undergoing angiography. 178 2

A 54-year-old man underwent aortic valve replacement for syphilitic aortic regurgitation. Eight years later, he was admitted with sudden precordial discomfort and symptoms of superior vena caval obstruction. Ascending aortic dissection was diagnosed by echocardiography and computed tomography of the thorax. The patient succumbed rapidly after admission. Postmortem findings and histological features were compatible with syphilitic aortitis, without significant atherosclerosis. This case report adds to the sparse literature on aortic dissection complicating syphilitic aortitis, and illustrates that, at certain stages of the disease process, syphilitic aortitis can lead to such a degree of mechanical instability of the aortic wall as to predispose to dissection.
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PMID:Ascending aortic dissection complicating syphilitic aortitis, late after aortic valve replacement. 232 23

PTA is an established method of revascularization in a variety of medical conditions. It is performed for specific morphologic and clinical indications. PTA is the procedure of choice in Fontaine stage IIB through IV lower extremity ischemia due to iliac and/or femoropopliteal stenosis or short occlusion. Its role is less certain in infrapopliteal disease, although current studies have begun to establish long-term effectiveness. PTA is the procedure of choice for renal revascularization in renovascular hypertension due to fibromuscular disease or non-ostial atherosclerosis, selected cases of renal artery stenosis associated with renal insufficiency, and transplant renal artery stenosis. It is also useful in treating the renovascular component of complex hypertension and may be indicated in severe renal artery stenosis (75%-99%), even in the absence of clinically demonstrable RVHTN. PTA has limited applications in the venous system and only short-term success in the treatment of stenoses in dialysis access fistulas. PTA often serves as an important adjunct to surgical revascularization by providing improved inflow or outflow. PTA is the procedure of choice when anatomically feasible in subclavian steal syndrome. The role of PTA in carotid artery disease, particularly atheromatous disease of the internal carotid artery, is uncertain. The same may be said of PTA for vertebral artery stenosis, although the overwhelming majority of vertebral artery stenoses are morphologically suitable for PTA. PTA and surgery are both effective in the treatment of abdominal angina. There are more data available to verify the long-term patency of thromboendarterectomy and bypass grafts than PTA for mesenteric ischemia. However, since the technical success for PTA is high and since coronary co-morbidity is the most common cause of perioperative mortality in surgical series, PTA should be seriously considered as the procedure of first choice. Serious complications of PTA occur in approximately 5% of cases. Two to three percent of PTA patients have complications requiring surgery or causing a prolongation or alteration of hospital course. The morbidity, mortality, and cost associated with PTA are low. The discomfort is minor, and postprocedural recovery rapid. The major limitations of PTA include its unsuitability for some lesions (long-segment occlusions and stenoses, orifice lesions, eccentric lesions) and postangioplasty restenosis. These problems are being addressed by ongoing laboratory and clinical research. In the near future, it is likely that endoluminal transmural sonography of the vessel wall will help guide our interventions.
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PMID:Noncoronary angioplasty. 252 45

An alternative method for left heart catheterization via the brachial artery, without cutdown, is described. Percutaneous brachial catheterization was done with a modified 7F side-arm sheath with check valve. A modified 7F high flow catheter was developed employing characteristics of both multipurpose and Sones catheters. The technique was used in 100 patients for left heart catheterization, in patients with and without aortic valve disease, for left ventricular angiography and selective coronary angiography. There were no failures or serious complications. All puncture sites were managed with 15-20 minutes of compression using only a blood pressure cuff or finger pressure. Bleeding was controlled with restoration of the radial pulse in all but one patient, who had severe peripheral brachial atherosclerosis. Cutdown and thrombectomy performed before he left the laboratory using standard catheterization techniques promptly restored blood flow. It is our impression that this technique facilitated outpatient catheterizations, repeat catheterizations at sites of previous cutdowns, and reduced patient discomfort.
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PMID:Percutaneous brachial catheterization using a modified sheath and new catheter system. 650 48

Early expectations of coronary revascularization prolonging life and reducing coronary events have been modified by 15 years' experience to mostly initial palliation of ischemic symptoms. Bypass surgery represents only a single therapeutic aspect for coronary atherosclerosis. Technically successful operations often fail miserably without overall risk factor alteration and functional capacity optimization which progressive exercise initiates during the postoperative period. Regular activity program participation improves physical conditioning, raises the symptom-limited exertional level, lessens post surgical musculoskeletal discomfort, and improves morale. Yet exercise alone without comprehensive secondary prevention and risk factor modification will be no more successful at arresting atherosclerosis than any other single measure. Both operative intervention and vigorous exertion are valuable components of coronary artery disease therapy, but must be part of an all-embracing effort. Whether regular exertion combined with overall risk factor modification will prolong life and reduce future cardiac events or beneficially alter the process of atherogenesis remain areas of avid investigation.
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PMID:Cardiac rehabilitation following coronary artery bypass surgery. 660 38

Anomalous origin of the right coronary artery may lead to myocardial ischemia despite the absence of atherosclerosis. We report the case of a 52-year-old man who was admitted to our hospital with exertional chest discomfort and palpitations. An anomalous origin of the right coronary artery was demonstrated by coronary angiography. There was no evidence of atherosclerosis in either the left or right coronary arteries. However, detailed information regarding the proximal portion of the anomalous artery was not acquired by coronary angiography. In this patient, ultrafast computed tomography (UFT) revealed an acute angle takeoff of the anomalous right coronary artery from the aorta. Furthermore, the proximal portion of the right coronary artery traversed the aorta and pulmonary trunk. This case illustrates that UFT is useful for detecting an anomalous origin of the coronary arteries and evaluating the mechanism of myocardial ischemia in patients with anomalous origin of the coronary arteries.
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PMID:Ultrafast computed tomography in the diagnosis and evaluation of anomalous origin of the right coronary artery. 862 86

