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

The results of 963 consecutive coronary angioplasties, with 1.135 lesions attempted in 816 patients, were prospectively analyzed. Initial angiographic success (residual stenosis less than 50%) was achieved in 1.017 lesions (89.6%), and final success was obtained in 838/963 procedures (87%). Major complications included: emergency surgery in 4 cases (0.4%), acute myocardial infarction in 28 (2.9%), and death during hospitalization in nine (0.9%). Surgical stand-by was required only for cases with vital risk should the attempted vessel occlude. This criteria was present in 230 (23.8%) angioplasties. Coronary angioplasty was performed during the diagnostic procedure in 300 (31.1%) case, with final success in 264 (88%) of them. A exercise test was achieved before the procedure in 419 (50%) successful angioplasties and in 246 (58.7%) of them it was abnormal because of angina (with or without ST depression). After procedure, exercise could be performed in 780 cases (93%), and the result remained unchanged in only 44 (5.6%) (p less than 0.01). At discharge 780 (93%) patients with final success considered themselves clinically improved. In our experience, coronary angioplasty is a good myocardial revascularization technique, with high success, low rate of major complications, and that provides a good clinical outcome. Surgical stand-by may be unnecessary in prost of angioplasty procedures if patients selection is carefully done, also, this approach makes it possible to perform angioplasty at time of diagnostic catheterization.
 ...
PMID:[Coronary angioplasty: experience at the University Hospital of Madrid]. 209 13

Predischarge exercise testing after acute myocardial infarction (AMI) is an important noninvasive modality for risk stratification. To study the impact of position on cardiopulmonary exercise response, 30 patients performed symptom-limited upright treadmill and supine bicycle ergometry exercise an average of 8 days after an AMI. The exercise sequence was randomly assigned with a minimum 4-hour interval between tests. Exercise time and peak oxygen consumption were significantly greater in the upright position (7.0 +/- 2.0 vs 5.6 +/- 2.0 minutes; p less than 0.001 and 14.9 vs 12.0 ml/min/kg; p less than 0.001, respectively). Compared to the supine position, exercise in the upright position was associated with a significant increased incidence of ischemic exercise-induced ST-segment depression (33 vs 20%; p less than 0.03), and chest pain (20 vs 10%; p less than 0.04). Thus, position is an important determinant of myocardial ischemic response and exercise tolerance in patients who perform symptom-limited exercise tests early after AMI.
 ...
PMID:Effects of posture on metabolic and hemodynamic predischarge exercise response after acute myocardial infarction. 211 87

To determine the ability of initial ST segment elevation and depression to predict infarct size limitation by thrombolytic therapy, data were analyzed in 721 patients with acute myocardial infarction who were admitted to a randomized, placebo-controlled study of intravenous recombinant tissue-type plasminogen activator. Patients with QRS duration of 120 msec or more or with previous history of myocardial infarction were excluded, leaving 322 in the treatment and 333 in the placebo group. Cumulative 72-hour release of alpha-hydroxybutyrate dehydrogenase and global ejection fraction as well as left ventricular wall motion derived from angiography were used as independent measures of infarct size. Electrocardiograms obtained at admission, 6 hours after start of therapy, and before discharge were analyzed. All ST measurements were made by hand at the J point and 60 msec after the J point. Patients with high ST segment elevation at admission (i.e., sum of ST elevation at 60 msec after the J point was 20 mm or more) had significantly larger infarction and higher hospital mortality when compared with those with lower (less than 20 mm) ST elevation. Reciprocal ST segment depression also showed a linear relation with infarct size and mortality, independent from ST elevation, both in anterior and inferior myocardial infarction. The sum of deviations measured at the J point and 60 msec after the J point differed significantly, especially in anterior myocardial infarction at admission (mean, 16 +/- 9 versus 23 +/- 11 mm). The prognostic value of one measurement was not, however, superior over the other. Treatment with recombinant tissue-type plasminogen activator was most effective in those with large ST deviations at admission, but patients with anterior infarction and smaller ST shifts also appeared to benefit from therapy. Results in individual patients were variable, and the overall correlation of initial ST shifts with enzymatic infarct size was rather low. In conclusion, the present study shows that the magnitude of initial ST elevation and also of reciprocal ST depression in the admission electrocardiogram is valuable for the management and assessment of thrombolytic therapy in patients with acute myocardial infarction.
 ...
PMID:Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial infarction. European Cooperative Study Group for Recombinant Tissue-Type Plasminogen Activator. 211 63

