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

We searched the medical literature for articles containing markers of cardiac ischemia and echocardiography in the evaluation of patients presenting to the emergency department to determine their combined clinical use. Several published articles indicate two-dimensional echocardiography is a useful and cost-effective imaging technique for the evaluation of patients with chest pain in the emergency department. New studies are emerging that evaluate ischemic markers in combination with echocardiography to assess patients presenting to the emergency department with chest pain. We searched the MEDLINE Database for English-language articles published from December 1980 to August 1998 using the key words troponin, echocardiography, myocardial infarction, and emergency. These key words were crossed referenced to determine publications in this area. Pertinent trials and reviews were selected from the database. There were six articles evaluating biochemical markers of ischemia and echocardiography to assess patients presenting with acute coronary syndromes in the emergency department. Very few studies combined the information obtained from novel ischemic markers and echocardiogram analysis to help delineate potential cardiac etiologies of acute coronary syndromes. However, the limited studies available indicate that echocardiography is both sensitive and specific for detecting acute myocardial infarction. The presence of regional wall motion abnormalities increases the chance of in-hospital complications and likelihood of developing congestive heart failure after admission for unstable angina. The combined use of troponin T levels and echocardiographic imaging was a more powerful predictor of adverse events than were isolated results. Myocardial scarring with ventricular wall thinning or aneurysm may allow for rapid diagnosis of 'occult' coronary artery disease in a patient presenting with chest pain who does not have a previous history of a cardiovascular event. Echocardiography may also help identify other cardiovascular causes of chest pain, such as aortic dissection, aortic stenosis, cardiac tamponade, pericarditis, and hypertrophic cardiomyopathy. The clinical use of combining ischemic markers of disease with echocardiographic imaging seems justified given their unique clinical advantages. Future clinical trials are needed to determine whether the combination of novel ischemic markers and echocardiography can provide for a more expedient and accurate diagnosis, resulting in improved patient care and a safe reduction in unnecessary hospitalization.
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PMID:Clinical Use of Ischemic Markers and Echocardiography in the Emergency Department. 1117 40

Acute gastric volvulus occurs when the stomach, or part of the stomach, rotates more than 180 degrees, creating a closed-loop obstruction, which eventually leads to ischemia and strangulation. Acute gastric volvulus may occur in association with a diaphragmatic defect, diaphragmatic elevation of any cause, tumors of the pancreas and stomach, trauma, and congenital abnormalities of mesenteric fixation. We describe an unusual case of an acute gastric volvulus causing cardiac tamponade, which was successfully treated by endoscopic reduction of the gastric volvulus.
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PMID:Endoscopic treatment of acute gastric volvulus causing cardiac tamponade. 1127 79

From March 1997 to January 2000, we operated eleven cases of Stanford type A acute closing dissection. The patients consisted of 4 men and 7 women with a mean age of 71 +/- 9 years. There were 9 cases (81%) of cardiac tamponade and 5 cases (45%) was in the shock state. There were no malperfusion and end organ ischemia. All cases were operated with deep hypothermia and circulatory arrest. Ascending aortic replacement were performed in 9 cases and 2 cases were performed total arch replacement. 6 cases (63%) were not required blood transfusion. There was one operative death and one hospital death. These result suggest that we had better to perform immediate graft replacement for Stanford type A acute closing dissection as soon as possible, even if there were no serious complications.
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PMID:[Early operation for acute type a closing dissection]. 1142 92

This study aimed to determine the safety and efficacy of percutaneous myocardial laser revascularization (PMLR). Seventy-three patients with stable angina pectoris (class III or IV) who were unsuitable for conventional revascularization and had evidence of reversible ischemia by thallium-201 scintigraphy, ejection fraction of > or =25%, and myocardial wall thickness > or =8 mm were randomized to optimal medical therapy alone (n = 37) or PMLR with optimal medical therapy (n = 36). Patients were followed up at 3, 6, and 12 months. The primary end point was exercise time. Secondary end points included angina scores, left ventricular ejection fraction, quality of life, changes in medical therapy, and hospitalizations. All 36 patients randomized to PMLR underwent the procedure successfully with no periprocedure deaths. One patient developed sustained ventricular tachycardia that required electrical cardioversion, and 1 patient developed cardiac tamponade that required surgical drainage. At 12 months, exercise times improved by 109 seconds in the PMLR group but decreased by 62 seconds in the control group (p <0.01). Angina scores improved by 2 classes in 36% of PMLR-treated patients at 12 months compared with 0% of the control patients (p <0.01). We conclude that PMLR is a relatively safe procedure that provides patients with symptomatic angina relief and improvement in exercise capacity and quality of life.
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PMID:Percutaneous myocardial laser revascularization in patients with refractory angina pectoris. 1263 94

