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)

Aim of this study was to analyze the cardiovascular response to graded physical exercise in patients who have undergone cardiac transplantation and to assess the ability of exercise stress testing in early detection of coronary artery disease. We studied 114 transplanted subjects (100 men and 14 women, mean age 46.6 +/- 11.3 years), who performed exercise stress testing 6 months after bypass and then every 6 (+/- 1) months during a 5-year follow-up. Variations of hearth rate (HR), systolic blood pressure (SBP), heart rate-pressure product (RPP) values and exercise stress tolerance were studied both in basal and maximum workload conditions. Mean HR values at basal conditions (103.9 +/- 11.3 b/min at 6 months and 89 +/- 12.7 b/min at 60 months, p < 0.05) and maximum workload tolerance (67.7 +/- 20.4 W at 6 months and 100 +/- 17 W at 60 months, p < 0.05) were significantly different at the beginning and at the end of follow-up. SBP values both at basal conditions and at peak exercise had always been constant. Exercise was stopped for leg muscle fatigue in 92% and dyspnea in 7% of the subjects; isolated T-wave and ST segment changes were found in 29.8% and in 10.5% of the patients respectively, whereas 11.4% exhibited both ST-T variations. Angiographic examination (performed in 80/114 patients) showed significant coronary disease (stenosis > 50%) in 8, coronary atherosclerosis (CAD) of minor degree in 4 and provoked spasm in 2 subjects. In this subgroup exercise stress testing induced ischemic ECG changes (ST segment depression > or = 1 mm) without angina in 1 patient, ST-T segment variations only in 5 and no electrocardiographic alterations (negative tests) in 2 patients. Four subjects with CAD and 1 with coronary spasm induced by angiography showed isolated ST segment and T-wave changes. Our work demonstrated that exercise stress testing plays a relevant role in the study of the denervated heart response to dynamic exercise. The rise in workload tolerated, observed in our population, seems to be related to time elapsed from surgery, improvement in clinical conditions, psychological stability and patient's confidence in his own abilities. The tolerance to exercise 6 months after graft seems to predict the quality of performance in the following tests. Our angiographic results reveal a low sensitivity of the exercise stress test in detecting CAD in this population according to traditional electrocardiographic criteria for myocardial ischemia.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:[The ergometric test after a heart transplant: its usefulness and limits]. 808 12

Emotional distress and interpersonal stress are extremely common in patients after myocardial infarction and typically lessen over several months. However, it is important for physicians to screen patients with CAD for certain conditions that may need further assessment and possible treatment by a mental health professional. The examination of the patient with CAD involves assessment of psychological functioning, including the patient's level of denial, anxiety, and depression; the presence of panic anxiety or depressive disorder; and neuropsychological functioning, including memory and concentration. Evaluation for the presence of persistent or excessive interpersonal strife, marital conflict, and sexual dysfunction is also important. Those with symptomatic anxiety, depression, or social or sexual dysfunction should be referred to a mental health professional who has expertise in working with CAD patients and is knowledgeable about a variety of psychosocial and psychopharmacological treatments. Patients with CAD who are unable to modify their cardiovascular risk factors satisfactorily after guidelines are clearly articulated should be referred to a center designed to help patients identify the obstacles to behavior change and to facilitate and maintain long-term adherence to these changes. Patients with CAD who are physiologically able to work but have marked work stress or a marked reluctance to return to work should be evaluated by a mental health professional.
 ...
PMID:Prevention of disability due to cardiovascular diseases. 815 78

The lipoprotein (Lp) pattern was analysed in patients with suspected unstable coronary artery disease (UCAD), to compare the pattern as a prognostic instrument regarding subsequent coronary events with smoking, hypertension, diabetes mellitus and with the result of an early exercise test. Included were 295 patients with UCAD. Blood samples for Lp values were obtained in the acute phase and after one year. Apolipoprotein-A1, Apolipoprotein-B (Apo-B), Lipoprotein(a) (Lp[a]) HDL-Cholesterol, Cholesterol (Chol) and Triglycerides (TG). were estimated in serum. During the 1-year follow-up coronary events (myocardial infarction, cardiac death, coronary artery by-pass surgery) occurred in 48 patients. The severity of CAD, overweight, smoking and beta-blockade influenced the Lp-pattern. Chol-, TG- and Apo-B-levels were highest in the group with a coronary event. Apo-B turned out to be the second best predictive variable in multiple regression analysis, in men. In women no such analysis was done because of very few coronary events during follow-up. Nevertheless, the exercise test variables, ST depression and pain were more predictive of coronary events than Apo-B in men.
 ...
PMID:Prognostic importance of plasma lipoprotein-analyses in patients with unstable coronary artery disease. 831 57