The impact of associated precordial ST segment depression in inferior myocardial infarction on angiographic and clinical outcomes after thrombolytic therapy and selective coronary angioplasty was studied in 583 patients with acute myocardial infarction. Anterior infarction (Group I), inferior infarction with precordial ST segment depression (Group II) and inferior infarction without precordial ST segment depression (Group III) were present in 289, 135 and 159 patients, respectively. Precordial ST segment depression was more frequent in circumflex than right coronary infarct-related arteries (44 [71%] of 62 versus 91 [40%] of 230; p = 0.000). Although acute patency rates were not statistically different, there was a trend toward different patency rates at day 7 (Group I 88%, Group II 84%, Group III 80%; p = 0.089) partly because of insignificantly higher reocclusion rates in inferior infarction without precordial ST segment depression (Group I 11%, Group II 10%, Group III 18%, p = 0.104). Infarct zone regional wall motion (standard deviations/chord) in inferior infarction was lower with precordial ST segment depression, both acutely (Group I -2.8 +/- 0.9, Group II -2.5 +/- 1.2, Group III 2.0 +/- 1.1; p = 0.000) and at day 7 (Group I -2.2 +/- 1.1, Group II -2.3 +/- 1.1, Group III -1.9 +/- 1.3; p = 0.011). Precordial ST segment depression was associated with a lower ejection fraction in inferior infarction both acutely (Group I 47 +/- 11%, Group II 53 +/- 11%, Group III 58 +/- 9%; p = 0.000) and at day 7 (Group I 49 +/- 12%, Group II 53 +/- 10%, Group III 58 +/- 8%; p = 0.000). Complication rates tended to be higher in inferior infarction when precordial ST segment depression was present. Mortality rates for Groups I, II and III were 8%, 6% and 5%, respectively. These results suggest that precordial ST segment depression in inferior infarction predicts a worse ventriculographic and clinical outcome despite reperfusion therapy.
 ...
PMID:Precordial ST segment depression predicts a worse prognosis in inferior infarction despite reperfusion therapy. The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group. 212 3

The results of several major trials of i.v. thrombolysis in patients with acute myocardial infarction have demonstrated the efficacy of the treatment in reducing mortality. Streptokinase and rt-PA have been shown to be effective (APSAC = anisoylated plasminogen streptokinase activator complex; GISSI = Gruppo Italiano per lo Studio della Streptochinasi nell' Infarto miocardico, ASSET = Anglo Scandinavian study of early thrombolysis, rt-PA). This treatment is associated with the potential for cerebral and major bleeding, especially in elderly patients. The benefit of this treatment in patients with cardiogenic shock or hypotension (ISIS-2) is discussed. There is no convincing evidence that patients with ST-segment depression or those with an equivocal electrocardiogram had been benefited from i.v. thrombolysis. Further studies with i.v. thrombolysis and/or other strategies need to be explored. Overall the use of i.v. thrombolytic agents in combination with PTCA in patients with acute myocardial infarction have resulted in improvement in ventricular function and survival in patients eligible for this therapy. However, new techniques and therapeutic approaches to prevent reocclusion, to prevent reperfusion injury, to prevent restenosis after PTCA, to prevent atherosclerosis in the infarct and non-infarct related arteries, and to reduce the potential for ventricular arrhythmias and sudden death as well as the potential for mural thrombi and embolization after infarction are needed. The 1990's will see attempts to determine the optimum adjunctive therapy or "cocktail" of agents to be used with i.v. thrombolysis.
 ...
PMID:Thrombolysis in acute myocardial infarction: need for a change in strategy and future directions. 212 41

Hemodynamic and vectorcardiographic variables were monitored in 23 patients with acquired heart disease, before and during the first 18 postoperative hours of cardiac surgery. The hemodynamic pattern directly after surgery was characterized by left ventricular depression and increased heart rate. Thus, stroke volume index had decreased from the preoperative 29 +/- 1 to 24 +/- 1 mL/beat/m2, and heart rate had increased from 61 +/- 2 to 94 +/- 4 beats/min. During the following hours a gradual normalization of stroke volume occurred, leading to a cardiac index that was adequate after 8 to 10 hours, judging from the mixed venous oxygen saturation (68% +/- 1%). Fourteen patients had an uneventful postoperative course, with no signs of acute myocardial infarction, and did not require inotropic support. These patients had small but consistent vectorcardiographic changes; the QRS vector difference increased moderately, and the ST vector magnitude also increased. No correlation was found between hemodynamic and vectorcardiographic variables, nor between timing of hemodynamic recovery and vectorcardiographic changes. Patients with a perioperative myocardial infarction had a vectorcardiographic pattern that was compatible with acute myocardial infarction. These patients had markedly elevated ST vector magnitude and QRS vector difference values, which were discernible during the first postoperative hours. The present data suggest that the timing of metabolic and electrophysiological recovery of the heart differ, and a computerized vectorcardiographic system may be of value in the early detection of perioperative myocardial infarction.
 ...
PMID:Myocardial recovery after cardiac surgery: a study of hemodynamic performance and electrophysiology during the first 18 postoperative hours. 213 96

