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)

A sharp and unusually high increase in the serum of glutamic-oxalacetic and glutamic-pyruvic transaminase and of lactic-dehydrogenase accompanied the terminal events, acute pulmonary edema with cardiogenic shock, in 2 patients suffering from chronic congestive heart failure caused by dilatative myocardiopathy. Experimental and clinical data raises the possibility that the considerable enzymic increase may be due to the combined effect of chronic stasis and acute ischemia on the liver.
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PMID:[Acute hepatic ischemia and cardiogenic shock in patients with dilated cardiomyopathy]. 208 28

To investigate the diagnostic value of carbon dioxide arteriograms in patients with peripheral vascular disease, ten patients in whom standard contrast arteriography was contraindicated underwent carbon dioxide digital subtraction arteriography. Lower extremity ischemia or severe hypertension with renal insufficiency were the indications for arteriography. Standard contrast arteriography was precluded by chronic nondialysis-dependent renal insufficiency, severe congestive heart failure or contrast hypersensitivity. All critical arterial segments were well visualized with the exception of the infrapopliteal arterial tree in three patients. Adequate imaging of this segment required the addition of 20 cc of dilute nonionic contrast. Guided by carbon dioxide digital subtraction arteriography, four percutaneous transluminal angioplasties and three reconstructive procedures were successfully performed. One patient did not have surgically reconstructible disease and two had renal arteries without critical stenoses. Renal function transiently deteriorated in one patient who received 20 cc of nonionic contrast. No adverse events occurred due to carbon dioxide. Clinically useful diagnostic arteriograms are possible using carbon dioxide as the contrast agent.
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PMID:Carbon dioxide digital subtraction arteriography: a pilot study. 212 Dec 15

From the discussion of these questions, several conclusions seem firm, whereas other issues await resolution. Patients with severe CHF should be treated with diuretics, digoxin, and an ACE inhibitor. In mild and moderate CHF, a diuretic should be combined with either digoxin or an ACE inhibitor--usually the latter. However, most of these patients would benefit from receiving all three drugs. Patients with asymptomatic left ventricular systolic dysfunction are at jeopardy for progressive deterioration. Angiotensin converting enzyme inhibitors and, possibly, direct vasodilators may prevent progression. In initiating vasodilator therapy, ACE inhibitors usually should be the agent of choice. Exceptions may be patients with ongoing ischemia in whom nitrates are an appropriate alternative and those who are poor candidates because of hypotension, renal insufficiency, or hyperkalemia.
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PMID:Should all patients with congestive heart failure and dilated cardiomyopathy be treated with vasodilators? 219 51

In order to correctly appreciate the way cardiology developed in the last 40 years, the "state-of-the-art" balance when the first World Congress took place, September-1950, in Paris, is made. The most current diagnostic methods were relatively scarce at the time-ECG, chest X ray, phonocardiography, pulse wave tracings, coupled with vectorcardiography and ballistocardiography, but in the well equipped hospitals right ventricular catheterization was already performed. The therapeutics of the important morbid situations-like congestive heart failure, arterial hypertension, myocardial infarction and ischemia was disappointing, but closed heart surgery was already taking place. Since then, things had changed suddenly. Over the last 40 years a marked scientific and technology explosion has emerged, that had benefited cardiology science, encompassing several broad areas, namely, patient approaching, pathophysiology understanding, the emergence of new drugs and clinical use, interventional cardiology and remarkable progress in open heart surgery. Imaging techniques development and other technology lead to a simple and accurate cardiac diagnosis. 24 hours ECG and blood pressure recording, and cardiac output measurement, greatly improves our medical knowledge. Computers development, representing the most significant technology advances, has given to cardiology non-predicted advances.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The development of cardiology in the last 40 years]. 220 85