The documentation of abnormalities related to myocardial ischemia, whether symptomatic or silent, is of central importance. Whenever this information is available, it should be used in the overall assessment of the patient at risk for adverse outcome. The level of concern for treatment of CAD should be based on the risk implications associated with the ischemia-related abnormalities detected during objective testing rather than on the presence or absence of pain. The exercise stress test is still the single most useful test to begin the evaluation of a patient with an analyzable ST segment. In persons suspected of having CAD, the detection of ischemic-type ST-segment depression, at a low workload (e.g., < 120 beats/min or < 6.5 METS) of > 2 mm magnitude or persisting for more than 6 min implies high risk for adverse outcome. Asymptomatic ischemia during everyday activities, detected by Holter monitoring, in the high-risk patient, most probably adds additional risk beyond the risk of an abnormal stress test alone. Left ventricular imaging by two-dimensional echocardiography, RNA, angiogram, vest, etc, showing an ejection fraction > or = 40%, reversible wall motion abnormalities in multiple regions and redistribution defects or a failure to increase ejection fraction during exercise even if the patient remains asymptomatic, also imply high risk. The presence of any of these abnormal findings, regardless of symptoms, should therefore prompt as high a degree of concern as with ischemia-related signals associated with pain. Thus any therapy chosen should be directed toward elimination of transient ischemia, not just relief of symptoms that may or may not be ischemia related. If this course is chosen, the efficacy of the therapeutic regimen and possible progression of CAD should be assessed with follow-up testing for ischemia. We believe that risk factor modification and aspirin should be considered for most, if not all, patients in whom ischemia, silent or symptomatic, is suspected or detected. If symptoms or ischemia suggesting low risk is present, anti-ischemic medical therapy may be considered, but follow-up is advised. If a high-risk ischemic signal, even without symptoms, is detected, medical therapy should be used to attempt to modify the signal. If the ischemic signal suggesting high risk persists despite medical therapy, revascularization should be considered. Until additional data from large clinical trials are available, this approach appears to have the greatest likelihood of modifying the adverse outcome of CAD.
 ...
PMID:Silent myocardial ischemia. 834 34

The purpose of this study was to examine the ability of SPECT imaging with thallium-201 during adenosine-induced coronary hyperemia to detect high-risk patients with left main or three-vessel CAD. There were 339 patients: 102 with either left main or three-vessel CAD (group 1) and 237 with no CAD, one-, or two-vessel disease (group 2). By means of univariate analysis, several variables were found to differ between groups 1 and 2: Q wave myocardial infarction (35% vs 25%, p < 0.05), ST segment depression (35% vs 19%, p < 0.001), age (67 +/- 9 vs 62 +/- 10 years, p < 0.001), resting systolic blood pressure (142 +/- 22 vs 135 +/- 20 mm Hg, p < 0.01), abnormal thallium images (95% vs 74%, p < 0.0001), multivessel thallium abnormality (76% vs 39%, p < 0.0001), extent of thallium abnormality (24 +/- 11% vs 19 +/- 13%, p < 0.0001), and increased lung thallium uptake (39% vs 15%, p < 0.01). According to stepwise discriminant analysis, only three variables were predictors of high risk: multivessel thallium abnormality (chi 2 = 27), increased lung thallium uptake (chi 2 = 10), and ST depression (chi 2 = 5). On the basis of these variables, patients were divided into three groups with different prevalence rates for left main and three-vessel CAD: 63% in 68 patients, 30% in 137 patients, and 13% in 137 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Identification of high-risk patients with left main and three-vessel coronary artery disease by adenosine-single photon emission computed tomographic thallium imaging. 846 39

