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

The diagnostic potentialities of bicycle ergometry (BEM) and treadmill test were comparatively analysed in 57 males aged 37-64 years who were examined to detect coronary heart disease. In 34 cases, the results of BEM and treadmill test were consistent, of them 13 were positive, 15, negative, 3 intermediate, and 3 inadequate. With positive results, the treadmill test was more reliable than BEM in revealing the criteria for ischemia from statistically significantly more pronounced ST-segment depression at a lower threshold heart rate. Inconsistency of the BEM and treadmill test results was found in 23 cases. In 14 of 18 patients who had indefinite BEM results, the treadmill test allowed one to make a definite conclusive diagnosis, showing 6 positive and 8 negative results. This is accounted for by lower cases when the treadmill test was discontinued due to a hypertensive reaction of blood pressure or fatigue. The study indicated that the treadmill test was more sensitive and better tolerated than BEM.
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PMID:[Comparing the informative value of bicycle ergometry and treadmill tests in the evaluation of the coronary reserve]. 180 56

Coronary arteriography, bicycle ergometry and transesophageal atrial pacing (TAP) in combination with Doppler echocardiography (stress-Doppler echocardiography) were used to evaluate cardialgias in 30 outpatients. Stress-Doppler echocardiography showed a high (94%) sensitivity and a high (86%) specificity to detect coronary heart disease (CHD). There was a high correlation (r = 0.79, p less than 0.001) between the wall motion values obtained by echocardiography during TAP and coronary rating. The left ventricular (LV) diastolic filling (DF) was studied by pulsed wave Doppler echocardiography in the postpacing period. The Doppler-derived parameters of LV DF obtained in that period appeared to be moderately sensitive (75%) and specific (64%) in detecting CHD. In post-pacing ischemia, the "pseudonormalized" LV filling pattern was observed in 5 of 6 patients (sensitivity 80%) having three-vessel disease and major left (or equivalent) coronary stenosis.
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PMID:[Stress-Doppler echocardiography in the diagnosis of ischemic heart disease in an ambulatory setting]. 180 57

The paper presents the results of the study into the diagnostic potentialities of 24-hour ECG monitoring in young patients. The monitoring is a sensitive and informative technique for the diagnosis of coronary heart disease in young patients, allowing the signs of coronary insufficiency to be revealed in 91.4% of the patients with verified coronary heart disease. The young patients were demonstrated to have ischemia accompanied by ST-segment elevation, presumably of vasospastic genesis.
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PMID:[24-hour ECG monitoring in young patients with ischemic heart disease]. 180 59

The purpose of this study was to assess the ischemic burden and the hemodynamic changes during daily activities in patients with coronary heart disease. Three exercise tests were performed during the day (10:00 a.m., 2:00 p.m., 6:00 p.m.), recording ST-segment depression, pulmonary artery pressure, pulmonary wedge pressure, and cardiac output as well as heart rate and systemic blood pressure during placebo and nitrate therapy. With placebo as well as nitrate therapy there was a gradual increase of ischemia and preload and a decrease of cardiac output during the day. High nitrate concentrations led to a significant reduction of both preload and ST depression with a marked circadian phase dependency of cardiovascular effects.
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PMID:Chronotherapy in coronary heart disease: comparison of two nitrate treatments. 181 88

Hypertension is a major contributor to cardiovascular morbidity and mortality, increasing risk threefold. It predisposes to every clinical manifestation of coronary heart disease, now the most common and lethal outcome. It is as relevant a risk factor in the elderly as in the young. Risk is proportional to the degree of blood pressure elevation without a discernible critical value. Cardiovascular sequelae do not derive chiefly from the diastolic component, and isolated systolic hypertension confers increased risk at all ages. Hypertension tends to cluster with other cardiovascular risk factors, which must be taken into account in evaluating the risk and in choosing treatment. The excess cardiovascular risk in hypertension is concentrated in those with an increased total/high density lipoprotein cholesterol ratio, glucose intolerance, cigarette smoking, elevated fibrinogen, and electrocardiogram abnormalities. Left ventricular hypertrophy (LVH) is a common feature of hypertension and an ominous harbinger of cardiovascular sequellae. Electrocardiographic evidence of LVH, when manifested by repolarization abnormalities and voltage elevations, is particularly hazardous, reflecting not only anatomical hypertrophy but also ischemia. Electrocardiogram-LVH adds to cardiovascular risk associated with X ray or echocardiographic evidence of anatomical LVH. Because of a tendency to ventricular ectopy, LVH is associated with increased risk of sudden death. Electrocardiogram-LVH can be corrected or avoided by control of hypertension and weight reduction. The efficacy of correcting LVH remains to be demonstrated but benefits seem likely.
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PMID:Hypertension, hypertrophy, and the occurrence of cardiovascular disease. 183 77

