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

The physician who understands the pathophysiology of angina pectoris can apply rational therapeutic measures based on an appreciation of the determinants of myocardial oxygen supply and demand. Most patients with angina secondary to coronary atherosclerosis can be treated conservatively using a systematic approach that includes correction or removal of underlying causes or precipitating factors and the judicious use of sublingual nitroglycerin. In patients with more resistant angina, use of oral or topical nitroglycerin or sublingual isosorbide dinitrite as well as propranolol can be advised. Aortocoronary bypass surgery can offer significant improvement in carefully selected patients with frequent angina poorly controlled by medical therapy. The most important consideration in the treatment of angina is protection of coronary blood flow reserve by primary prevention of the atherosclerotic process itself. All individuals from families prone to coronary artery disease should be evaluated for alterable risk factors, the most important being cigarette smoking, hypertension, and hypercholesterolemia. Considering the high risk of unheralded sudden death in previously asymptomatic patients with coronary atherosclerosis, angina can, in a sense, be considered a fortunate harbinger of coronary stenosis, identifying candidates for secondary preventive measures aimed at retarding the progression of vascular disease. More importantly, angina serves as an index for detecting families at high risk of coronary artery disease, in whom early application of primary prevention may afford a more promising outlook.
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PMID:Angina pectoris. Diagnosis and treatment. 0 83

The media of arteries is virtually avascular. Thus, oxygen and nutrients must reach the cells of the media by diffusion from the lumen of the vessel and from adventitial vessels. The thickness of the thoracic aorta of man and dog exceeds the effective diffusion distance of oxygen, but nutrition is supplemented by vasa vasorum which enter into the outer layers of the media. Occlusion of vasa vasorum in dogs produces medial necrosis, which indicates that these vessels are essential for the nourishment of the aorta. Recently the microsphere method has been used to provide the first measurements of blood flow through vasa vasorum. There is substantial flow to the outer layers of media of the thoracic aorta in dogs, with virtually no blood flow in the inner layers. The vessels are very responsive to physiological stimuli: they dilate during infusion of adenosine and constrict during stimulation of sympathetic nerves. During acute increases in arterial pressure, blood flow to the media decreases probably from distortion of vasa vasorum. Vasa vasorum may play role in disease states. Insufficient blood flow through vasa vasorum may contribute to medial necrosis of the aorta and to aortic atherosclerosis. A role of vasa vasorum in aortic changes in hypertension and other vascular diseases merits further study.
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PMID:Role of vasa vasorum in nourishment of the aorta. 4 7

Male albino rabbits were exposed to intermittent nitrogen breathing every 30 sec for 5 sec, 15 min daily over a period of 3 weeks, and every 30 sec for 5 sec over a period of 10 hr. A third group of animals was exposed continuously to 8% oxygen breathing for 2 weeks. Neither intermittent not continuous hypoxia induced gross or microscopic alteration in the aorta. The effects of hypoxia upg which hypoxia was distributed than upon the total period or the degree of hypoxia. Exposure to hypoxia over a short period stimulated the synthesis of glycosaminoglycans, whereas distribution of the hypoxia over a longer period resulted in a reduction in the amount of glycosaminoglycans, probably secondary to an inhibition of the synthesis. Similarly, continuous exposure to 8% oxygen for a longer period decreased the aortic content of collagen. The alterations in the glycosaminoglycans and collagen induced by hypoxia may cause changes in the passage of macromolecules through the aortic wall. The changes may also influence the mechanical properties of the aorta and lead to impaired healing of vascular injury.
Atherosclerosis
PMID:Effects of intermittent and continuous hypoxia on the aortic wall in rabbits. 12 91

Uncontrolled hypertension increases the workload of the left ventricle causing the development of hypertrophy and an increase in myocardial oxygen consumption that may precipitate ischemia because of inadequate oxygen delivery related to accelerated coronary atherosclerosis. Control of the hypertension should prevent the further development of hypertrophy, delay the development of fibrosis and possibly also slow the rate of development of atherosclerosis. Furthermore, when myocardial function is impaired because of hypertrophy or other myocardial diseases, the level of blood pressure becomes an important determinant of left ventricular performance. Regardless of the level of arterial pressure, vasodilator drugs that lower arterial pressure may result in marked improvement in left ventricular performance and relief of symptoms of left ventricular failure. Therefore, control of blood pressure in the presence of heart disease may involve treatment of normotensive patients to bring them into a lower normotensive range as well as the more traditional treatment of hypertensives to bring them into the normotensive range. Although this scenario is consistent with conventional wisdom and clinical experience, intricacies of the relationship between hypertension, hypertrophy, myocardial oxygen delivery, atherosclerosis and intramyocardial blood flow distribution remain poorly understood. Until these aspects of the natural history of heart disease are better worked out therapy will remain largely empirical.
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PMID:Heart disease in the hypertensive patient. 14 Feb 80

