Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical implications of isolated late recovery ST depression were tested in patients with scintigraphically defined ischemia (coronary artery disease [CAD], n = 18) compared with patients without ischemia (n = 25). Spontaneous (78.4 versus 12.0%, P < 0.008) and exercise-induced angina (44.4 versus 0%, P < 0.0001) were more frequently seen in patients with CAD. Histories of unstable angina (33.3%), prior myocardial infarction (27.8%), ST elevated angina (22.2%) and significant stenosis in the left anterior descending artery (17 of 18, 94.4%) were almost exclusively seen in the CAD group. There was no significant difference between the two groups in capacity for exercise, maximum deviation of ST level or TV2 amplitude. Balloon angioplasty abolished late recovery ST changes in 63.6% of CAD patients. These results suggest that isolated late recovery ST depression, when accompanied with typical chest pain, may be considered as an indicator of myocardial ischemia, but this phenomenon is difficult to distinguish electrocardiographically.
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PMID:Isolated post exercise delayed ST depression as a sign of severe ischemia: the influence of percutaneous transluminal coronary angioplasty. 128 36

Clinical presentation and course were studies in 45 consecutive patients (p)--39 males, 6 females with angiographically proven left main coronary artery stenosis (LMCA) > 50%. Mean age was 54.7 years. Three (6%) had no history of chest pain, 2 p (4%) had atypical chest pain, and the remaining (90%) had typical angina pectoris. 19 p (42%) had unstable angina, 20 p (44%) had suffered a myocardial infarction in the past. Outside an episode of chest pain most of the patients had an abnormal ECG with ST-T segment depression 2 mm or more in leads V3-6 and ST-T elevation in leads V1 and aVR. No significant differences were found when the abnormalities of the ST-T segment were compared to severity of LMCA obstruction. A symptom limited exercise test was performed in 17 (37%) p. It was abnormal in 13 p (29%). Thirty eight patients (85%) underwent bypass surgery and the mean number of bypass graft was 3.3. Seven patients were treated medically. In the surgical group four p (10.5%) died perioperatively. All of them had subtotal occlusion of LMCA, without significant lesions in the remaining coronary arteries, the ejection fraction (EF) was above 66%. Among thirty four living patients thirty have been asymptomatic. In the medically treated group 3 p (42%) died and only two of four survivors were asymptomatic at a mean follow-up 35.7 months. Left ventricle of all died patients were severely damaged (EF mean 28%), right coronary artery (RCA) was totally occluded and all had rythm disturbances. We conclude, that patients with significant LMCA stenosis had a good prognosis when treated surgically.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Constriction of the left main coronary artery. Early and long term treatment outcome]. 129 44

On exercise testing after an episode of unstable coronary artery disease (CAD; unstable angina or non-Q-wave myocardial infarction), a proportion of patients show ST-segment depression, indicating myocardial ischaemia, but do not report concomitant symptoms of angina. Treatment of such "silent" ischaemia aims mainly to reduce the risk of subsequent cardiac events. We have studied the effect of low-dose aspirin in patients with myocardial ischaemia defined at the predischarge test as silent (though patients might have had symptomatic ischaemia at other times) or symptomatic. 740 men with unstable CAD aged 70 years or less underwent symptom-limited exercise testing before hospital discharge; 144 showed ST depression without pain and 230 ST depression with simultaneous chest pain. Of the silent ischaemia group, 67 were randomly assigned placebo and 77 aspirin (75 mg daily); the corresponding numbers in the symptomatic group were 125 and 105. Angina symptoms were less common in the silent than in the symptomatic ischaemia group both before inclusion and during follow-up, and a greater proportion of the silent ischaemia group were included because of myocardial infarction. In both ischaemia groups aspirin treatment reduced the risk of subsequent myocardial infarction or death by 3 months' follow-up (silent 4% of aspirin-treated vs 21% of placebo-treated patients, p = 0.004; symptomatic 9% vs 18%, p = 0.05); at 12 months' follow-up a significant benefit of aspirin was still apparent in the silent ischaemia group (9% vs 28%, p = 0.005) but not in the symptomatic group (13% vs 22%, p = 0.109). Low-dose aspirin reduced the risk of subsequent myocardial infarction at least as well in silent as in symptomatic myocardial ischaemia. Since improvement of outlook is the main treatment objective in symptom-free patients, aspirin should be a mainstay of their treatment.
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PMID:Prevention of serious cardiac events by low-dose aspirin in patients with silent myocardial ischaemia. The Research Group on Instability in Coronary Artery Disease in Southeast Sweden. 135 74

