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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Glucocorticoids are commonly given to patients with global brain ischemia, although their efficacy has not been proved. The database of the Brain Resuscitation Clinical Trial I, a multi-institutional study designed to evaluate the effect of thiopental sodium therapy on neurological outcome following brain ischemia, was used for a retrospective review of the effects of glucocorticoid treatment on neurological outcome after global brain ischemia. This study included 262 initially comatose cardiac arrest survivors who made no purposeful response to pain after restoration of spontaneous circulation. The standard treatment protocol left glucocorticoid therapy to the discretion of the hospital investigators. This resulted in four patient groups that received either no, low, medium, or high doses of glucocorticoids in the first 8 hours after arrest. Neurological outcome was scored using a modification of the Glasgow Cerebral Performance Category Scale. None of the steroid regimens statistically improved mean group survival rate or neurological recovery rate over that observed in the group that did not receive steroids. The routine clinical practice of administrating glucocorticoids after global brain ischemia may be associated with serious complications and is not justified.
JAMA
PMID:Glucocorticoid treatment does not improve neurological recovery following cardiac arrest. Brain Resuscitation Clinical Trial I Study Group. 268 82

Cigarette smoking has been causally linked to coronary heart disease. To investigate the effect of smoking on the activity of ischemic heart disease, 65 patients with chronic stable manifestations of coronary disease and a positive exercise tolerance test underwent continuous ambulatory monitoring to quantify the amount of ischemic ST segment depression during daily life. Twenty-four smokers were compared with 41 nonsmokers for frequency and duration of electrocardiographic signs of ischemia during 24 hours. A total of 4,968 hours of ambulatory monitoring were analyzed. The frequency of episodes was three times as often (median) and the duration of ischemia was 12 times longer (median duration, 24 vs 2 min/24 h) in smokers than nonsmokers. This finding remained statistically significant when a number of potentially confounding factors were controlled by means of logistic regression. This study shows that patients with coronary artery disease who smoke have significantly and substantially more active myocardial ischemia during daily life than patients who do not.
JAMA 1989 Jan 20
PMID:Effect of smoking on the activity of ischemic heart disease. 290 79

Nonclinical factors that may pressure physicians to intervene when a patient presents with so-called silent ischemia, and that may compel a management course not necessarily in the patient's best interest, are explored. These factors include the public's "obsession" with cardiac health, the enormous potential market for pharmaceuticals and medical devices, the funding of ischemia research by drug and medical device companies, the growth of "interventional cardiology" as a subspecialty, the increasingly entrepreneurial approach to medical care on the part of physicians and hospitals, and the fear of malpractice litigation. Given the financial advantage to health facilities and practitioners in recommending an interventionist rather than a conservative approach to silent ischemia, Graboys questions whether studies to determine the optimal management of this condition will ever be undertaken.
JAMA 1989 Apr 14
PMID:Conflicts of interest in the management of silent ischemia. 292 46

Angina and ischemic electrocardiographic changes occurred after administration of oral dipyridamole in four patients awaiting urgent myocardial revascularization procedures. To our knowledge, this has not previously been reported as a side effect of preoperative dipyridamole therapy, although dipyridamole-induced myocardial ischemia has been demonstrated to occur in animals and humans with coronary artery disease. Epicardial coronary collateral vessels were demonstrated in all four patients; a coronary "steal" phenomenon may be the mechanism of the dipyridamole-induced ischemia observed.
JAMA 1987 Mar 20
PMID:Dipyridamole-induced myocardial ischemia. 295 Feb 48

Predictive indexes for atherosclerotic risk are imperfect, suggesting that there are predictive factors not commonly considered. Such a factor may be the white blood cell (WBC) count. Epidemiologic studies have shown correlations between the WBC count and the risk of myocardial infarction and stroke. The risk of acute myocardial infarction is approximately four times as great in persons with WBC counts high in the normal range (greater than 9000/microL [9 X 10(9)/L]) as in persons with WBC counts low in the normal range (less than 6000/microL [6 X 10(9)/L]); only 50% to 65% of the excess risk of the high-count individuals is explainable by tobacco smoking (which covaries with WBC count). A high WBC count also predicts greater risk of reinfarction and of in-hospital death. Less rigorously studied, the constitutional neutropenia of Yemenite Jews appears to afford protection against atherosclerotic disease. Among WBC types, the strongest epidemiologic association has been with the neutrophil count. Such a predictive value of WBC count is plausible and satisfying, because WBCs make a major contribution to the rheologic properties of blood; alter adhesive properties under stress--including the stress of ischemia, enhancing their rheologic importance; and participate in endothelial injury, both acutely and chronically, by adhering to endothelium and damaging it with toxic oxygen compounds and proteolytic enzymes. Techniques newly developed or under development may allow us to refine the predictive value of the WBC count by combining it with measures of cell activation and/or activatability.
JAMA 1987 May 01
PMID:Leukocytes and the risk of ischemic diseases. 355 28