The oxygen and glucose uptake, lactate formation, ATP/ADP and NADH/NAD ratios and incorporation of [14C]acetate and [14C]linolenic acid into lipids of early fatty streaks and more advanced complicated atherosclerotic lesions of human aorta were determined during aerobic and hypoxic incubation. Compared with grossly normal appearing sections of the aorta in intima and media preparations of early fatty streaks the oxygen uptake was increased while that in further developed atheroma was slightly diminished. Under aerobic incubation conditions the metabolic state of fatty streaks and atheroma was characterized by increased lactate formation, NADH/NAD ratio and incorporation of [14C]acetate and [14C]linolenic acid into the lipids, but by a lowered ATP/ADP ratio. More pronounced changes in these metabolic parameters were observed when the aortic tissue segments were incubated under hypoxic conditions. The analysis by argentation TLC of fatty acid methylesters derived from total lipids of aerobically incubated fatty streaks revealed an increased incorporation of [14C]acetate into the highly unsaturated long-chain fatty acids. In developed atherosclerotic lesions and in hypoxia the incorporation of radioacetate into the polyunsaturated fatty acids and the formation of 20:4 fatty acid from [14C]linolenic acid were, in contrast to the above finding, decreased while the synthesis of eicosatrienoic acid was increased. This finding suggests a block in the desaturation step of linoleic into 20:4 fatty acid in further developed atheroma and in hypoxia. In aerobically incubated atherosclerotic lesions and in hypoxia the palmitic acid was synthesized mainly by chain elongation while in grossly normal areas of the aorta at least part of this acid was synthesized de novo.
Atherosclerosis 1976 Sep
PMID:Comparative studies on fatty acid synthesis in atherosclerotic and hypoxic human aorta. 18 99

The activity of collagen prolyl hydroxylase in aortic wall was studied in rabbits exposed to chronic 10% ambient oxygen tension for 30 days. Prolyl hydroxylase in rabbit aorta was shown to be similar to the enzyme from other sources in that it required molecular oxygen, alpha-ketoglutarate, ferrous iron and ascorbate for its activity. The activity of prolyl hydroxylase was increased to 180% of controls in the intima-media samples from rabbits exposed to hypoxia. No atherosclerotic lesions could be seen in arteries of animals kept in chronic hypoxia. If the arteries of rabbits were injured with a single mechanical dilatation, the activity of prolyl hydroxylase increased more than 2-fold, as reported previously. The exposure of these animals to chronic hypoxia further elevated the prolyl hydroxylase activity.
Atherosclerosis 1979 Aug
PMID:Increased collagen prolyl hydroxylase activity in the aortic wall of rabbits exposed to chronic hypoxia. 22 78

Diabetes is associated with a fluctuating impairment in oxygen transport of the erythrocytes. This impairment is correlated with hyperglycemia by the formation of glycosylated hemoglobin (HbAIC) and with inhibitory factors of glycolysis i.e. hypophosphatemia and acidosis which lower the concentration of red cell 2,3-diphosphoglycerate. Diabetic angiopathy may be the ultimate result of innumerable microvascular responses to discrete hypoxic injuries associated with increased plasma permeation through the vessel walls. It is shown that two additional risk factors for atherosclerosis--smoking and hypertriglyceridemia may also lead to arterial wall hypoxia by changing the position of the oxyhemoglobin dissociation curve.
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PMID:Diabetic vascular disease. The importance of insulin deficiency, hyperglycemia and hypophosphatemia on red cell oxygen unloading. 27 65

The remote results of aorticocoronary shunting were studied in 105 patients (follow-up periods of 1 to 5 years and more). The values of bicycle ergometry and spiroergometry (rehabilitation coefficient, oxygen expenditure per 1 kgm of work, maximum oxygen consumption per 1 kg body mass during muscular exertion, effectiveness of work) were studied before and after operation. The data obtained were compared with the results of spiroergometry in 175 patients with various lesions of the coronary arteries identified by coronarography and in 50 healthy individuals. Spiroergometry is an effective method for diagnosing coronary atherosclerosis before performing coronarography. Patients with good postoperative results showed values which were close to normal; in poor results of surgery and in thrombosis of the coronary shunts initial values characteristic of atherosclertoic involvement of the coronary arteries are encountered. Increase of the effectiveness of work to normal, decrease in oxygen expediture per 1 kgm of work, diminution of maximum oxygen consumption per 1 kg body mass during muscular exertion in the remote postoperative period make it possible to presume, before performing coronarography, that the shunts are functioning. The study conducted allow bicycle ergometry and spiroergometry to be considered demonstrative functional methods for appraising the remote results of operation.
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PMID:[Spiroergometry in assessing the late results of the aortocoronary shunting operation]. 30 29

Cytochemical, biochemical and morphological changes in peroxisomes have been described in human metabolic disorders, in experimental models of disease and in response to drugs and toxins. These include the cerebrohepatorenal syndromes, in which peroxisomes can not be detected and mitochondrial respiration is inhibited, atherosclerosis, alcoholic cardiomyopathy, and tolerance to oxygen toxicity. Although information on the role of peroxisomes in disease is limited, increased awareness of their widespread distribution and the availability of an improved cytochemical procedure for staining peroxisomes in human specimens should provide new insights into their function.
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PMID:Peroxisomes in disease. 39 36

A vasomotor (nitritoid) reaction occurred following an initial injection of gold sodium thiomalate (GST; Myochrysine) in a 69-year-old man with rheumatoid arthritis (RA). An acute anterior wall myocardial infarction, documented by serial electrocardiographic and serum enzyme changes, developed immediately thereafter. A second patient, a 49-year-old man with RA and a history of GST-associated vasomotor reactions, was monitored clinically and electrocardiographically after GST administration. Sinus tachycardia developed and peripheral blood pressure fell within 2 minutes of injection, simultaneous with the onset of vasomotor symptoms. Vasomotor reactions from GST may compromise myocardial perfusion by their action on arteriolar smooth muscle, and thus result in peripheral vasodilatation, or they may act by adrenergic discharge initiated by such a reaction, and thus increase myocardial work and oxygen demand. Aurothioglucose (Solganal), rarely produces vasomotor reactions, and may be preferred to GST in elderly RA patients with concomitant cardiovascular disease or atherosclerosis.
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PMID:Acute myocardial infarction following gold sodium thiomalate induced vasomotor (nitritoid) reaction. 40 17


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