Recent investigations of SMI occurring during daily life have advanced our understanding of the pathophysiology of myocardial ischemia. These contributions have directed our attention away from "chest pain" alone and physical exertion as the central provoking factor toward transient myocardial ischemia and its broader triggers and consequences. Transient myocardial ischemic episodes, the majority of which are silent, are found in a subset of patients with any clinical manifestations of CAD (eg, stable angina, unstable angina, myocardial infarction, and sudden death), as well as in those patients with CAD who are and have been totally asymptomatic. These episodes are an independent predictor of increased risk for future cardiac events. Most medical therapy and revascularization therapies have the potential to prevent or relieve these silent episodes; however, we do not yet know which method is superior in reducing SMI episodes or preventing future cardiac events. Furthermore, the benefit of reducing SMI versus the cost and potential morbidity of these chosen therapies is not known. At least three trials are now underway to examine some of these concerns (Table 2). Focus on pain relief alone does not appear to be an adequate approach to alter outcome in patients with CAD and may prove insufficient to control SMI. Until these issues are resolved, we believe a conservative approach to the management of patients with CAD is warranted. Documentation of ischemia (painful or painless) is essential. Three general principles should be kept in mind. First, the presence of detectable ischemia is of central importance. This information should be used in the overall risk assessment of the patient. Second, the level of concern or aggressiveness of treatment should be based on the risk associated with the ischemic abnormalities documented (Table 3). The exercise stress test is the most useful to begin this process. The detection of ischemic-type ST-segment depression, either silent or painful, at a low workload (eg, less than or equal to 120 beats per minute or less than or equal to 6.5 metabolic equivalents [METS]) implies high risk for adverse outcome. Likewise, these ST-segment changes occurring in leads that reflect multiple coronary artery distribution, of greater than 2 mm in magnitude and persisting for greater than 6 minutes, are all markers for high risk. Thallium redistribution defects occurring at low work loads, in multiple areas, associated with increased lung uptake and enlargement of the cardiac pool all imply high risk.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Treatment strategies for daily life silent myocardial ischemia: a correlation with potential pathogenic mechanisms. 135 7

In order to examine the possible role of coronary artery spasm in the pathogenesis of unstable angina, provocative testing for coronary spasm was performed in 43 patients with unstable angina who had 0- or 1-vessel disease. Coronary spasm was induced in 20 (65%) of 31 patients by hyperventilation testing (ST increases in 18, ST decreases in 2). Anginal attacks with either ST-segment elevation or ST-segment depression in patients without a significant organic stenosis were induced in 23 (55%) of 42 patients during treadmill exercise testing. Coronary artery spasm, showing severe (> or = 90%) vasoconstriction with angina and/or ischemic electrocardiographic ST-segment deviation, was also documented angiographically in 42 (98%) of 43 patients following intracoronary injection of acetylcholine. We conclude that dynamic coronary obstruction plays an important role in the genesis of attacks in patients with unstable angina who had 0- or 1-vessel organic coronary artery disease.
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PMID:Pathogenesis of unstable angina with 0- or 1-vessel disease. Important role of coronary artery spasm. 136 32

We studied 141 patients to evaluate the pathogenesis and clinical picture of high-risk unstable angina (UA), designated as impending myocardial infarction (IMI) in this study, or severe early post-infarction angina (PIA). IMI and PIA were diagnosed when chest pain appeared at rest and lasted 15 min or more despite extensive pharmacological therapy during hospital stay among consecutive 510 patients with UA. All patients underwent coronary angiography urgently within 72 h after chest pain, and were divided into 2 subgroups according to ST segment shifts during chest pain. In IMI, 42 patients with ST depression had higher incidences of prior myocardial infarction (MI), worsening UA, multivessel disease and complex lesions such as eccentric irregular lesion or ulceration. On the contrary, in 44 with ST elevation, new onset UA, single vessel disease and coronary thrombus (CT) were dominant. In PIA, 32 patients with ST elevation revealed higher incidences in Q wave MI, ST elevation at the MI onset, single vessel disease and CT, compared to 23 with ST depression who showed a high proportion of complex lesions. Thus, it was evident that there was a common link between the pathogenesis of IMI and PIA. The therapeutic options were also different in the groups according to ST segment shift. We conclude that ST segment shifts during chest pain may be useful for determining the pathogenesis and clinical features of high-risk UA.
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PMID:Pathogenesis, treatment and prognosis of impending myocardial infarction and early post-infarction angina--relation between ST-segment shift during myocardial ischemia and the pathogenesis. 145 39

