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

Male weanling rats were made copper deficient with a purified diet containing all known essential dietary nutrients except copper. Copper deficiency was verified by indirect (anemia, growth retardation, hypercholesterolemia, gross pathology, and abnormal electrocardiograms) and direct (tissue copper analysis) criteria. His bundle electrographic and electrocardiographic changes detected in the copper-deficient group consisted most notably of depressed His-Purkinje system conductivity and S-T segment depression. Phosphorus-31 nuclear magnetic resonance spectroscopic analysis of cardiac, renal, and hepatic tissue perchloric acid extracts revealed significant metabolic changes associated with the dietary copper deficiency, including a generalized marked decrease in ATP and phosphocreatine levels and a corresponding increase in inorganic orthophosphate and ADP levels in the various tissues. Tissue-specific changes consisting of elevated ribose 5-phosphate (heart), phosphocholine (heart), and inosine monophosphate (kidney) and decreased glycerol 3-phosphorylethanolamine (liver) and glycerol 3-phosphorylcholine (liver) levels were detected in copper-deficient rats. Microscopic examination of heart tissue from copper-deficient rats revealed extensive disruption of mitochondrial fine structure, including fragmentation of cristae and inner and outer mitochondrial membranes, which resulted in pronounced vacuolization throughout the tissue. Although the physiological and metabolic disturbances manifested in hearts from copper-deficient animals generally mimic myocardial responses to chronic ischemia, the observed changes are interpreted in a broader context to represent the appearance of a copper-dependent cardiomyopathy.
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PMID:Physiological and metabolic characterization of a cardiomyopathy induced by chronic copper deficiency. 663 5

Patients with hypercholesterolemia have impaired coronary and peripheral endothelial function. In patients with coronary artery disease, intracoronary acetylcholine infusion or mental stress causes paradoxical vasoconstriction, whereas lowering cholesterol restores endothelial function. The impact of lipid lowering by fluvastatin on myocardial perfusion in hypercholesterolemic patients with perfusion abnormalities was assessed by thallium-201 single photon-emission computed tomography (SPECT). A total of 22 patients were treated with fluvastatin (40 mg once daily) for 6 weeks, followed by 40 mg twice daily if low density lipoprotein cholesterol (LDL-C) levels were decreased by < or = 30%. During the 12-week treatment period, myocardial perfusion was measured by quantitative SPECT after standardized stress testing at baseline and after 12 weeks. Preliminary results for 17 male patients (mean age, 59.3 +/- 6.7 years) are presented here. LDL-C decreased from 191 +/- 26 to 146 +/- 28 mg/dL (p < 0.001). In ischemic segments myocardial perfusion increased by 30% (280 +/- 100 to 365 +/- 110 counts per matrix; p < 0.001). In normal segments perfusion increased by only 5% (451 +/- 74 to 473 +/- 69 counts per matrix; p < 0.005). The change in perfusion rate between ischemic and normal segments was significant (p < 0.005). In conclusion, LDL-C lowering with short-term fluvastatin therapy improved myocardial perfusion, especially in areas of ischemia. This suggests that improvement is due to functional restoration of coronary endothelium by fluvastatin, before anatomic regression of stenosis can occur following long-term treatment.
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PMID:Improvement of myocardial perfusion by short-term fluvastatin therapy in coronary artery disease. 760 86

Short-term outcome after coronary angioplasty is mainly determined by restenosis, while long-term outcome is determined by new events due to incomplete revascularization, by atherosclerosis progression and by late-restenosis. The aim of this study is to assess if correctly treated coronary risk factors are predictors of poor prognosis after coronary angioplasty. Two-hundred and twenty six patients (209 males, 17 females, mean age 56 +/- 9 years) with successful coronary angioplasty were treated for coronary risk factors. New events (death, myocardial infarction, repeat angioplasty, bypass surgery) were recorded. Ischemia was evaluated by serial exercise tests. The mean follow-up was 31 +/- 12 months. Survival was 99.5% at 1 year and 97.4% after 5 years; "event free survival" was 84.6% at 1 year and 65.9% after 5 years; "ischemia free survival" was 84.6% at 1 year and 44.8% after 5 years. "Ischemia free survival" was higher in patients with single coronary angioplasty and in patients with infarct-related vessel angioplasty. Smoke addiction, diabetes, hypercholesterolemia and hypertension were not significantly correlated with "ischemia free survival". Smokers and diabetics had a trend towards a less favorable 5 year outcome, but without statistical differences. In conclusion, this study shows that correctly treated coronary risk factors do not worsen prognosis after coronary angioplasty.
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PMID:[Long-term prognosis after coronary angioplasty in relation to the presence of modifiable factors of coronary risk]. 767 Dec 80

