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

Ascending aortic arch aneurysms and aortic dissections are serious conditions with high mortality and morbidity. Aneurysms can be defined according to morphology or location and are usually precipitated by atherosclerosis or cystic medial necrosis. Intact aortic aneurysms are often asymptomatic, while chest pain is frequently the predominant symptom associated with aortic dissections. The diverse clinical presentation of aneurysms and dissections makes diagnosis difficult. When the aneurysm is large or the patient is symptomatic, surgical intervention is the preferred treatment and consists of replacing a segment of the aorta with a synthetic graft. Postoperative nursing care focuses on altered tissue perfusion, fluid volume deficit, potential respiratory insufficiency and patient teaching.
Prog Cardiovasc Nurs
PMID:Ascending aortic arch aneurysms and dissections: discussion and nursing management. 185 52

Aneurysms of the coronary arteries occur in from 0.3% to 4.9% of angiograms. Only 12 cases of left main artery (LMA) aneurysms have been reported. Of these, seven were associated with atherosclerosis in patients more than 56 years old. This report details the case of a 39-year-old patient with a large LMA aneurysm associated with atherosclerosis.
Cathet Cardiovasc Diagn 1991 May
PMID:Left main coronary artery aneurysm in association with severe atherosclerosis: a case report and review of the literature. 186 57

In 1981-1989 we performed repeat coronary artery bypass grafting on 42 men and 10 women (mean age 55 years) with angina pectoris recurring on average 27 months after the primary operation. The cause was occlusion or stenosis of vein grafts alone (59%) or in combination with progression of native coronary atherosclerosis (31%) or progression in the native circulation without graft failure (10%). Complications at the repeat operation included five lesions of the right ventricle and five lesions of patient grafts. The 30-day mortality was 3.8% (95% confidence limits 0.5-13.2%). Survival after observation averaging 2 1/2 years was 92.3% (95% confidence limits 81.5-97.9%). Angina pectoris was completely relieved after the operation in 48% of the patients, lessened in 35% and unchanged in 17%. Although repeat coronary artery bypass grafting carries heightened mortality and morbidity, and the results are less satisfactory than after first-time bypass, the operation can be worthwhile.
Scand J Thorac Cardiovasc Surg 1991
PMID:Repeat coronary artery bypass grafting. 194 7

Manual coronary endarterectomies heal in the long-term by a poorly understood process of myofibrointimal proliferation. A retrospective analysis of detailed cardiovascular pathologic examinations of 51 patients dying at varying intervals after endarterectomy provides insight into the sequence of this proliferative response. Twenty-one patients died within 7 days, 6 at 8 to 30 days, 3 at 31 days to 6 months, 4 at 6 months to 5 years, and 17 at more than 5 years after endarterectomy. The observations made suggest that the denuded arterial surface heals after the fibrin-platelet mural thrombus that covers it is organized and is replaced by fibrosis and myofibroblast proliferation. In unusual cases proliferation is exuberant, resulting in significant restenosis, an outcome in which recurrent atherosclerosis contributes to only a minor degree. This is the first series in which the sequential reparative changes at varying times after manual coronary endarterectomy have been studied.
J Thorac Cardiovasc Surg 1991 Dec
PMID:A study of the sequential morphologic changes after manual coronary endarterectomy. 196 Sep 93

The incidence of atherosclerosis in internal mammary, subclavian, carotid and coronary arteries was studied in an autopsy series of 153 patients, and the structure of the internal elastic lamina was compared in internal mammary and radial arteries. Atherosclerotic changes were exceptional in internal mammary artery, whereas only 12-30% of the other arteries were macroscopically normal. The internal elastic lamina of internal mammary artery was found to be significantly less fragmented than that of radial artery, which may partly explain both the lower incidence of atherosclerosis in internal mammary artery and failure of radial artery grafts. As six (3.9%) of the 153 patients had total or almost total subclavian artery occlusion, subclavian angiography is recommended for patients who are candidates for coronary bypass grafting with internal mammary artery.
Scand J Thorac Cardiovasc Surg 1990
PMID:Atherosclerosis in internal mammary and related arteries. 197 99

The subject of the cerebral circulation in the elderly is reviewed. In old age, cerebral blood flow (CBF), which is closely coupled to cerebral oxidative metabolism, decreases along with the amount of brain tissue. In healthy old people, the cerebral circulation is regulated as earlier in life, by autoregulation, metabolic regulation, and chemical and other factors. CBF and its regulation is influenced by disease processes prevailing in old age, such as dementia, atherosclerosis, diabetes mellitus, stroke, and hypertension. Hypertension, apart from being a risk factor for stroke, causes adaptive cerebral vascular changes, leading to a shift of the lower limit of autoregulation towards high pressure, with an impaired tolerance to pressure decrease. In old age, this adaptation may not be reversible. With this background, a conservative approach to elderly hypertensive patients is suggested, aimed at some reduction of pressure but carefully avoiding overtreatment.
Cardiovasc Drugs Ther 1991 Jan
PMID:Cerebral blood flow in the elderly: impact of hypertension and antihypertensive treatment. 200 45

