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)

The Bland-White-Garland Syndrome represents the anomalous origin of the left coronary artery of pulmonary trunk. Only 10% of the patients reach adulthood. Clinical manifestations of the syndrome are angina, dyspnoe, ECG signs of ischemia, myocardial infarction, and death in childhood. We present the case of a 47 year old woman with Bland-White-Garland Syndrome, who was resuscitated from ventricular fibrillation. The only symptom shown in her personal history was progressive dyspnoea in the last 6 months, though mitral insufficiency was known since childhood. On echocardiographic examination, she showed an anterolateral infarction and a mitral insufficiency II. As operation procedure, the ligation of the left main coronary artery and bypass surgery with a left internal mammarian graft to the left descending branch of the left coronary artery was chosen. The mechanism of onset of ventricular tachycardia in our patient is not known. Three pathophysiological mechanisms may be possible: (1) local ischemia caused by the shunt, (2) a reentry circuit in the border zone of myocardial infarction, (3) electrical instability caused by endocardial fibrosis. As local ischemia and reentry circuit were widely excluded, only endocardial fibrosis could induce further ventricular arrhythmia. We therefore intended to implant an AICD to have the most possible safety for our patient. But this, postoperatively was refused by the patient. In analogy to Coronary Artery Disease, the risk for sudden cardiac death postoperatively may be due to three factors: (1) presence of a reentrant circuit, (2) LV-function below 40%, and (3) presence of endocardial fibrosis. Our patient showed a low risk for sudden cardiac death. On electrophysiological study, no ventricular tachycardia could be induced in our patient, indicating the absence of a reentry circuit. LV function exceeded more than 40%. In Holter ECG, only few ventricular premature beats could be registrated, indicating a low risk for sudden cardiac death in the presence of endocardial fibrosis. In the follow-up of fourteen months, the patient remained free from arrhythmic events.
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PMID:[Successful resuscitation of a patient with ventricular fibrillation in Bland-White-Garland syndrome in adulthood. A case report]. 974 68

Mitral insufficiency caused by ischemia is frequently found in anomalous origin of the left coronary artery from the pulmonary artery. We report a case of a 25-year-old woman who was diagnosed to have anomalous origin of the left coronary artery from the pulmonary artery and had successful left internal mammary artery bypass grafting 16 years after mitral valve replacement for mitral insufficiency of an unknown cause in her childhood.
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PMID:Delayed diagnosis of anomalous origin of the left coronary artery 16 years after mitral valve replacement. 987 6

Dynamic mitral regurgitation (MR) is typically associated with either severe systolic left ventricular dysfunction or episodes of acute myocardial ischemia. We report three patients with mild combined mitral stenosis and regurgitation and normal global left ventricular systolic function who presented with severe exertional dyspnea. Upright bicycle exercise echocardiography revealed development of severe dynamic MR in all three cases with Doppler evidence of severe pulmonary hypertension. There was no echocardiographic or electrocardiographic evidence of ischemia. Exercise echocardiography is an established tool for assessing dynamic changes in transvalvar pressure gradients. These results suggest that exercise echocardiography may also be useful for evaluating changes in severity of MR and for the assessment of dynamic changes in pulmonary artery systolic pressures.
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PMID:Exercise echocardiography in combined mild mitral valve stenosis and regurgitation. 1014 21

Left ventricular hypertrophy (LVH) is supposed to be a useful marker of cardiovascular (CV) complications during the course of hypertension (HT). To evaluate it, authors compared the clinical findings in hypertensive patients (pts) with and without LVH defined by echocardiography (echo). Hospital records of hypertensives treated in the 1st Medical Department during the year 1995 were analysed. LVH was defined by echo (Penn convention) as left ventricular mass index (LVMI) > 125 g/m2 in men and > 115 g/m2 in women. Presence of LVH was found in 72 pts (mean age 66 y), absence of LVH in 38 pts (mean age 56 y). There were statistically significant more CV complications in LVH-positive pts (incidence of myocardial infarction, arrhythmias, heart failure, ischemia (ECG), mitral regurgitation) as in LVH-negative. Tendency for other complications in LVH-positive pts (incidence of renal failure, stroke, LV diastolic dysfunction and aortic regurgitation) was also present. LVH-positive pts were about ten years older than the LVH-negative. In other risk factors (LVH and age not included) the both groups of pts were matched. LVH in pts with HT brings usually a complicated course of the disease. Age is an important contributing factor. Authors recommend to look after LVH presence in hypertensives as it carries much more complicated course of the disease.
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PMID:[Significance of left ventricular hypertrophy in hypertension]. 1035 60

