Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hemodynamic measurements were performed and ECG recorded before and shortly after infrarenal aortic cross-clamping during operation for abdominal aortic aneurysm in five patients without evidence of heart disease (group I) and in ten patients with severe coronary artery disease (group II). All patients sustained an increase in systemic arterial pressure. Group I demonstrated a decrease in pulmonary artery, pulmonary capillary wedge (PCW), and central venous pressures when the aorta was clamped, whereas group II demonstrated an increase. The difference in response of the groups is significant (P less than 0.05). All three patients who responded to cross-clamping with increases of 7 mm Hg or greater in PCW demonstrated myocardial ischemia during cross-clamping. None of the values measured prior to cross-clamping predicted with certainty the response to cross-clamping. Sodium nitroprusside reversed the elevation of left ventricular filling pressure in all three patients, and in two patients, relieved evidence of myocardial ischemia concurrently. In the third patient, ventricular irritability was abolished by lidocaine and did not recur. We conclude that infrarenal aortic cross-clamping may cause myocardial ischemia in patients with severe coronary artery disease. This ischemia may be predicted by a rise in PCW at the time of cross-clamping, and vasodilator therapy is indicated in such patients.
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PMID:Myocardial ischemia due to infrarenal aortic cross-clamping during aortic surgery in patients with severe coronary artery disease. 126 32

In a randomized, cross-over, double-blind study, the effects of nifedipine were compared with those of diltiazem in 20 patients with severe stable angina pectoris and multivessel coronary artery disease treated with nitrates and beta-blockers. The comparison was performed by bicycle ergometry, clinical evaluation, and ambulatory 24-h ECG monitoring for 7-8 weeks. As compared with placebo, both nifedipine and diltiazem significantly reduced the daily number of anginal attacks and nitroglycerin consumption; prolonged exercise duration, time to 1-mm ST segment depression, and to onset of angina; and reduced the sum of ST segment depressions at maximal identical load in ergometry. In ambulatory ECG monitoring, only nifedipine significantly diminished the duration of asymptomatic ST segment depression as compared with placebo. Antianginal and antiischemic effects of nifedipine and diltiazem were similar. Both nifedipine and diltiazem significantly increased the effects of treatment with nitrates and beta-blockers. Administration of nifedipine was safer because at night diltiazem caused significant bradycardia despite careful titration of optimum doses of the drug. Although the maximum well-tolerated doses of conventional medication suppressed anginal symptoms in some patients, they did not abolish ischemia either at ergometry or in daily life.
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PMID:Effects of nifedipine and diltiazem on myocardial ischemia in patients with severe stable angina pectoris treated with nitrates and beta-blockers. 128 86

The beneficial effects of calcium-channel blockers against myocardial stunning have been tested in experimental studies, showing that, when added before or during ischemia, a protective effect against postischemia stunning is achieved. The present study was undertaken to test and compare the protective effect of calcium antagonists [nisoldipine (NIS) and nifedipine (NIF)] and nitrates (NIT) against myocardial stunning in patients with coronary artery disease undergoing percutaneous transluminal coronary angioplasty (PTCA) with prolonged inflation as PTCA represents a model of induced acute and severe ischemia for a brief period and might cause myocardial stunning. The study included 30 patients between the ages of 42 and 67 years, all with exercise-induced angina and single-vessel disease, with severe stenosis (80% to subtotal occlusion) localized on the left anterior descending artery and with the absence of collaterals on the coronary angiograms. Moreover, all patients had normal left ventricular (LV) overall function, as well as normal systolic thickening of the anterior wall, supplied by the diseased artery. Patients were randomized to a pre-PTCA treatment with NIT, 80-120 mg/day (10 patients), NIF, 40-60 mg/day (10 patients), and NIS, 10-20 mg/day (10 patients). Pre-PTCA treatment was initiated 7 days before the procedure and continued after. During the PTCA, at the first balloon inflation, an additional dose of 300 micrograms of NIT was injected into the left anterior descending artery through the balloon catheter in the patients in the NIT group, as well as 0.2 mg of NIF in NIF group patients and 0.05 mg of NIS in NIS group patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Myocardial stunning following coronary angioplasty: protective effects of calcium-channel blockers. 128 9