Normal left ventricular systolic performance with impaired left ventricular diastolic filling may be present in a substantial number of patients with congestive heart failure (CHF). To evaluate the effect of oral verapamil in this subset, 20 men (mean age 68 +/- 5 years) with CHF, intact left ventricular function (ejection fraction greater than 45%) and abnormal diastolic filling (peak filling rate less than 2.5 end-diastolic volumes per second [edv/s]) were studied in a placebo-controlled, double-blind 5-week crossover trial. All patients underwent echocardiography to rule out significant valvular disease, and thallium-201 stress scintigraphy to exclude major active ischemia. Compared to baseline values, verapamil significantly improved exercise capacity by 33% (13.9 +/- 4.3 vs 10.7 +/- 3.4 minutes at baseline) and peak filling rate by 30% (2.29 +/- 0.54 vs 1.85 +/- 0.45 edv/s at baseline) (all p less than 0.05). Placebo values were 12.3 +/- 4.0 minutes and 2.16 +/- 0.48 edv/s, respectively (difference not significant for both). Improvement from baseline in an objective clinico-radiographic heart failure score (scale 0 to 13) was significantly greater with verapamil compared to placebo (median improvement in score: 3 vs 1, p less than 0.01). Mean ejection fraction and systolic blood pressure were unchanged from baseline; diastolic blood pressure and heart rate decreased to a small degree. Verapamil may have therapeutic efficacy in patients with CHF, preserved systolic function and impaired diastolic filling.
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PMID:Usefulness of verapamil for congestive heart failure associated with abnormal left ventricular diastolic filling and normal left ventricular systolic performance. 222 Jun 22

Stimulated skeletal muscle grafts have been proposed as a means to reinforce ventricular wall in the treatment of severe myocardial failure. Latissimus dorsi cardiomyoplasty was performed in 11 patients with advanced heart failure due to cardiomyopathy who were in New York Heart Association (NYHA) class III or IV despite maximal medical therapy. There were no operative deaths. Eight patients were followed for a mean of 10.8 months. Two patients remain in muscle conditioning protocol. One patient died with latissimus dorsi ischemia and congestive heart failure. Four of the eight patients in long-term follow-up are in NYHA class I, three in class II, and one in class III. At 3 months of follow-up, rest radioisotopic left ventricular ejection fraction increased from 20.5 +/- 3.6% to 26.8 +/- 8.1% (p less than 0.01). Doppler-echocardiography demonstrated that left ventricular segmental wall shortening improved from 11.3 +/- 2.5% to 16.5 +/- 3.9% (p less than 0.01) and left ventricular stroke volume from 22.9 +/- 4.6 to 33.1 +/- 10 ml (p less than 0.01). Cardiopulmonary exercise test showed that maximal oxygen consumption during treadmill test increased from 14.8 +/- 3.7 to 18.2 +/- 3.3 ml/kg.min (p less than 0.05). At 6 months of follow-up, all the above values remained essentially unchanged. Furthermore, nonsustained ventricular tachycardia was abolished without specific medical therapy in four patients. Thus, cardiomyoplasty improves left ventricular function, reverses congestive heart failure, and may improve long-term survival in severe cardiomyopathies.
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PMID:Latissimus dorsi cardiomyoplasty in the treatment of patients with dilated cardiomyopathy. 222 13

The ability of maximal exercise thallium testing to stratify patients after non Q wave myocardial infarction was prospectively examined in 20 patients. Patients were enrolled in the study if there was no evidence of residual ischemia nor congestive heart failure during initial hospitalization. The thallium exercise test showed four patients to be at high risk, three of whom had successful revascularization. The remaining 16 patients were considered to be at low risk. There were no re-admissions for unstable angina, no myocardial infarctions and no deaths in the follow-up period (average 15 months). Thus patients with no evidence of early ischemia, no signs of left ventricular failure and a negative maximum thallium exercise test are at low risk following non Q wave myocardial infarction.
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PMID:Risk stratification in patients with non Q wave myocardial infarction: a role for thallium exercise testing. 227 99

