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

A close relation between the Doppler-echocardiographic transmitral flow signal (TMF) and the left ventricular filling pressure in patients with coronary heart disease (CHD) was described in several reports. The present study investigated the validity of this relation during an episode of acute ischemia induced by coronary angioplasty (PTCA) by simultaneous recording of TMF and mean pulmonary capillary wedge pressure (PCm). Thirty-nine patients were examined at rest, and 33 of them were further studied during a subsequent PTCA of the left anterior descending artery (n = 22) or the right coronary artery (n = 11). The onset of ischemia was evaluated by electrocardiography. The Doppler-echocardiographic parameters of diastolic ventricular function were correlated with PCm; the closest correlation was obtained for the relation between PCm and the ratio of the early/atrial velocity integral (Ei/Ai: r = 0.59; p less than 0.0001), and between PCm and the relative share of the early diastolic velocity integral (Ei%: r = 0.58; p less than 0.0001). A wide confidence interval of individual values did not allow a calculation of PCm from Ei/Ai. By a semiquantitative approach an elevated PCm could be estimated from Ei/Ai greater than 1.5 with a high sensitivity (86%) and specificity (81%). During PTCA an increase of PCm was observed (start: 10.2 +/- 4.8; end: 15.0 +/- 6.5; p less than 0.0001), while Ei/Ai decreased slightly (start: 1.37 +/- 0.41; end: 1.27 +/- 0.51; p = 0.32). With increasing duration of inflation, the correlation between PCm and Doppler-echocardiographic parameters was attenuated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Estimated relation of Doppler echocardiography parameters of diastolic ventricular function and pulmonary capillary pressure in acute ischemia]. 239 60

It is far from clear whether ischemia plays a major role in the genesis of ventricular arrhythmias in patients with chronic coronary heart disease. Since patients with left main coronary artery disease suffer from transient or even chronic ischemia including significant parts of the left ventricular muscle mass, it seems worthwhile looking for spontaneous arrhythmias in this particular clinical setting. Therefore we studied 56 patients (53 males, 3 females) with documented left main coronary artery disease (20 patients (35%) with 30-50% luminal narrowing, 36 patients (65%) with greater than or equal to 50% stenosis) using 24-hour continuous ambulatory electrocardiography. Only 5 patients were without ectopic activity. 32 patients (57%) showed ventricular extrasystoles (VES) of uniform or multiform configuration according to Lown class I-III, whereas 19 patients (34%) demonstrated consecutive VES equivalent to Lown class IV. In ten of the latter short runs of ventricular tachycardia (Lown IVb) were the maximal finding. No relation could be assessed between spontaneous ventricular arrhythmias and the extent of coronary artery disease, neither with regard to the degree of narrowing of the left main coronary artery, nor with regard to the additional coronary involvement in terms of 1-, 2- or 3-vessel disease. In contrast, there was a significant relationship between impaired left ventricular function in terms of biplane left ventricular ejection fraction and frequent VES (chi 2 = 11.272; p less than 0.01) as well as complex, namely consecutive forms (chi 2 = 9.548; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Ventricular arrhythmias in left coronary main branch stensosis]. 240 84

Although death occurs suddenly in coronary heart disease, it is associated with a prior history of cardiac disease in 85% and with prodromal symptoms in 73.8% of the patients resuscitated from cardiac arrest outside the hospital. Sudden death was the first expression of coronary heart disease in 3.6% of the patient population. The fact that out-of-hospital sudden death is usually secondary to myocardial infarction and ischemia is supported by this clinical study and is suggested by other clinical and pathological studies of individuals dying suddenly.
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PMID:The epidemiology of tachyfibrillation in sudden death. 243 59

Repeated annual 24-hour Holter's ECG monitoring sessions were used as a basis for 4-year follow-up of 108 male coronary patients with episodes of painless myocardial ischemia in the course of their everyday routines, and 144 control patients showing no signs of transient asymptomatic ischemia at 24-hour Holter's ECG monitoring. Four years of follow-up demonstrated no differences between the two groups, compared with respect to the incidence of myocardial infarction and associated mortality as well as aggravations of coronary heart disease, in terms of clinical pattern of the disease, the incidence of acute coronary episodes and survival rates. There were no sudden deaths in either of the groups. Transient painless myocardial ischemic episodes are shown to carry no additional risk of myocardial infarction and sudden death in elderly coronary patients with occasional anginal attacks.
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PMID:[Prognosis for ischemic heart disease patients with episodes of painless myocardial ischemia alternating with rare attacks of stenocardia. The correlation between ischemia and ventricular extrasystole]. 244 44

Isonitrile-technetium, a Thallium 201 analog, was used for myocardial perfusion imaging in 12 patients with known coronary heart disease. 10-40 mCu of the isotope were injected at maximal effort during a Bruce stress test. Imaging was performed using 3 projections immediately after exercise and 24 hr later, using a gamma camera attached to a computer. Myocardial necrosis was detected with a sensitivity of 89% and specificity of 63%. Corresponding figures for stress induced ischemia were 89% and 100%. Accurate localization of ischemia or necrosis was obtained in 70% of all cases, improving to 100% in cases of total artery occlusion. These results, similar to those reported in the literature, encourage the use of Tc labeled isonitrile for myocardial perfusion imaging whenever Thallium 201 is difficult to obtain.
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PMID:[Myocardial perfusion during exercise and rest in coronary patients. Evaluation with a thallium 201 analog (isonitrile-technetium 99 m)]. 251 96