Aortic intramural hematoma (IMH) is an acute, potentially lethal disorder that is similar to but pathologically distinct from acute aortic dissection. Although hemorrhage into the aortic media occurs in both disorders, an intimal tear with resultant false lumen is not present in IMH. Instead, hemorrhage occurs within the aortic wall either due to rupture of the vasa vasorum or, less commonly, because of an atherosclerotic penetrating aortic ulcer. The most common risk factors associated with IMH are hypertension, atherosclerosis, and advanced age. IMH is life-threatening because the hematoma may extend along or rupture through the aorta, leading to hemothorax, cardiac tamponade, stroke, mesenteric ischemia, or renal insufficiency. Optimal treatment is still somewhat controversial; however, there is no question that hypertension must be treated effectively and immediately. This is usually best accomplished by intravenous infusion of beta-blocking agents, with or without the addition of sodium nitroprusside. Recent studies support surgical treatment (ie, aortic root replacement) for IMH involving the ascending aorta, although some subsets of this population may be at lower risk and may benefit from medical therapy alone. In patients with IMH involving only the descending aorta, medical therapy alone is recommended (unless impending rupture, aortic aneurysm, or end-organ ischemia occurs). Patients who survive the acute event require intensive treatment of hypertension and frequent follow-up examinations. Because this population (especially the subset with penetrating aortic ulceration) is at high risk for aortic aneurysm and rupture, serial imaging studies of the aorta are essential.
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PMID:Aortic Intramural Hematoma: Current Diagnostic and Therapeutic Recommendations. 1506 38

To evaluate the clinical characteristics, risk factors, and outcomes of hypotension in unselected patients who had acute aortic dissection (AAD), we studied 1,073 such patients who were enrolled in the International Registry of Acute Aortic Dissection between 1996 and 2001. Hypotension was noted in 313 patients (29.2%) who had AAD (46.0% on admission). Multivariate logistic regression identified age >or=70 years (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.4 to 2.9), type A dissection (referent type B AAD; OR 2.1, 95% CI 1.4 to 3.2), neurologic deficit (OR 3.8, 95% CI 2.2 to 6.6), syncope (OR 2.9, 95% CI 1.8 to 4.7), aortic regurgitation requiring valve surgery (OR 1.9, 95% CI 1.1 to 3.3), cardiac tamponade (OR 5.1, 95% CI 3.0 to 8.8), and new Q-wave or ST-segment deviation on an electrocardiogram (OR 1.6, 95% CI 1.1 to 2.4) as independent associations of hypotension (c statistic 0.78). Hospital complications (neurologic deficits 22.7% vs 12.0%, altered mental status 26.1% vs 4.4%, myocardial ischemia 14.6% vs 6.9%, mesenteric ischemia 6.9% vs 2.6%, or limb ischemia 14.6% vs 6.9%, and death 55.0% vs 10.3%) occurred more frequently in patients who had hypotension than in those who did not (p <0.001 for all comparisons). We concluded that hypotension that occurred in >25% of patients who had AAD was associated with a much higher rate of in-hospital adverse events. Our study also identified factors associated with hypotension in patients who had AAD.
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PMID:Clinical characteristics of hypotension in patients with acute aortic dissection. 1561 93