Nitrates have been widely used in the treatment of patients with chronic congestive heart failure. Although the use of these drugs has not been approved by the Food and Drug Administration, multiple studies have shown their favorable effects. Organic nitrates have been shown to have a beneficial effect on ischemia, hemodynamic profile, magnitude of a mitral regurgitation, endothelial function, and cardiac remodeling. These drugs, when used in combination with hydralazine, have improved exercise capacity and survival. Recent studies have shown that the use of nitrates in patients already treated with standard heart failure therapy, including angiotensin converting enzyme (ACE) inhibitors, resulted in hemodynamic improvement, marked enhancement of exercise tolerance, reduction of left ventricular size, and augmentation of systolic function. These data suggest a role for organic nitrates as an adjunctive therapy to ACE inhibitors in patients with chronic heart failure and for nitrates in combination with hydralazine as an alternative treatment in patients who are intolerant to ACE inhibitors.
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PMID:The role of organic nitrates in the treatment of heart failure. 1036 48

To answer whether atrial ischemia plays an important role in the genesis of atrial fibrillation in patients with coronary artery disease, we analyzed the electrocardiograms obtained at the time of coronary angiography and left ventriculography in 3220 consecutive patients. Atrial fibrillation was found in 74 (2.3%). Among those with significant coronary artery disease were 49 (66.2%) patients with atrial fibrillation and 88.5% with sinus rhythm (P<0.02). Angiograms of patients with atrial fibrillation and significant (>50%) coronary stenosis were re-evaluated and results compared to the control group which consisted of 108 consecutive patients who were in sinus rhythm at the time of coronary angiography. There were no differences between groups with respect to either frequency of injury to the right coronary artery and circumflex branch of left coronary artery or localization of the injury to this region (before or after atrial branch take-off). But patients with atrial fibrillation significantly more often had heart failure (55.1% versus 18.5%, P<0.001) and three vessel disease (30.5% versus 20.4%, P=0.05) as well as mitral valve insufficiency (20.4% versus 10.2%, P<0.05). In conclusion, in patients with coronary disease, systolic heart failure may be more important than atrial ischemia in causing atrial fibrillation.
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PMID:Atrial fibrillation in coronary artery disease. 1122 79

Between January 1990 and December 1999, 20 patients underwent the valve surgery concomitant with coronary artery bypass grafting. There were 16 males and 4 females, their mean age was 66.5 years. Of the 20 patients, aortic stenosis was noted in 7, aortic regurgitation in 3, mitral stenosis in one, and mitral regurgitation in 9 patients. The cause of mitral regurgitation was considered to be an ischemic change in six patients, including ruptured papillary muscle due to myocardial infarction in two patients. On the contrary, LMT lesion was recognized in 5, LAD lesion in 17, LCX in 16, and RCA in 12 patients. Seven patients had preoperative myocardial infarction, three patients were required preoperative IABP support. AVR was performed in 10, MVR in 5, and MAP in 5 patients. The number of bypass was 1.9 +/- 0.85. Four patients died of LOS and MOF. The remaining 16 patients have been doing well. The significant difference between the survived and the not survived patients was recognized in the factor of emergency, preoperative IABP, papillary muscle rupture due to myocardial infarction, history of PTCA, LAD lesion, and the time of CPB. The factors regarding coronary artery had the influence on the outcome of a patients of valve surgery concomitant with CABG. Therefore, an appropriate myocardial protection and perioperative management for ischemia were mandatory.
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PMID:[Perioperative risk factors in valve surgery concomitant with coronary artery bypass grafting]. 1093 83