Present-day therapeutic possibilities, both medical and surgical, make it mandatory for the practitioner to identify elderly patients with ischemic heart disease which in these patients often presents with atypical symptoms. Twenty elderly patients with not clear-cut symptoms of coronary disorder were submitted to an exercise test on a walking belt. In 14 (70%) the test was positive and in 8 of these 14 cases previous dynamic electrocardiography had not yielded signs of ischemia. The authors consider correctly performed exercise testing the best means for identifying the often not diagnosed coronary impairment of elderly subjects.
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PMID:[Personal experiences concerning the usefulness of the exercise test in the diagnosis of ischemic heart disease in aged patients with atypical symptomatology]. 252 97

Reversible, prolonged functional and metabolic abnormalities result from brief coronary occlusions with subsequent reperfusion (stunned myocardium). In the present study the effects of a new antiarrhythmic, vasodilator agent with intracellular calcium antagonist properties in vascular smooth muscle, KT-362 (5-[3-[( 2,3,4-dimethoxyphenyl]-ethyl)amino-1-oxopropyl]- 2,3,4,5-tetrahydro-1,5-benzothiazepine fumarate) on postischemic functional (percentage of segment shortening) recover and regional myocardial blood flow (radioactive microspheres) in the stunned myocardium were investigated in anesthetized dogs subjected to a 15-min coronary artery occlusion followed by 3 hr of reperfusion. Saline or KT-362 (300 micrograms/kg/min i.v.) were infused 15 min before and throughout occlusion of the left anterior descending coronary artery. There were no significant differences between groups in ischemic bed size or collateral blood flow, however, during ischemia and after reperfusion, KT-362 produced a significant decrease in the heart rate-systolic pressure product, an index of myocardial oxygen demand. In addition, there was a significant decrease in the incidence of reperfusion-induced ventricular fibrillation in the drug-treated animals. KT-362-treated dogs showed a marked improvement in myocardial segment function of the ischemic-reperfused region at 1, 2, and 3 hr of reperfusion as compared to the saline-treated animals (3 hr percentage of segment shortening of pretreatment: saline group, 14 +/- 10; KT-362 group, 59 +/- 7). These results demonstrate that KT-362 has a favorable effect on the functional recovery of the ischemic-reperfused myocardium and incidence of ventricular fibrillation, and may be of potential benefit as a new therapeutic agent for the treatment of coronary heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardioprotective effects of a new vascular intracellular calcium antagonist, KT-362, in the stunned myocardium. 253 31

A new transdermal system (BIO TSD) containing the beta-adrenergic blocker mepindolol was assessed in a placebo controlled clinical trial in 12 patients with coronary heart disease. On therapy, the number of anginal attacks and the consumption of oral nitroglycerin (glyceryl trinitrate) were reduced significantly. During ergometer exercise the exercise tolerance was improved and the ischemic ST-segment depression was reduced significantly. Holter monitoring revealed significant reductions of the number of manifest and silent episodes and the total duration of ischemia. No relevant side effects were observed.
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PMID:[Anti-ischemic action of the transdermally applied beta-receptor blocker, mepindolol in patients with stable angina pectoris]. 257 3

We investigated the anti-ischemic effects of PK 11195 (RP 52028), a selective ligand for peripheral type benzodiazepine binding sites in man. In a first series of patients, we did not find any hemodynamic effect of 10 mg (8 patients) or 20 mg (8 patients) of the intravenously administered drug. The anti-ischemic effect was evaluated on 16 patients with coronary heart disease and a positive stress test in a double blind study of 20 mg of intra-venous PK 11195 (8 patients) versus placebo (8 patients). Ischemia was induced by pacing, and assessed by ST segment depression and lactates extraction before and 15 minutes after administration of the drug. No statistical differences could be found on these ischemia indices between the placebo and PK 11195 treated groups. Although experimental studies have shown interaction of the drug with the calcium channels, our study did not demonstrate any anti-ischemic effect with the dosage used.
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PMID:[Absence of an anti-ischemic effect of the peripheral benzodiazepine receptor antagonist PK 11195. Study by atrial stimulation in man]. 259 44

Despite recent declines in mortality from coronary heart disease (CHD), it remains the major cause of death in the United States for blacks and whites. Although the prevalence of the ischemic syndromes in blacks and whites is similar, cardiac mortality and sudden cardiac death rate are higher in blacks. Recent attempts to explain the excess mortality in blacks have focused on barriers to health care and on sociocultural differences in perceptions of and responses to symptoms of CHD. However, the anatomic substrates of ischemia and sudden cardiac death are also different in blacks and whites. Obstructive coronary artery disease tends to be more severe in whites, while blacks have a greater prevalence of hypertensive heart disease. A body of evidence has recently emerged showing that the presence of left ventricular hypertrophy (LVH) is an important, potent predictor for subsequent cardiac death and that the mortality risk of LVH may be particularly high when underlying coronary disease is present. The greater prevalence and severity of hypertension and LVH in blacks may explain the higher cardiac mortality in blacks, even in the presence of less severe coronary disease. The reason why mortality risk is increased in the presence of LVH has not been established. Evidence suggests that it may be due to the increased predisposition to malignant arrhythmias and the increased frequency of potentially lethal silent ischemic events that occur in hypertensive individuals, particularly those with LVH.
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PMID:Anatomic substrate differences between black and white victims of sudden cardiac death: hypertension, coronary artery disease, or both? 262 Apr 68


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