In a cross-sectional survey, we estimated the prevalence of coronary heart disease in a sample of 975 middle-aged males (35-59 years), from a defined population in the Central province of Sri Lanka using the London School of Hygiene cardiovascular questionnaire and a 12-lead electrocardiogram. The estimated prevalence rates were: (a) Definitive evidence of ischemic heart disease (positive symptoms and ECG changes of ischemia), 16/1000 (95% C.L., 9-27). (b) Evidence of coronary heart disease based on history alone 54/1000 (95% C.L., 40-71). (c) Estimate based on ECG changes of ischemia without symptoms 32/1000 (95% C.L., 21-46). Median values for major risk factors were: systolic blood pressure 120 mmHg, diastolic blood pressure 88 mmHg, serum cholesterol 4.99 mmol/l, high density lipoproteins 0.99 mmol/l and body-mass index 20.4 kg/m2. About half (57.9%) the subjects were current smokers, 17% had actual hypertension (systolic blood pressure > 159 mmHg and/or diastolic blood pressure > 94 mmHg and/or been treated for hypertension), 12.6% had hypercholesterolemia (serum cholesterol levels > 6.5 mmol/l), 18.4% had a body-mass index > 24 kg/m2 and 5.8% were diabetic. Hypercholesterolemia (> 6.5 mmol/l), a higher body-mass index (> 24 kg/m2) and diabetes were more prevalent among subjects living in an urban rather than a rural environment.
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PMID:Prevalence of coronary heart disease and cardiovascular risk factors in middle aged males in a defined population in central Sri Lanka. 781 62

Excessive tiredness is one of the most prevalent premonitory symptoms of myocardial infarction and sudden cardiac death. This state is labelled as vital exhaustion and consists of three components: fatigue, increased irritability, and demoralization. Vital exhaustion has been found to be an independent risk-indicator of myocardial infarction in one prospective study and several case-control studies. It is as yet unclear whether the association between vital exhaustion and future myocardial infarction can be explained by confounding of (subclinical) coronary artery disease. Therefore, the present study investigates the predictive value of vital exhaustion for the occurrence of new cardiac events after percutaneous transluminal coronary angioplasty (PTCA), while explicitly controlling for the severity of coronary artery disease. Patients with a successful PTCA were followed during 1.5 years. A new cardiac event was defined as present if one of the following end points occurred: cardiac death, myocardial infarction, coronary bypass surgery, repeat-PTCA, increase of coronary atherosclerosis, or new anginal complaints with documented ischemia. Vital exhaustion was assessed using the Maastricht Questionnaire two weeks after hospital discharge. Participants of the present study were 127 patients (mean age 55.6 +/- 9.1; 105 men, 22 women). Fifteen (35%) of the 43 exhausted patients experienced a new cardiac event, whereas 14 (17%) of the 84 not exhausted patients had a new cardiac event (OR = 2.7; CI = 1.1-6.3; p = .02). Multiple logistic regression analysis revealed that vital exhaustion continued to be of predictive value when other significant risk factors for new cardiac events were controlled for (i.e., severity of coronary artery disease and hypercholesterolemia).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Vital exhaustion predicts new cardiac events after successful coronary angioplasty. 797 9

Coronary heart disease, stroke and peripheral arterial disease are the major causes for death and disability in industrialized countries. These diseases have a common cause: Their development is based on atherosclerotic changes of blood vessels, induced by risk factors such as elevated values of lipoproteins and fibrinogen. There is no doubt that the risk factors mentioned above are even related to a dramatically deterioration of the hemorheologic pattern, thus reducing perfusion. Due to this massage there are attempts to treat ischemia via hemorheological intervention. Although a number of different methods is available--hemodilution, defibrinogenation or oral medication--it was not possible to improve the hemorheologic pattern fast, safe, and efficient to date. A new treatment modality, utilizing the heparin-induced extracorporeal LDL precipitation (HELP), now offers the possibility to obtain therapeutical success not only in cases of severe hypercholesterolemia but even in the field of hemorheology: Using HELP a safe and rapid reduction of lipid fractions and fibrinogen has become feasible, thus providing an acute improvement of red cell aggregation and filterability of blood cells, whole blood and plasma viscosity and thereby of microcirculation. As it is known that cerebrovascular diseases are related to disturbances of the hemorheological situation, the HELP system is used at the Department of Neurology, Karl-Franzens University of Graz, for the treatment of acute stroke, cerebral multi-infarct disease but even in cases of peripheral arterial disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Heparin-induced extracorporeal LDL precipitation (HELP): a new therapeutic intervention in cerebrovascular diseases and peripheral arterial occlusive disease]. 815 30

Patients surviving acute myocardial infarction are susceptible to heart failure, recurrence of angina, reinfarction, arrhythmias, and sudden cardiac death. Most deaths occur in the first six months after infarction. Advancing age is the most important nonmodifiable prognostic factor for long-term prognosis, whereas left ventricular function assessed clinically or measured as either ejection fraction or end-systolic volume is the most important modifiable factor. Other significant long-term prognostic factors include: postinfarction angina at rest, inducible ischemia during exercise testing with or without radioisotope imaging, severity and extent of coronary artery disease, patency of the infarct-related artery, late ventricular arrhythmias, decreased heart rate variability, cigarette smoking, hypercholesterolemia, and diabetes mellitus. Identification of these adverse prognostic factors permits risk stratification and enables physicians to determine the most appropriate and cost-effective treatment. Most patients should have a stress test for inducible ischemia and a non-invasive (echo or radionuclide) assessment of left ventricular function. For high-risk patients such as those with prior infarction, heart failure, early postinfarction angina, or frequent late ventricular arrhythmias, coronary angiography and ventriculography prior to discharge are recommended. Assessment of late potentials and heart rate variability will help identify a subgroup of patients at risk for ventricular arrhythmias and cardiac death. However, a more accurate prediction of reinfarction is not possible at present, and no reliable test for atherosclerotic plaque instability has been developed.
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PMID:Factors affecting outcome after recovery from myocardial infarction. 819 87