The echocardiographic examination is generally performed in patients with heart failure and it often gives a significant contribution to the differential diagnosis. Firstly, the evaluation of left ventricular pump function by measuring the ejection fraction (EF) can distinguish patients with heart failure into two different groups, with depressed or preserved EF. The most frequent causes of heart failure and depressed EF are coronary artery disease, idiopathic dilated cardiomyopathy (DCM) and hypertensive heart disease. Although the echocardiographic features of coronary artery disease versus idiopathic DCM may be similar, the demonstration of inducible ischemia at dobutamine echocardiographic test suggests the presence of significant coronary artery disease and may be useful in the selection of cases for coronary arteriography. The association of left ventricular hypertrophy, hypokinesis and, sometimes, significant dilation is compatible with hypertensive heart disease or end-stage hypertrophic cardiomyopathy. No useful echocardiographic findings can identify the patients with genetic DCM or affected by myocarditis from other cases with idiopathic DCM. Some advanced cases of right ventricular dysplasia/cardiomyopathy may show a biventricular involvement and mimic DCM; these patients are usually characterized at echo by predominant right ventricular dilation and multiple a-dyskinetic bulges in the absence of pulmonary hypertension. Very difficult to manage are the patients with significant left ventricular dysfunction and severe valvular heart disease (such as aortic stenosis or mitral regurgitation). According to the literature, the left ventricular systolic function is relatively preserved (EF > 40%) in 30-40% of patients with heart failure. In these cases a diastolic dysfunction may be hypothesized. Echo-Doppler evaluation can be helpful in the recognition of signs of increased left ventricular stiffness ("restrictive filling pattern") and of increased filling pressures. In the differential diagnosis one must first consider the most frequent heart disorders that may present with this clinical syndrome, coronary artery disease and hypertensive heart disease. Furthermore, other less common diseases characterized by heart failure due to predominant diastolic dysfunction are the following: hypertrophic and restrictive cardiomyopathies, infiltrative heart diseases, such as amyloidosis, and constrictive pericarditis. Restrictive cardiomyopathy is characterized by heart failure and preserved left ventricular EF in the absence of significant ventricular dilation and hypertrophy; typical, although not pathognomonic, echocardiographic features are atrial enlargement ad restrictive filling pattern. In distinguishing constrictive pericarditis from restrictive cardiomyopathy useful Doppler signs are the wide respiratory variability in flow velocities at mitral and tricuspid levels, due to increased ventricular interdependence caused by the presence of an abnormally rigid pericardium.
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PMID:[Contribution of echocardiography to the diagnosis of patients with chronic heart failure]. 1106 13

The data regarding the potential benefits of direct stenting in the setting of angiographically apparent thrombus-containing lesions are scarce. The aim of this study was to evaluate the impact of direct stenting on the angiographic results in the setting of thrombus. We reviewed our institutional interventional database and identified 30 patients who had undergone stenting in the setting of angiographically apparent thrombus-containing lesions (33% unstable angina pectoris, 67% acute myocardial infarction). The majority of patients had a baseline TIMI 2 and 3 flow (80%). Of the 6 patients (20%) who had TIMI 0-1 flow at baseline, four of them achieved a TIMI 2 flow immediately after crossing the lesion with a 0.014 guidewire. Although the remaining 2 patients had TIMI 1 flow, as distal opacification beyond the stenosis was obtained we successfully implanted the stents directly. All stents were successfully implanted without any crossing failure or stent loss. There was no "no re-flow", with a final TIMI 3 flow rate in 93%. In 1 patient with TIMI 2 flow after stenting, TIMI 3 flow was obtained after intracoronary verapamil. In 2 patients (7%, TIMI 2 flow), a final TIMI 3 flow could not be achieved despite intracoronary nitroglycerin and verapamil. There was no stent loss and imprecise stent placement. There were no in-hospital deaths, repeat interventions or coronary artery bypass graft surgeries. However, two patients had undergone mitral valve replacement due to severe mitral regurgitation. Eight patients with recurrent ischemia had control angiography; stents were found to be patent in all 8 patients. Two patients experienced recurrent myocardial infarction (6.6%). Direct stenting strategy in thrombus-containing lesions seems to be a safe and feasible approach in avoiding no re-flow. We believe that benefits observed with direct stenting in this study should be compared to conventional stenting in the same setting with a randomized study.
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PMID:Direct stenting in angiographically apparent thrombus-containing lesions. 1168 18

Mitral regurgitation is a common valvular abnormality that can result in substantial morbidity. Primary care physicians should maintain a high index of suspicion for this disorder, especially in patients with symptoms of heart failure. The paramount concern is early identification of patients with mitral regurgitation and prompt referral to a cardiologist when symptoms occur or if evidence of ventricular enlargement or reduction in ejection fraction is found. Echocardiography is an invaluable tool in determining the severity of regurgitation, the integrity of the mitral valve apparatus, the extent of left ventricular enlargement, and the ejection fraction. Although no standard medical treatment has been established for mitral regurgitation, use of ACE inhibitors is appropriate. Patients presenting with severe, acute mitral regurgitation from papillary muscle rupture should be evaluated for ischemia and treated expediently. The preferred operative procedure in patients with severe mitral regurgitation and left ventricular dysfunction is mitral valve repair, if possible, or mitral valve replacement with posterior chordal preservation, if feasible.
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PMID:Native mitral valve regurgitation. Proactive management can improve outlook. 1178 16


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