The present study was designed to investigate the effect of the calcium-channel antagonist gallopamil on myocardial ischemia during percutaneous transluminal coronary angioplasty (PTCA). Twenty-four adult patients with coronary artery disease and significant proximal stenosis of the left anterior descending coronary artery (LAD) were randomly assigned to receive gallopamil or placebo under double-blind conditions. Patients with recent myocardial infarction, apparent collateralization of the LAD, myocardial failure, sinoatrial or atrioventricular block, severe hepatic disease, or renal failure were excluded from the study. PTCA was performed with use of at least two balloon inflations, each of 2 min in duration. Gallopamil (0.4 mg) or placebo (0.9% sodium chloride) was administered during the 10-min interval between the two inflations. For determination of myocardial lactate and hypoxanthine release, blood samples were taken simultaneously from the great cardiac vein and the femoral artery before and immediately after each inflation. Electrocardiogram changes were analyzed by measuring ST-segment deviations (80 ms after the J point) and maximal T-wave deviations of the leads I, II, III, and V2, V4, and V6. The most sensitive leads for identification of myocardial ischemia in the LAD area were V2 and V4. If compared to the first balloon inflation, the degree of ST-segment/T-wave changes induced by the second inflation was significantly reduced only in the presence of gallopamil. Furthermore, if compared to placebo, ischemia-induced lactate and hypoxanthine release was decreased in the presence of gallopamil. These results suggest that intracoronary application of gallopamil attenuates myocardial ischemia during PTCA.
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PMID:Intracoronary gallopamil during percutaneous transluminal coronary angioplasty. 128 55

Calcium-antagonist drugs are therapeutic agents of first choice in patients with coronary artery disease. We have reviewed a number of clinical trials in which the safety and efficacy of calcium blockers have been tested and discuss the established clinical effects of these compounds, which range from relief of angina and improved quality of life (both in patients with ischemia due to reduction in coronary flow and in patients with ischemia due to increased O2 demand) to a favorable effect on the course of coronary atherosclerosis and, finally, (at least for some of these agents) to an improvement in prognosis.
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PMID:Clinical evaluation of calcium-antagonist drugs. 128 60

The clinical implications of isolated late recovery ST depression were tested in patients with scintigraphically defined ischemia (coronary artery disease [CAD], n = 18) compared with patients without ischemia (n = 25). Spontaneous (78.4 versus 12.0%, P < 0.008) and exercise-induced angina (44.4 versus 0%, P < 0.0001) were more frequently seen in patients with CAD. Histories of unstable angina (33.3%), prior myocardial infarction (27.8%), ST elevated angina (22.2%) and significant stenosis in the left anterior descending artery (17 of 18, 94.4%) were almost exclusively seen in the CAD group. There was no significant difference between the two groups in capacity for exercise, maximum deviation of ST level or TV2 amplitude. Balloon angioplasty abolished late recovery ST changes in 63.6% of CAD patients. These results suggest that isolated late recovery ST depression, when accompanied with typical chest pain, may be considered as an indicator of myocardial ischemia, but this phenomenon is difficult to distinguish electrocardiographically.
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PMID:Isolated post exercise delayed ST depression as a sign of severe ischemia: the influence of percutaneous transluminal coronary angioplasty. 128 36

The prognosis of left bundle branch block is determined by associated cardiovascular disease. Exercise electrocardiography is not helpful in detecting ischemia in these patients. Exercise thallium-201 scintigraphy has been widely accepted for that purpose. The authors made an overview of several studies suggesting that exercise thallium-201 scintigraphy has low specificity regarding left anterior descending coronary artery disease. They also review the mechanisms of perfusion defects in patients with left bundle branch block without coronary artery disease. One important question to be clarified is weather small defects are unrelated to coronary artery disease. Finally the authors analyse a few methods to increase diagnostic accuracy of perfusion scintigraphy in left bundle branch block. First the employment of a new criterium that requires the apex to be abnormal to indicate left anterior descendent artery disease. Second Pharmacological Stress with Dipyridamole or Adenosine. Third imaging with Tc-99m-MIBI.
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PMID:[What is the value of myocardial perfusion studies with isotopes in patients with complete left bundle branch block?]. 129 Jun 46