A consecutive series of 28 patients operated on at the Oulu University Hospital during the years 1974-1994 for aneurysms of the descending thoracic aorta is presented. Twenty-five cases were elective and three were operated on as emergencies. Their mean age was 58 years. During the aortic cross-clamp, circulatory support of the lower body, was used in 27 cases as follows: a direct aorto-femoral shunt without a pump (12/28), left-heart bypass (11/28) or femoro-femoral perfusion (4/28). Hospital mortality was 14% (4/28). One patient with a ruptured aneurysm died of renal failure, but there were no other renal complications. None had paraplegia postoperatively. Three had symptoms of paraparesis, but only one of them had a slight permanent discomfort while walking. The mean follow-up time was 100 months, range 2-242 months. Late actuarial survival including hospital mortality, was 65% at 5 years and 41% at 10 years, reflecting the generalized aortic disease with a high risk of very late rupture (4) and other manifestations of atherosclerosis with myocardial infarction (6) or cerebral atherosclerosis (1), the remaining late deaths being unrelated. The efficacy of lower body circulatory support in avoiding peroperative renal and spinal cord ischaemic complications is demonstrated.
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PMID:Surgical and long-term outcome of graft replacement of aneurysms of the descending thoracic aorta. Analysis of 28 consecutive cases. 926 61

A 50-year-old woman was examined because of chest discomfort. Chest X-ray films disclosed a tumorous shadow behind the heart. Chest computed tomography (CT) scans revealed a mass connected to the descending aorta, with increased blood flow in the left basal segment. The patient was admitted for further examination. Chest CT scans and cardioscintigrams were very useful as diagnostic tools, but the final diagnosis was made on the basis of angiography. An anomalous tortuous artery ran from the descending aorta into the left basal segment and returned to the left inferior pulmonary vein. The left pulmonary arterial trunk had no basal branch (A8-A10). A loop corresponding to the superior vein (V6) ran beneath the anomalous tortuous artery. To our knowledge, this is the second case of Pryce type-I interlobar pulmonary sequestration with anomalous return to the left inferior pulmonary vein to be reported in Japan. A left inferior lobectomy was performed. Histological finding from the excised tissues showed prominent interstitial fibrosis, atypical adenomatous hyperplasia, and atherosclerosis. Following surgery, the patient's PaO2 increased from 80.4 Torr to 95.8 Torr, suggesting that left inferior lobectomy was an appropriate treatment.
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PMID:[Pryce type I interlobar pulmonary sequestration with anomalous return to the left inferior pulmonary vein]. 989 30

In every year since 1984, cardiovascular disease has claimed the lives of more females than males. More than 450,000 women succumb to heart disease annually, and 250,000 die of coronary artery disease. Despite the proportions, most women believe they will die of breast cancer. The perception that heart disease is a man's disease and that women are more likely to die of breast cancer is alarming. Although women develop heart disease about 10 years later than men, they are likely to fare worse after a heart attack. The poorer outcomes are due, in part, to the failure to identify heart attack symptoms. Approximately 35% of heart attacks in women are believed to go unnoticed or unreported. However, because of increased age, women are more likely to have co-morbid diseases such as diabetes and hypertension. In women, not only is "tightness" or discomfort in the chest a warning sign, but in addition, nausea and dizziness are common indicators of myocardial ischemia. Other symptoms include breathlessness, perspiration, a sensation of fluttering in the heart, and fullness in the chest. In comparison to men, women are less likely to undergo tertiary care interventions such as cardiac catheterization, angioplasty, thrombolytic therapy, and bypass surgery; to participate in cardiac rehabilitation; and to return to work full-time after myocardial infarction. In the past, most research about treatments for heart disease focused on men, and gender differences have been ignored. Recent studies are enrolling enough women to test if there are differences between men and women in outcomes. One of the major areas of research relates to estrogen and hormonal replacement therapy to reduce the relative risk of heart attack and stroke. The Women's Health Initiative is a major NIH-sponsored trial that addresses the issue of primary prevention of cardiac disease by hormonal replacement therapy. The results will be available in 2004. The Heart Estrogen/Progestin Replacement Study (HERS), disappointingly, did not show a significant reduction of coronary events in women taking hormonal replacement therapy, nor did the Estrogen Replacement and Atherosclerosis (ERA) trial of 309 postmenopausal women who underwent coronary angiography. New insight into the role of vitamins, phytoestrogens and other natural sources, and selective estrogen receptor modulators may provide other options for management. Until then, modification of risk factors and healthy life style choices are recommended for reducing the risk of cardiac disease. In fact, the key to a healthy heart in the year 2000 appears closely tied to life style choices. Prevention of disease is the key, and current recommendations are simply to stop smoking, or do not start; treat and control blood pressure >140/90 mm Hg; manage elevated lipids by diet, exercise, and cholesterol-lowering medications (if necessary); treat diabetes; lose weight so that BMI is <25; walk for 20-30 minutes at least three times a week; and take an aspirin tablet daily.
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PMID:Heart disease in women. 1114 May 44


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