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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The fear of cerebral complications after cardiopulmonary bypass in patients with heart disease and severe carotid artery disease has led many authors to suggest combined approaches in these patients. The pathogenetic mechanism for stroke is based partly on the stenotic narrowing of the carotid artery. A diameter reduction of 75% is frequently considered hemodynamically significant and indicative of an increased risk for neurological morbidity. We studied the cerebral blood flow in 7 patients undergoing coronary artery bypass grafting who also had severe bilateral carotid disease. The results were compared with the results in 17 patients without carotid disease who had bypass grafting. The cerebral blood flow was measured by xenon 133 washout technique before, during, and after cardiopulmonary bypass with moderate hypothermia. Acid-base regulation was according to the alpha-stat theory, and blood pressure was kept greater than 50 mm Hg. The cerebral blood flow levels (mL.100g-1.min-1) before, during, and after cardiopulmonary bypass in the study group (30 +/- 11, 31 +/- 8, 47 +/- 20) (mean +/- standard deviation) were almost identical to those in the control group (30 +/- 11, 28 +/- 8, 47 +/- 12). The cerebral blood flow levels for the left and right hemispheres in the group with carotid disease were comparable and within normal ranges. In 2 patients, slight differences were noted between hemispheres, and this finding may indicate an increased risk for ischemia. These patients, however, did not show any signs of postoperative deficit. The flow limitations of critical carotid stenoses do not seem to imply a risk for cerebral hypoperfusion if cardiopulmonary perfusion is performed in a controlled manner.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiopulmonary perfusion and cerebral blood flow in bilateral carotid artery disease. 201 11

Platelet scintigraphy (PSC) with indium-111 labelled platelets has been confirmed as an adequate method for the detection of intracardiac thrombi in patients with heart disease. We performed PSC of the heart and the neck vessels in 27 stroke patients with suspected cardiac embolism and as control on 10 patients with atherosclerotic lesions of the carotid arteries without evidence of heart disease. The carotid PSC was positive in 6 of 10 patients with carotid disease, and twice in the 27 with suspected cardiac embolism. In these 27 the PSC of the heart indicated pathological conditions 13 times. Pathological platelet accumulations could be visualized in 3 cases in the atrial space, in 9 cases in the region of the left ventricle, and once at the aortic valve. Scintigraphy was negative in all 10 patients with atherosclerosis of the neck vessels. The two-dimensional echocardiography revealed pathological findings in 8 of the 13 patients with positive heart PSC (3 with intraventricular thrombi, 3 with valvular disease, 2 with decreased ventricular contractility) and was normal in the 10 control patients. Open-heart surgery was performed in 2 patients with pathological PSC and revealed an intracardiac thrombus. Three of 4 patients with positive atrial PSC showed mitral or aortic valve disease. These results suggest that PSC can provide a valuable method for detecting cardiac thrombi in stroke patients.
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PMID:Identification of intracardiac thrombi in stroke patients with indium-111 platelet scintigraphy. 381 Jul 71

Two hundred fifty consecutive patients with carotid transient ischemic attacks (TIAs) and no previous stroke were assessed with cerebral angiography (95%), two-dimensional echocardiography (86%), electrocardiography (100%), and Holter monitoring (99 selected patients). Angiography disclosed a lesion appropriate to the TIAs in 84%. Lesions also occurred in the asymptomatic carotid artery, but stenosis of more than 75% of the lumen diameter and ulcers were significantly more frequent on the symptomatic side. Twenty-three percent of the patients had a potential source of emboli from the heart, usually in the context of symptomatic heart disease. Among the 205 patients who underwent full angiographic and cardiac investigations, 6% had an isolated potential cardiac source of emboli and 19% had a potential cardiac source of emboli associated with appropriate carotid disease. The search for a potential cardiac source of emboli is strongly indicated in patients with carotid TIAs and known heart disease. In the patients with no history of heart disease, the yield of this search is low, but our results suggest that at least 14 of such patients have an undetected potential cardiac source of emboli. Cardiac and arterial lesions commonly coexist in carotid TIAs.
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PMID:Cardiac and arterial lesions in carotid transient ischemic attacks. 394 70

Cardiac disorders are increasingly recognised as an important source of cerebral embolism. Atrial fibrillation is the most common cardiac dysrrhythmia that can predispose to stroke. Recent advances have significantly increased the identification of clinical, hematological and echocardiographic risk factors that predict the occurrence of atrial fibrillation related stroke. Also, clinical risk stratification has been used to determine medical therapy (aspirin or warfarin) for prevention of atrial fibrillation related brain embolization. Among the various structural heart diseases causing stroke, the role of patent foramen ovale remains controversial. Strides have been made in the use of ultrasonographic techniques such as transesophageal echocardiography and contrast transcranial doppler to detect patent foramen ovale. Coronary artery bypass grafting is often performed in patients with concomitant aortic atheroma and carotid stenosis that may predispose to stroke in the perioperative period. It is now possible to identify perioperatively significant aortic atherosclerosis (using transesophageal echocardiography and aortic ultrasound) and significant carotid disease (using carotid ultrasound) and make appropriate modifications in surgical technique to reduce the incidence of coronary artery bypass grafting related stroke. Because of shared risk factors it is not surprising that coronary artery disease is frequently found in stroke patients. Recent studies suggest that more than one-third of stroke patients have asymptomatic coronary artery disease. Conversely, the brain damaged by infarction may itself be responsible for the production of cardiac structural and electrical abnormalities. Both these factors may contribute to the finding that cardiac events are the leading cause of death in stroke patients on long term follow-up. Recognition of these correlations has enhanced our ability to treat and prevent stroke related mortality.
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PMID:Cardiac disorders and stroke. 948 17