To evaluate the efficacy of stress Tc-99m MIBI myocardial perfusion imaging using intravenous dipyridamole in detecting coronary artery disease (CAD) and to determine if chest pain symptom is a proper index for detection of myocardial ischemia in post-infarction patients, we observed 73 cases (65 men, 8 women, 38-79 years old) between Sept. 1990 and May 1992. All patients were suffered from old myocardial infarction (MI) evidenced by history and ECG and were divided into two groups: group I involving 41 patients with post-infarction chest pain symptom and group II including 32 patients without post-infarction chest pain symptom. Among them, 19 (group IA) of group I and 11 (group IIA) of group II received coronary arteriography (CAG) for comparison. Of the 41 group I post-infarction chest pain patients, 17 suffered from old anterior or antero-septal wall (AW) MI, 21 from old inferior wall (IW) MI, 1 from old lateral wall (LW) MI and 2 from combined old AW and IW (AIW) MI by ECG. All 17 patients with AWMI suffered from AW perfusion defect (7 were MI, 10 were MI with ischemia) but 7 of them from multivessel disease (MVD) by Tc-99m MIBI. All 21 patients with IWMI suffered from IW perfusion defect (9 were MI, 12 were MI with ischemia) but 13 of them from MVD by Tc-99m MIBI. Of the patient with LWMI and 2 patients with AIWMI suffered from MVD by Tc-99m MIBI. Of the 32 group II post-infarction patients without chest pain symptom, 12 suffered from old AWMI, 14 from old IWMI, 2 from old LWMI, 3 from AIWMI and 1 from ALWMI by ECG. Of the 12 patients with AWMI, 11 suffered from AW perfusion defect (6 were MI, 5 were MI with ischemia) but 1 of them from MVD by TC-99m MIBI. All 14 patients with IWMI suffered from IW perfusion defect (12 were MI, 2 were MI with ischemia) but 4 of them from MVD by Tc-99m MIBI. Of the 2 patients with LWMI suffered from LW infarction by Tc-99m MIBI. Of the 3 patients with AIWMI and 1 with ALWMI suffered from MVD by Tc-99m MIBI. Of the 11 patients in group IA and 5 patients in group IIA with AWMI, CAG revealed the incidence of infarct-related recanalization of LAD was 9/11(82%) and 4/5(80%) respectively and the respective incidence of MVD was 6/11(55%) and 0/5(0%).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Dipyridamole Tc-99m MIBI myocardial perfusion scintigraphy in patients with post-infarction chest pain symptom]. 129 41

Nisoldipine represents a new attractive second generation calcium channel blocker of the dihydropyridine-class for the treatment of all types of coronary artery disease. The effect on chronic ischemia is comparable to long-acting nitrates, side-effects have been rarely observed. The advantages will be the high vascular selectivity with only slight negative inotropic effect as well as a long-lasting positive influence on the myocardial metabolism. Up to now, no studies have been reported which compare nisoldipine and long-acting nitrates directly, but this calcium antagonist appears to influence duration and intensity of symptomatic and silent episodes of ischemia similar to the nitrates.
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PMID:[Nisoldipine in comparison with long-term nitrates]. 129 42

A 9-lead Holter monitor using the lead-switching technique (9-lead DCG) and conventional 12-lead electrocardiograph (12-lead ECG) were simultaneously used for recording during treadmill exercise testing (Td-test) in 140 patients with coronary artery disease. Coronary arteriography was performed in 118 of the 140 patients, and the correlation between coronary stenosis and anterior or inferior projection of ST depressions occurring during the Td-test was investigated. Additionally, 10 patients with acute myocardial infarction (AMI) were studied to test ST elevation detection by the 9-lead DCG. The CM5 lead demonstrated ST depressions in 92 of the 109 patients showing ST depressions in one or more leads. High lateral (HL) and/or low lateral leads detected all ST depressions occurring in the I and aVL leads of the 12-lead ECG. Leads CM1, CM2 and CM3 exhibited low sensitivity (0-32%) and high specificity (56-100%), while leads CM4, CM5, and CM6 provided greater sensitivity (66-95%), but less specificity (3-32%) in detecting diseases of the left anterior descending artery, left circumflex artery and/or right coronary artery (RCA). In contrast, the low back (LB) lead demonstrated high sensitivity (88%) and high specificity (86%) in detecting RCA disease. Lead CM3 detected ST elevations in all 6 patients with anterior AMI, while the LB lead did so in all 4 patients with inferior AMI. With a Holter monitor, 4 leads are needed: CM5 like, CM3 like, lateral (such as HL) and inferior (such as LB). The LB lead is useful in detecting inferior ischemia.
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PMID:Correlation of coronary artery stenosis site with anterior or inferior projection of ST changes induced by treadmill exercise using a newly devised 9-lead Holter method. 130 17


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