Inotropic and vasodilator therapy for congestive heart failure improve left ventricular systolic performance by different mechanisms. However, the nature and extent to which diastolic filling is altered have not been well described. Acute severe left ventricular dysfunction was induced in 21 dogs by severe left ventricular global ischemia produced by left main coronary artery microsphere embolization until left ventricular end-diastolic pressure was greater than or equal to 18 mm Hg. Dobutamine was infused in seven dogs until the peak positive first derivative of left ventricular pressure (dP/dt) increased by greater than or equal to 33%. Nitroprusside was infused in seven dogs until left ventricular end-diastolic pressure was less than 15 mm Hg. Seven dogs were observed for 1 h after the induction of acute severe left ventricular dysfunction and served as the control group. In all groups of dogs, severe left ventricular dysfunction resulted in left ventricular dilation, reduction in area ejection fraction, elevation of left ventricular end-diastolic pressure and an early redistribution of diastolic filling (increased 1/3 and 1/2 filling fractions) despite a markedly abnormal time constant of relaxation. No changes were noted in any variable after 1 h of observation in the seven control dogs. Nitroprusside reduced left ventricular size and filling pressure, increased cardiac output, improved relaxation and redistributed diastolic filling to later in diastole as characterized by a reduced 1/3 filling fraction (19.4 +/- 7.4% versus 51.4 +/- 10%, p less than 0.001). The pressure-area curve was shifted downward and leftward.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of inotropic and vasodilator therapy on left ventricular diastolic filling in dogs with severe left ventricular dysfunction. 231 73

During the five-year period between March 1980 and February 1985 selective intracoronary thrombolysis with streptokinase was performed in 469 patients with clinical and ECG signs of acute transmural myocardial infarct. Coronary arteriography prior to thrombolysis showed the infarct related vessel still or again patent in 21% of the patients. Among 372 patients with complete occlusion streptokinase infusion was successful in 87%, but failed in 13%. Due to the high risk of reocclusion, early bypass surgery was performed in 69 patients (18.5%) of the successfully reperfused group. Indication was based primarily on an ischemic time interval of less than 4 hours between the acute onset of clinical symptoms and reperfusion. Early mortality was 1.5% in this surgically treated group and actuarial survival was 92% at 5 years with all but 3 patients in functional class I or II. Marked but non-fatal early congestive heart failure was more significant when patients underwent operation within the first 2 days after thrombolysis than thereafter. Late recatheterization studies in 29 patients showed a slight but statistically insignificantly higher occlusion rate for vein grafts to the infarct vessel (14%) than to concomitantly grafted arteries (6%). No correlation was found between the initial ischemic time interval and graft patency. Late left ventricular function was excellent or minimally impaired in 52% of these patients while 48% had significantly reduced LV function. Again, no correlation was found between the ischemic time interval and late LV function. LV aneurysm, however, occurred only in patients with an ischemia of more than 3 hours. Thrombolysis combined with early bypass surgery represents the optimal therapy for acute myocardial infarct.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Intracoronary thrombolysis and early bypass surgery for acute myocardial infarct: five years' experience. 242 39

The hemodynamic effects of cardiac pacing at different rates and in different modes were studied in 21 patients who were candidates for permanent pacemaker implantation. Nine of these had primary conduction disturbances (PCD), ten had ischemic heart disease (IHD), seven with additional cardiac failure (CHF), and two had hypertrophic cardiomyopathy (HCM). In patients with PCD, atrial (AOO) and AV sequential (DVI) pacing did not change systolic blood pressure and pulse pressure but ventricular (VVI) pacing caused a progressive fall in these measurements, especially as heart rate increased. Ventricular volume and stroke volume (counts) derived from radionuclide ventriculography (RVG) decreased progressively with higher pacing rates, especially during VVI pacing. Cardiac output was maintained during VVI pacing by the increase in heart rate; during AOO and DVI pacing, cardiac output increased. Similar but more marked differences were observed in patients with IHD and CHF and the changes were even greater in the patients with HCM. Left ventricular (LV) ejection fraction changed little with increasing heart rate in PCD but decreased progressively with the onset of ischemia in IHD and CHF. There was no difference in ejection fraction in the different pacing modes. Graphs related to LV contractility (end-systolic pressure-volume relations) showed that AOO pacing produced the highest and VVI pacing produced the lowest curves of myocardial contractility in all patient groups, except that at higher rates the AOO curve shifted down again in patients with IHD and CHF, presumably with the onset of myocardial ischemia. This study showed that physiological pacing produced the best hemodynamic results in all patient groups. Higher pacing rates should be avoided in patients with ischemic heart disease while VVI pacing should not be used in patients with HCM. Blood pressure and RVG studies during temporary pacing are useful in selecting the optimal pacing system in an individual patient when the clinical choice is not clear.
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PMID:Left ventricular function during physiological cardiac pacing: relation to rate, pacing mode, and underlying myocardial disease. 243 37


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