Myocardial ischemia causes regional myocardial contractile and relaxation abnormalities. The extent of ischemia is determined by the distribution and severity of coronary artery stenoses. In coronary heart disease, two powerful predictors of prognosis are the coronary anatomy and ventricular function. Management in coronary heart disease is directed by accurate diagnosis and individualized objectives. Echocardiography at rest and exercise, combined with Doppler and color flow imaging, are properly applied to the differential diagnosis of common clinical syndromes in ischemic heart disease, the identification of the proximal coronary arteries, and the effects of ischemia and prior infarction. Subsequent use of coronary arteriography partially depends on the philosophy regarding the applicability of coronary surgery or angioplasty in an individual patient. Prediction of multivessel, left main, or proximal left anterior descending coronary artery disease by extensive wall motion abnormalities or an abnormal left ventricular ejection fraction may direct the clinician to coronary arteriography to select among coronary surgery, angioplasty, or medical management.
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PMID:Use of echocardiography for patient management in chronic ischemic heart disease. 188 7

A total of 85 patients (68 with coronary heart disease in the presence of effort angina of various functional classes (a major group) and 17 with neurocirculatory++ dystonia and cardialgic syndrome (a control group)) were examined. Heart failure severity and blood flow distribution in the functioning myocardial areas were evaluated in transient ischemia induced by atrial pacing. Three levels of coronary venous blood flow were defined in patients with coronary heart disease. A relationship between the coronary blood flow, disease history duration, and coronary blood flow changes was examined in cardioselective exercise.
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PMID:[Status of coronary venous blood flow in patients with ischemic heart disease in myocardial ischemia induced by the atrial stimulation test]. 189 38

The prognosis of coronary patients in terms of the mortality of coronary heart disease shows a positive relation to the severity of clinical and functional diagnostic parameters. Thus exercise therapy should be monitored by criteria that take ischemia, the myocardial situation and rhythm disorders into account. These criteria should be reliable and should be easy to determine as well as to apply. For pragmatic reasons the non-invasive evaluation of findings and the diagnostic symptom-limited ergometer test are especially significant for dosage and monitoring of exercise therapy. Monitored exercise therapy is here understood to mean individually adjusted exercising by patients, and training thus has to be based on diagnostic findings. First existing complaints have to be analyzed and such findings as size of infarction in the ECG, heart volume in the X-ray, size and function of the left ventricle by echography, etc. checked. Afterwards maximum physical work capacity on a multistage bicycle ergometer test is measured with respect to the following termination criteria: a) subjective reports by the patient during exercise (e.g. onset and severity of angina pectoris, dyspnea and/or fatigue of the leg muscles) and b) objective criteria such as significant ischemic ST-depression, exercise-hypertension, age-related submaximal heart rate and significant rhythm disorders. An inverse correlation is found between measured maximum symptom-limited physical performance and the frequency of cardiac termination criteria; a comparable inverse correlation exists with heart volume: max. O2 pulse.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Can the training of coronary patients be monitored by readily measurable parameters?]. 191 21

To study the effect of apnea and hypoventilation-induced hypoxemia on the heart, we carried out polysomnographic recordings over 4 nights with electrocardiographic tracings in 30 patients with and without coronary heart disease. Evaluations of the data were based on the 2nd and 4th nights. In six subjects, five with coronary heart disease, we found 85 episodes of nocturnal ischemia, mainly during REM sleep (83.5%), high apnea activity, and sustained and progressive hypoxemia. Complex ventricular ectopy was observed in 14/13 patients (nights 2/4) and repetitive ventricular ectopy in 5/3. There was no significant difference in the quality and quantity of ventricular ectopy during wake and sleep states between the CHD group and the control group. In one patient ventricular bigeminy was observed only at a threshold of SaO2 below 60%. Bradyarrhythmia was made evident in four subjects from the CHD group and correlated mainly with apnea activity. We suppose that patients with sleep apnea and CHD are at cardiac risk because coronary heart disease can be aggravated by insufficient arterial oxygen supply due to cumulative phase of apnea and hypoventilation. The reduced hypoxic tolerance of the heart may lead to myocardial ischemia and increased electrical instability.
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PMID:Nocturnal myocardial ischemia and cardiac arrhythmia in patients with sleep apnea with and without coronary heart disease. 192 Dec 30

Coronary disease is the main cause of mortality and morbidity among long-term survivors on renal replacement therapy (RRT). Despite the additional risk factors, myocardial revascularization has been recently attempted with various success in some patients on RRT. We report on 26 patients (13 dialyzed and 13 transplanted, mean age: 50 years [range 38-66]) who have undergone either surgical aorto-coronary bypass (CABG) (n = 16) with mammary artery grafts, or percutaneous coronary angioplasty (PTCA) (n = 9), or both procedures (n = 2). Indication was angina pectoris in all but three patients with painless ischemia. Eight patients had unstable angina (NYHA class IV). A previous myocardial infarction was documented in 11 cases. Coronary angiography disclosed mainly multiple vessel disease (81%). Post CABG complications consisted of severe intrathoracic bleeding (n = 3) resulting in death in 2 cases. PTCA entailed no major complication. After the critical postoperative period, the long-term survival was the same as that of non-uremic patients and the clinical improvement, according to the NYHA classification, was highly satisfactory at 6 months and persists up to 2 years. We conclude that coronary angiography and myocardial revascularization should be considered in patients on long-term RRT developing coronary disease.
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PMID:Myocardial revascularization in patients on renal replacement therapy. 193 71


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