A consecutive series of 30 patients 75 years of age and older who underwent isolated coronary artery bypass graftings during a 6 year period (from 1985 to 1990) was analyzed. This group was compared with a consecutive series of 512 patients under the age of 75 who underwent the same procedure during the same period. The elderly patients had a higher incidence of unstable angina pectoris, left main or triple vessel disease and depression of ejection fraction. There were no deaths in the hospital or within 30 days of operation (0%), but postoperative complication occurred in 26 cases (86.7%) in the elderly patients. Mean postoperative hospital stay was longer in the elderly patients than the younger ones (21.7 +/- 8.7 days, 18.9 +/- 5.9 days, respectively). The factors frequently noted in the elderly cases with major complications were emergency or urgent operation, history of congestive heart failure and diabetes. The factors associated with prolonged postoperative hospital stay in elderly cases were octogenarians, intraoperative blood transfusion, wound complications, perioperative myocardial infarction, pulmonary failure and low cardiac output state. It is concluded that CABG can be performed safely even in elderly patients by the proper postoperative management, in spite of having increased postoperative complications and resulting in a prolonged postoperative hospital stay.
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PMID:[Morbidity and mortality of coronary artery bypass surgery in patients 75 years of age or older]. 148 30

In patients with angina pectoris, ambulatory ST segment monitoring has documented that asymptomatic myocardial ischemic episodes occur with greater frequency than previously suspected. During such episodes, ischemia has been verified by nuclear, echocardiographic, and biochemical techniques. Painless ST segment depression is consistent with severe coronary artery disease when detected by ambulatory monitoring in patients with angina and portends a worsened prognosis in patients about to have vascular surgical procedures. On the other hand, ST depression without angina has a better prognosis than ST depression with angina during treadmill exercise testing. Silent ischemia of prolonged duration per 24-hour period suggests a poor prognosis in patients with a history of unstable angina or myocardial infarction.
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PMID:Ambulatory monitoring of silent myocardial ischemia: what is its utility? 154 54

Two-dimensional echocardiography can detect regional wall motion abnormalities resulting from myocardial ischemia produced by dobutamine infusion. In 60 patients undergoing elective aortic surgery (27 with aneurysms, 33 with occlusive disease), we evaluated the ability of dobutamine stress echocardiography to predict perioperative cardiac events. Echo images were obtained at rest and during incremental dobutamine infusion to a peak dose of 50 micrograms/kg/min, unless another test end point was reached (angina, heart rate greater than or equal to 85% of age-predicted maximum, significant ST segment depression, or new stress-induced wall motion abnormalities). Dobutamine stress echocardiography results were stratified as follows: group I, no wall motion abnormalities; group II, resting wall motion abnormalities unchanged with stress; group III, stress-induced worsening of resting wall motion abnormalities; group IV, new-onset wall motion abnormalities with stress. Twelve cardiac events occurred within the first 30 postoperative days: three cardiac deaths (5%), six nonfatal myocardial infarctions (10%), two patients with unstable angina (3.3%), and one patient with asymptomatic elevation of creatine phosphokinase MB isoenzymes without electrocardiographic changes (1.7%). Eleven events occurred in the 38 patients with an abnormal dobutamine stress echocardiograph (groups II to IV); in contrast, only one of 22 patients with a normal dobutamine stress echocardiograph (group I) had a cardiac event. These event rates (29% vs 4.6%) differed significantly (p less than 0.025). Dobutamine stress echocardiography is a new, safe, rapid, relatively low cost, noninvasive, nonexercise cardiac stress test for risk stratification before major vascular surgery.
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PMID:Dobutamine stress echocardiography as a predictor of cardiac events associated with aortic surgery. 157 39

Silent myocardial ischaemia (significant ST depression without chest pain) is a common occurrence in most forms of coronary heart disease and can be associated with permanent changes in myocardial structure. The haemodynamic and ECG manifestations of silent episodes are similar to those observed in painful ischaemia. Exercise testing is the most appropriate method for assessing the severity of coronary artery disease; increased sensitivity can be obtained by combining it with radionuclide scintigraphy or ventriculography. Ambulatory ECG monitoring may fail to detect ischaemic changes revealed by exercise provocation. The treatment approach should depend on the degree of ischaemia. Numerous clinical investigations in stable and unstable angina and in patients with a previous myocardial infarction indicate that the prognosis of patients with myocardial ischaemia does not depend on whether the ischaemia is silent or symptomatic. Silent and symptomatic episodes alone represent the same degree of coronary disease. Moreover, it appears that ischaemic episodes are a more powerful adverse prognostic influence than left ventricular function or the extent of coronary artery disease. All anti-ischaemic agents, such as beta-blockers, calcium antagonists and nitrates, and interventions such as coronary balloon angioplasty or coronary bypass surgery, are very effective treatments for myocardial ischaemia. All efforts should be made to prevent ischaemic episodes, whether silent or symptomatic, since the severity of disease rather than the presence or absence of symptoms more accurately reflects the need for intervention.
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PMID:Silent ischaemia in the 1990s. 171 95


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