From October 1984 up to February 1989, 40 patients had "redo" myocardial revascularizations using one or both internal mammary arteries (IMA) in over 1000 cases operated upon in our Department for coronary bypass grafts. Thirty-one patients had a further operation for unstable angina difficult to control with drugs. Mean interval of recurrence of angina after previous surgery was 48.5 months for all the cases, but the mean interval before the second bypass operation was 68 months. Severe disease of previous vein grafts was the reason for surgery in 25 patients and progressive atherosclerosis in native coronary arteries in 15 patients. Twenty-one patients had a single mammary artery; both mammary arteries were used in 19. Two cases had endarterectomy on left anterior descending (LAD). Four patients had peroperative acute myocardial infarction (AMI), 3 a low cardiac output syndrome, postoperative bleeding occurred in 3 cases and wound infection in one case. An intraaortic balloon pump was used preoperatively in one case and coming off bypass in two others. One patient died on the second day postoperatively from cardiac arrest following bilateral pneumothorax. There were no late deaths. At a mean follow-up of 20.5 months, 28 patients are free of symptoms but 11 are complaining of angina, 5 during exercise and 6 at rest. An exercise test was positive in 8 patients.
J Cardiovasc Surg (Torino)
PMID:Reoperation for myocardial revascularization using the internal mammary artery. 201 Apr 57

Atherosclerosis frequently develops in SVGs during the first 10 years. This process appears related to coronary risk factors. Several studies have found an association between hyperlipidemia and atherosclerosis documented at pathology. Late changes attributed to atherosclerosis that were observed at angiography were also significantly related to elevated serum levels of total cholesterol and triglycerides. They also were found in association with diabetes, systemic hypertension, and smoking in some studies. Several clinical studies have documented an association of one or several coronary risk factors with postoperative clinical events, including recurrence of angina, myocardial infarction, heart failure, reoperation because of clinical deterioration, and survival. These factors have been shown to act alone or in combination. The most important is an abnormal lipid profile and diabetes. Smoking and hypertension were seldom found to be significant predictors when considered separately, but appear to play an important role in association with the others. Control of coronary risk factors, particularly hyperlipidemia and smoking, seems mandatory in order to prevent SVG atherosclerosis and progression of the disease in the native coronary arteries.
Cardiovasc Clin 1991
PMID:Coronary risk factors and the postbypass patient. 204 86

Cardiovascular pathology in African and Afro-Caribbean blacks features three major conditions: hypertension, rheumatic heart disease, and the cardiomyopathies. Ischemic heart disease is as yet distinctly uncommon in these societies but the adoption of Western lifestyle and its inevitable risk factors for atherosclerosis makes it likely that coronary artery disease will emerge ultimately. Hypertension poses special problems in these regions--its prevalence rate is high both in rural and urban settings, its consequences devastating in its severity of target organ involvement, and its management strategy complicated by the high cost of drugs, poor patient compliance, and the lack of clinical resources for effective monitoring of detected and referred cases. Rheumatic heart disease remains an eminently preventable condition. The ultimate strategy lies in improving the quality of life in these communities through adequate housing, sanitation, and health education, and integrating primary prophylaxis into national health care programs to forestall the development of rheumatic fever. Cardiomyopathy poses the greatest challenge as its etiology remains elusive. Its dilated form has been linked with Toxoplasma and with Coxsackie B viruses, but hard evidence of a cause-effect relationship is still lacking.
Cardiovasc Clin 1991
PMID:Heart disease in blacks of Africa and the Caribbean. 204 16

Calcium-channel blockers (Ca blockers), such as nifedipine, verapamil, diltiazem, flunarizine, and their respective derivatives, have been reported to suppress the formation of arterial lesions in animals fed atherogenic diets. The fact that structurally unrelated Ca blockers exert similar antiatherogenic effects may suggest that the drugs act by a calcium-channel-dependent mechanism. However, in cell culture experiments in which putative antiatherosclerotic effects were observed only in the presence of a very high drug concentration (greater than 10 microM), calcium-channel-independent mechanisms are likely. It does not appear that Ca blockers act predominantly by altering coronary risk factors such as arterial pressure or hypercholesterolemia. On the other hand, current evidence is accumulating that Ca blockers may act by suppressing chemotaxis and the proliferation of cells involved in lesion formation. Recent reports indicate that relatively low concentrations (less than 1 microM) of nifedipine may promote the release of cholesterol from fat-laden smooth cells and macrophages. Controlled clinical trials are needed to determine whether Ca blockers have utility in the prevention of the progression of atherosclerosis in humans.
Cardiovasc Drugs Ther 1990 Aug
PMID:Antiatherogenic effects of calcium-channel blockers: possible mechanisms of action. 207 87


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