We evaluated the results of 213 emergency operations of acute type A aortic dissection in our center from January 2003 to December 2006. They were 101 male and 112 female, and the mean age was 64.6 years. The hospital mortality rate of all cases was 13.6% (29/213). And that of cases with malperfusion was 31.9% (15/47). They consisted of stroke 8/17 (47.1%), myocardial ischemia 5/27 (18.5%) [right coronary artery: 2/22 (9.1%), left main trunk: 3/5 (60.0%)], and intestinal ischemia 2/3 (66.7%). The hospital mortality rate of pulseless electrical activity (PEA) cases was 57.1% (4/7), and that of aortic rupture cases was 33.3% (3/9). On the other hand, the mortality rate of cases with cardiac tamponade alone was 4/45 (8.9%). That of cases without cardiac tamponade and malperfusion was 3/105 (2.9%), and was significantly (p < 0.05) lower than that with malperfusion.
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PMID:[Early and late sugical results of emergency operation for acute type A aortic dissection]. 1741 93

We report a case of a 24-year-old woman with an unremarkable past medical history who was presented to the emergency department with acute onset of breathlessness and weakness of right lower limb. Clinical examination was suggestive of malignant hypertension with acute left ventricular failure and acute ischemia of right lower limb. Colour Doppler and CT findings were consistent with dissection of entire aorta with extension into its major branches. She died in less than 18 h after admission following cardiac tamponade. Autopsy revealed left renal artery stenosis with features of Takayasu's arteritis with intimal rupture in the abdominal aorta with Stanford type A dissection of aorta extending to all the major branches of aorta, and hemopericardium. This case demonstrates a rare example Takayasu's arteritis involving left renal artery leading to secondary hypertension presenting as malignant hypertension with fatal dissection of aorta with cardiac tamponade and emphasizes the varied presentations of this disease and importance of early diagnosis and interventions to prevent these fatal complications.
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PMID:Malignant hypertension, dissection of aorta, cardiac tamponade and monoparesis--unusual presentation of Takayasu's arteritis: clinicopathological correlation. 1837 65

Acute aortic dissection is a relatively uncommon but highly lethal condition. Without proper treatment, devastating consequences can occur due to aortic rupture, cardiac tamponade, or irreversible ischemia involving the spinal cord or the visceral organs. The treatment strategy of this condition is in part influenced by the location and the severity of aortic dissection as immediate surgical intervention is necessary in acute ascending aortic dissection, whereas medical therapy is the initial treatment approach in uncomplicated descending aortic dissection. Recent advances of endovascular technology have broadened the potential application of this catheter-based therapy in aortic pathologies, including descending thoracic aortic dissection. In this article, the etiology, pathogenesis, and classification of this condition are discussed. The diagnostic benefits of various imaging modalities for descending aortic dissection are also discussed. Current treatment strategies, including medical, surgical, and catheter-based interventions, are reviewed. Lastly, clinical experiences of endovascular treatment for descending aortic dissection and various endovascular devices potentially applicable for this condition are discussed.
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PMID:Descending thoracic aortic dissection: evaluation and management in the era of endovascular technology. 1858 4

In patients with acute aortic dissection, an early diagnosis is essential to anticipate aortic rupture, cardiac tamponade, organ ischemia and improve surgical results. A specific blood laboratory marker able to rule out the presence of aortic dissection has not been identified yet. Recently, several studies suggested using D-dimers as a negative predicting test to rule out diagnosis of acute aortic dissection in patients presenting with chest pain. In 61 patients with confirmed aortic dissection, preoperative D-dimers were assayed and correlated with time from symptom onset and extension of the false lumen dissection (according with De Bakey classification). Abnormal D-dimers values were considered those being greater than 400 microg/l. D-dimers values were above 400 microg/l in 50 patients (82%) and below 400 microg/l in 11 patients (18%). There was no correlation between preoperative D-dimers values and time from symptoms onset (r = -0.232; P = 0.1). We found that D-dimers are not always elevated in patients presenting with acute aortic dissection. Given the potential devastating effects of denying the diagnosis of acute aortic dissection with consequent delay of adequate treatment, a word of caution regarding the negative predictive value of D-dimer test in the diagnosis of aortic dissection seems warranted.
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PMID:D-dimers are not always elevated in patients with acute aortic dissection. 1937 87


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