Reducing the numbers of coronary care unit (CCU) beds would decrease expensive unnecessary admissions, but might also block appropriate admissions. To study how physicians adapt to limited CCU beds, we compared their decisions to admit patients to the CCU when the CCU was full with those made when the CCU was not full. We studied 4479 patients who presented with symptoms suggesting acute cardiac ischemia to six New England hospital emergency rooms over 16 months. Of the 2931 patients found on follow-up not to have acute ischemia, 33% of those presenting when the CCU was not full were admitted to the CCU vs 24% of such patients presenting when the CCU was full (P = .0005), a 27% drop. Of the 725 patients proving to have angina pectoris, 74% of those presenting when the CCU was not full were admitted to the CCU vs 62% of such patients presenting when the CCU was full (P = .007), a 16% reduction. Of the 823 patients found to have myocardial infarction, 90% were admitted to the CCU both when the CCU was not full and when it was full. Importantly, for no group did mortality increase when the CCU was full. These data suggest that physicians can safely adapt to substantial reductions in the availability of CCU beds.
JAMA 1987 Mar 06
PMID:How do physicians adapt when the coronary care unit is full? A prospective multicenter study. 380 15

The clinical importance of myocardial ischemia without associated symptoms in patients with atherosclerotic coronary disease has not been clarified. We present three patients in whom painless cardiac ischemia was associated with the induction of cardiac arrest and/or ventricular tachycardia/fibrillation. In the two surviving patients, programmed ventricular stimulation did not induce ventricular arrhythmias. In one patient, successful coronary bypass surgery resulted in the elimination of exercise-induced painless myocardial ischemia and associated ventricular fibrillation; the other patient suffered a myocardial infarction after which ischemia and ventricular tachyarrhythmias could not be reproduced with exercise testing. We conclude that painless myocardial ischemia can cause life-threatening arrhythmias and is, therefore, a potentially lethal phenomenon.
JAMA 1987 Apr 10
PMID:Life-threatening ventricular tachycardia and fibrillation induced by painless myocardial ischemia during exercise testing. 382 May 14

Outcome from coma caused by cerebral hypoxia-ischemia (eg, cardiac arrest) was compared with serial neurological findings in 210 patients. Thirteen percent of patients regained independent function at some point during the first postarrest year. Computer application of new multivariate techniques to the prospectively observed findings generated easily utilized rules that classified patients by likely outcome. At the time of initial examination, 52 patients (one fourth of the total population) had absent pupillary light reflexes, and none of these patients ever regained independent daily function. By contrast, the initial presence of pupillary light reflexes, the development of spontaneous eye movements that were roving conjugate or better, and the findings of extensor, flexor, or withdrawal responses to pain identified a smaller group of 27 patients, 11 (41%) of whom regained independence in their daily lives. By 24 hours after onset, 93 poor-outcome patients were identified by motor responses that were absent, extensor, or flexor and by spontaneous eye movements that were neither orienting nor roving conjugate; only one regained independent function. This contrasts with recovery in 19 (63%) of 30 patients who at that time showed improvement in their eye-opening responses and obeyed commands or had motor responses that were withdrawal or localizing. Similarly simple rules distinguished between good- and poor-prognosis patients on postarrest days 3, 7, and 14.
JAMA 1985 Mar 08
PMID:Predicting outcome from hypoxic-ischemic coma. 396 72

Ninety-one patients treated with streptokinase for vascular occlusion were studied retrospectively to document the incidence of cerebral hemorrhage. Three cerebrovascular complications occurred. Two patients had cerebral hemorrhage, one following limb ischemia, the other after acute myocardial infarction. The third patient received streptokinase for an occluded right subclavian bypass graft and suffered a right frontoparietal infarction, presumably secondary to retrograde embolization, but not angiographically proved. This incidence of cerebrovascular complications must be taken within the framework of the baseline incidence following systemic ischemia, but suggests that caution be exercised with this therapy.
JAMA
PMID:Cerebrovascular complications of streptokinase infusion. 397 59

In order to determine whether or not regular exercise could alter myocardial perfusion or function, we randomized 146 male volunteers with stable coronary heart disease to either a supervised exercise program (n = 72) or to a usual care program (n = 74). Subjects underwent exercise tests initially and one year later. Significant differences between the two groups included improved aerobic capacity, thallium ischemia scores, and ventricular function in the exercise intervention group. It was not possible to classify the conditions of patients as to the likelihood of improvement or deterioration. This study demonstrated changes in myocardial perfusion and function in a select group of middle-aged men with coronary heart disease who underwent a medically appropriate exercise program lasting one year, but these changes were relatively modest.
JAMA 1984 Sep 14
PMID:A randomized trial of exercise training in patients with coronary heart disease. 638 70


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