On the basis of the available data concerning the indications for and the timing of arteriography after thrombolysis, the inevitable conclusion is that conservative instead of aggressive management is indicated for the 40% to 50% of patients at low risk who do not have spontaneous myocardial ischemia or myocardial ischemia that was provoked. Factors to be considered in treatment decisions for individual patients after thrombolytic therapy include risk factors before and after thrombolytic therapy, the results of studies assessing conservative versus aggressive post-thrombolytic management, the accuracy of risk stratification by noninvasive testing, and the relevance of the "open artery" hypothesis. The low-risk patient with a left ventricular ejection fraction above 40% and no ischemia during adequate stress testing has a low 3-year mortality rate. Although benefits of routine coronary arteriography exist relative to determining the severity of coronary artery disease and whether the infarct-related artery is patent, selective coronary arteriography is a more feasible and less expensive approach for appropriate patients. The low annual mortality rate with this approach is equal to that obtained when patients undergo routine coronary arteriography with myocardial revascularization based upon the result of the routine procedure. The modification of various coronary risk factors appears as valuable for patients who have undergone thrombolytic therapy as for those who did not. Specifically, the cessation of smoking, the control of hypertension, and the treatment of hypercholesterolemia are indicated for patients after thrombolysis when any of these modifiable risk factors are present. Secondary prevention with pharmacologic agents appears to be similar for those who have undergone standard or thrombolytic therapy. Long-term aspirin therapy is routine for secondary prevention; long-term beta-blocker therapy is useful for high-risk patients; and long-term treatment with angiotensin-converting enzyme inhibitors is indicated for patients after thrombolysis who have a low left ventricular ejection fraction.
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PMID:Management of patients after myocardial infarction and thrombolytic therapy. 820 34

We have evaluated in a case-control study the association of the main risk factors with cerebrovascular ischemic accidents in elderly patients. Two hundred and twenty patients aged 65 year or more (average age 77.3 +/- 7.3 yr, 93 males and 127 females) admitted to our Division for stroke (122) or transient ischemic attacks (TIA) (98) were enrolled: 220 hospitalized patients, age and sex-matched, without actual or previous cardiovascular clinical manifestations were the control group. Advanced senile decay, hepatic or renale failure and malignancies were considered exclusion criteria for both groups. The following risk factors have been considered: family history, obesity, cigarette smoking, diabetes, hypercholesterolemia, hypertriglyceridemia, atrial fibrillation, left ventricular hypertrophy, and related continuous variables. After logistic multiple regression analysis, atrial fibrillation, hypertension and blood cholesterol concentration above 240 mg/dl were significantly and independently associated with stroke, while only hypertension and hypercholesterolemia were associated with TIA. The unexpected finding of a significant association between hypercholesterolemia and cerebrovascular ischemia seems attributable to the choice of hospitalized patients as control group. These results indicate that hypertension and atrial fibrillation are independently associated with ischemic stroke even in advanced age.
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PMID:[Ischemic stroke and transient ischemic attacks: a case-control study of the risk factors in elderly hospitalized patients]. 848 30

This study reports the results of routine evaluation to detect coronary and carotid atherosclerosis in 200 asymptomatic and hypercholesterolemic patients (48 +/- 10 years: 72.5% men). All patients underwent physical examination, blood lipid profile, an exercise test and cervical echo-doppler. If the exercise electrocardiogram was abnormal, a thallium isotope scan and/or coronary arteriography were performed. Hypercholesterolemia was severe (3.03 +/- 0.52 g/l). 77.5% of patients had pure hypercholesterolemia. Carotid atherosclerosis in the form of plaque (27.5%) or stenosis (3.5%) was found in 31% of patients. This carotid atheroma was commoner in older patients (51.9 +/- 9 years as against 47 +/- 10 years, p < 0.01). Twenty patients (10%) had electrical signs of ischemia provoked by exercise. Six of them had a normal thallium isotope scan and did not undergo coronary arteriography. Coronary arteriography was abnormal in 10 patients (5%): 7 had stenotic lesions and 3 showed evidence of spasm during the methylergometrine test. In total, the hypercholesterolemic patients investigated here were characterised by subclinical atherosclerosis which was frequent but certainly underestimated by non-invasive studies. The existence of an atherosclerotic lesion is an additional argument in favour of starting cholesterol-lowering treatment.
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PMID:[Systematic cardiovascular evaluation and hypercholesterolemia. Results in 200 asymptomatic patients]. 849 98


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