In clinical practice the use of terms transmural and non-transmural infarction, based on the evaluation of the electrocardiogram is abandoned, as the correlation of an abnormal Q wave and transmural infarction and its absence in non-transmural ischaemic lesions is inadequate. A cardiac infarction with a Q wave and a non-Q wave infarction have certain different clinical and prognostic characteristics. A non-Q infarction is characterized during hospitalization usually by more frequent episodes of angina pectoris and a lower mortality than infarction with a Q wave. The depression of the ST segment in a standard electrocardiogram in acute coronary attacks is not a more benign phenomenon than its elevation. From the aspect of long-term prognosis the sub-group of patients specially at risk are those with marked depressions of the ST segment. A non-Q infarction, even if of smaller extent, is an unstable form of ischaemic heart disease and therefore in these patients more intense and post-hospitalization monitoring for a so-called vulnerable heart muscle is justified. The basic classification of the ECG in acute coronaries into infarctions with and without a Q wave is inadequate, unless based on the corresponding pathological correlate as patients with non-Q infarctions are not a homogeneous group. The way to obtain optimal electrocardiographic informations and their classification in acute myocardial infarction is to evaluate electrocardiograms where not only changes in the initial portion of the QRS complex are evaluated but also changes in its medium and end portions, changes of ST segments and T waves as well as their combinations, distribution and duration.
 ...
PMID:[Electrocardiographic diagnosis and classification of acute coronary attacks]. 213 67

A patient with symptoms of acute myocardial infarction but ST-segment depression rather than elevation constitutes a clinical dilemma for which few guidelines exist. Herein we describe such a patient, in whom serial tomographic imaging with a new radiopharmaceutical agent, technetium-99m sestamibi, was useful in demonstrating a large area of myocardium at risk and subsequent substantial benefit from acute reperfusion therapy. Because this perfusion agent washes out slowly from the myocardium, imaging can be delayed for several hours; thus, acute reperfusion therapy can be performed without delay. Subsequent imaging, however, will reflect myocardial perfusion at the time of administration of the radionuclide. Additional studies with this agent may be valuable in identifying those patients with ST-segment depression who will benefit from acute reperfusion therapy.
 ...
PMID:Measurement of myocardium at risk and salvage in myocardial infarction with ST-segment depression. 214 84

The frequency of ventricular premature complexes and the degree of impairment of left ventricular ejection fraction are major predictors of cardiac mortality and sudden death in the year after acute myocardial infarction. Recent studies have implicated psychosocial factors, including depression, the interaction of social isolation and life stress, and type A-B behavior pattern, as predictors of cardiac events, controlling for known parameters of disease severity. However, results tend not to be consistent and are sometimes contradictory. The present investigation was designed to test the predictive association between biobehavioral factors and clinical cardiac events. This evaluation occurred in the context of a prospective clinical trial, the Cardiac Arrhythmia Pilot Study (CAPS). Five-hundred two patients were recruited with greater than or equal to 10 ventricular premature complexes/hour or greater than or equal to 5 episodes of nonsustained ventricular tachycardia, recorded 6 to 60 days after a myocardial infarction. Baseline behavioral studies, conducted in approximately 66% of patients, included psychosocial questionnaires of anxiety, depression, social desirability and support, and type A-B behavior pattern. In addition, blood pressure and pulse rate reactivity to a portable videogame was assessed. The primary outcome was scored on the basis of mortality or cardiac arrest. Results indicated that the type B behavior pattern, higher levels of depression and lower pulse rate reactivity to challenge were significant risk factors for death or cardiac arrest, after adjusting statistically for a set of known clinical predictors of disease severity. The implication of these results for future research relating behavioral factors to cardiac endpoints is discussed.
 ...
PMID:Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS). 219 97

The Framingham study demonstrated that 25% of all episodes of acute myocardial infarction (AMI) do not present clinical symptoms, and are later recognized in a routine ECG. Silent ischaemia is frequently found after acute myocardial infarction, and has been identified in 25-60% of the patients according to the results of different studies and the different criteria employed for diagnosis. Silent ischaemia after AMI, as well as angina, is related with the presence and extent of severe coronary lesions located in the infarct related coronary artery or in other vessel not responsible for the acute episode of necrosis. The prognostic significance of silent ischaemia after AMI has not been well established. In some studies the painless ST segment depression during an exercise test soon after AMI presented the same prognostic value that the ST segment depression accompanied by angina, but in others the symptomatic episodes were a better predictor of major events and long term survival after the infarct. Several studies employing ambulatory ECG monitoring (Holter) also seem to indicate that the painless and transient episodes of ST segment depression identify a group of patients with worse prognosis, but in these studies the patients were selected, introducing a clear bias in the results of these investigations. Finally, asymptomatic transient perfusion defects in thallium studies clearly identify a group of high risk patients with a higher incidence of complications and higher mortality rate than the patients with negative thallium studies. The efficacy of anti-ischaemic drugs or myocardium revascularization procedures, including surgery, has not been studied in patients with silent ischaemia after acute myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Silent ischemia after myocardial infarct]. 220 24


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>