Atherosclerosis of the extracranial carotid artery is a major public health burden. Stroke is the third leading cause of death in Western countries, after heart disease and cancer, and the leading cause of long-term disability. In the United States, there are more than 500,000 strokes annually, accounting for approximately 3 million stroke survivors with varying degrees of disability. Data from stroke registries suggest that internal carotid artery atheroembolic disease accounts for approximately 35% of all ischemic cerebral infarctions; therefore, approximately 150,000 strokes in the United States per year may be ascribed to carotid disease. Surgical endarterectomy has been shown to be superior to medical management in the management of severe carotid stenosis in both symptomatic and asymptomatic patients. Indeed, carotid endarterectomy has been one of the most heavily scrutinized operations over the past 40 years, and newer methods of revascularization are being actively explored. With the great technological advances in the endovascular treatment of both peripheral and coronary atherosclerotic disease, many of these techniques are now being applied to the extracranial circulation. We explore the rapidly expanding field of carotid artery angioplasty and stenting. The upcoming prospective randomized clinical trials of surgical endarterectomy versus carotid angioplasty and stenting also are reviewed.
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PMID:Intermediate outcome after carotid stenting: what should we expect? 1087 53

The purpose of the study was to assess the implementation of secondary prevention guidelines of coronary artery disease (CAD) in patients undergoing peripheral revascularization surgery. The design was a descriptive study of the prevalence of cardiac risk factors and preventive pharmacological therapy in vascular surgical patients set in an academic medical center between July 1996 and February 1999. A total of 237 patients were recruited, 82 (35%) having carotid surgery and 155 (65%) having lower extremity bypass. Data were collected from an existing database of a study examining perioperative cardiac events in vascular surgery patients. The majority of patients were hypertensive and 58% of patients had a blood pressure >140/90 mmHg. Most patients (81%) reported a history of tobacco use and 23% were active smokers. Of the 41% of patients who were diabetic, 46% had a random glucose >140 mg/dl. Half of the patients took aspirin, 35% a lipid-lowering medication, 30% a beta-blocker. Patients with lower extremity disease were less likely than patients with carotid disease to be on aspirin (45% vs. 62%), a lipid-lowering agent (30% vs. 45%), or a beta-blocker (26% vs. 39%) (all p<0.05). Of patients with heart disease, more men than women were on aspirin (62% vs. 45%) (p<0.05). In conclusion, our findings suggest that patients presenting for vascular surgery have a high prevalence of modifiable CAD risk factors that are not being adequately managed. Preoperative examination of vascular patients is an important opportunity to assess and implement neglected secondary prevention measures.
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PMID:Secondary prevention of coronary artery disease in patients undergoing elective surgery for peripheral arterial disease. 1135 59

QT dispersion (QTD) reflects heterogeneity of myocardial repolarization, which is modulated by the central nervous system. Previous studies have shown increased QTD to be a predictor of adverse outcomes in various cardiac states. The objective of this study was to determine the significance of QTD in patients hospitalized with cerebrovascular accidents (CVA) and transient ischemic accidents (TIA). We studied 140 consecutive patients (72 years old, 48% male) admitted to our institution with neurologic events from January 1998 to April 1998. QTD was calculated from admission electrocardiogram as the difference between maximum and minimum QT intervals in at least 11 of 12 leads. Three separate instruments (NIH Stroke Scale, Barthel Index and Modified Rankin Scale) were used to assess functional status on discharge. QTD was higher in patients with intercerebral hemorrhage as compared to CVA and TIA (70 15 msec versus 53 27 msec versus 48 31 msec, respectively; p = 0.03). Increasing QTD was associated with lower functional outcomes on all 3 scales (all p < 0.05) and with higher mortality (p = 0.02). QTD was higher in patients with congestive heart failure (80 43 msec versus 47 24 msec; p = 0.006) and with carotid disease (59 32 msec versus 46 27 msec; p = 0.045) as compared to those without. On multivariate analysis, other independent predictors of worse outcome were QTD (odds ratio, 1.35; 95% confidence interval, 1.08 1.68) and a trend toward age (odds ratio, 1.07; 95% confidence interval, 0.99 1.16). On age-adjusted logistic regression, mortality increased by odds ratio of 1.28 and 95% confidence interval of 1.02 1.61 for every 10 msec increase in QTD. QTD is an independent predictor of functional outcome and mortality following acute neurological events. In this setting, QTD reflects neurological injury as well as underlying heart disease.
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PMID:The prognostic value of QT dispersion in patients presenting with acute neurological events. 1249 26