A decrease in cardiac parasympathetic tone is a recognized finding in patients with ischemic heart disease, correlating closely with disease severity and overall survival. The aim of this study was to assess whether transdermal scopolamine (Tds), which increases parasympathetic tone in healthy volunteers, increases vagal tone in patients with severe CAD and whether it might have an antiischemic effect. Fifteen patients (10 men, aged 55 +/- 8 years) with three-vessel CAD, but with no prior MI and preserved ventricular function, underwent 24-hour Holter monitoring and exercise testing before and after wearing a scopolamine patch for 24 hours. Time-domain measures of heart rate variability (HRV) and the total number and duration of ischemic episodes were obtained from the Holter recordings for each patient. Tds significantly (P < 0.05) increased the values of all HRV measures. Tds also reduced the total number of ischemic episodes (from 273 to 159, P < 0.05) and their total duration (from 136 to 46 min per patient, P < 0.05). Tds also increased treadmill exercise duration from 293 +/- 101 to 345 +/- 95 seconds (P < 0.05) and the time to 1-mm ST depression from 177 +/- 105 to 244 +/- 128 seconds (P < 0.02), while maximum ST depression was reduced from 2.86 +/- 0.6 to 2.3 +/- 0.3 (P < 0.05). No significant side effects were observed. Tds modifies the autonomic balance in patients with severe CAD toward a condition associated with a better prognosis. It may also be useful as an adjunctive treatment for ischemic heart disease.
 ...
PMID:Effect of transdermal scopolamine on heart rate variability in patients with severe coronary heart disease. 894 58

In addition to traditional risk factors (cigarette smoking, high blood pressure, and elevated cholesterol) psychosocial factors (depression, social isolation, and low socioeconomic status) have an adverse impact on prognosis of patients with CAD. Several studies of psychosocial and behavioral treatments provide encouraging evidence for the clinical efficacy of psychosocial interventions in CAD patients. A new, multicenter clinical trial now underway (see sidebar) will evaluate the impact of psychosocial interventions (compared to usual care) on all-cause mortality and nonfatal MI in post-MI patients with depression or perceived low levels of social support or both.
 ...
PMID:Psychosocial factors and coronary disease. A national multicenter clinical trial (ENRICHD) with a North Carolina focus. 939 58

Although clinically manifest CAD is present in about one-fourth of individuals older than 65 years, a like proportion of additional persons have asymptomatic coronary artery stenoses, manifest only by inducible myocardial ischemia. A major challenge to contemporary cardiology is to detect the subset of such asymptomatic subjects at highest risk for future coronary events, especially myocardial infarction and sudden death. In the BLSA, we have employed various strategies toward this goal. In apparently healthy BLSA men and women, conversion from a normal to an ischemic ST segment response to treadmill exercise testing on serial biennial visits did not improve the prediction of subsequent coronary events. However, the combination of ischemic ST segment depression and a segmental thallium-201 perfusion defect induced by treadmill exercise identified a small subset of asymptomatic older subjects, 48% of whom developed a coronary event over a 4.6 year mean follow up period. The pathophysiology, risk factors, and treatment of silent myocardial ischemia are also briefly reviewed.
 ...
PMID:Myocardial Ischemia in the Asymptomatic Older Patient. 1141 46

Depression is an important predictor of morbidity and mortality in patients with coronary disease, particularly after myocardial infarction, independent of previous cardiac history or CAD severity. Depression also is associated with poor long-term psychosocial outcomes. The prevalence of major depression among post-MI patients is 15 to 20%, with an additional 27% reporting symptoms of minor depression. This article briefly reviews the literature on depression in patients with coronary disease, including previously published efforts to treat the disorder in this group. A case review then is provided, highlighting important aspects of treatment.
 ...
PMID:Depression in chronic medical illness: the case of coronary heart disease. 1159 Jun 18

Diagnostic exercise stress testing is commonly performed in patients with known or suspected cardiovascular disease. The significance of an ischemic response, manifested as significant ST-segment depression, angina pectoris, transient myocardial perfusion abnormalities, or combinations thereof, is well established. However, the diagnostic implications of exercise-induced nonsustained VT are uncertain, especially as an isolated finding. The patient had threatening ventricular arrhythmias at peak exercise without an ischemic response. Subsequent cardiac catheterization revealed significant CAD requiring percutaneous coronary intervention.
 ...
PMID:Exercise-induced nonsustained ventricular tachycardia: a significant marker of coronary artery disease? 1214 Nov 51


<< Previous 1 2 3 4 5 6 7 Next >>