Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiac anesthesiologists have the responsibility to detect myocardial ischemia in a timely manner, which can be a challenging task in the perioperative environment. Transesophageal echocardiography pulmonary artery catheterization, and electrocardiography are the 3 major methods available for monitoring perioperative ischemia. Echocardiography, the newest and most sophisticated method, has been shown to be highly sensitive for detecting ischemia associated with systolic dysfunction. Echocardiography can detect wall-motion abnormalities before electrocardiographic changes develop in patients who are likely to experience supply-mediated ischemia. Perioperative ischemia that occurs after bypass and is detected using transesophageal echocardiography has been found to be related to an adverse outcome. However, the use of echocardiography has some limitations, including the detection of abnormalities not induced by ischemia and the presence of ischemia in areas not visible in the view selected. Pulmonary artery catheterization can provide information about systolic dysfunction, diastolic dysfunction, and mitral regurgitation, but the sensitivity and safety of catheterization have been questioned. Electrocardiography can be a superb monitoring device as long as clinicians pay adequate attention to lead selection and placement, filter selection, and gain adjustment. The optimal monitoring approach should integrate all 3 available monitoring systems in order to increase the likelihood of detecting both supply- and demand-mediated ischemia.
 ...
PMID:Multimodal detection of perioperative myocardial ischemia. 1642 87

Ischemia-induced mitral insufficiency (IMI) can occur when a papillary muscle ruptures in the acute phase of myocardial infarction (MI) or, more commonly, when ischemic heart disease reaches the chronic stage, with or without infarction. In the latter case it can be distinguished from organic mitral regurgitation because the structure of the valve and the subvalvular apparatus are not affected. Many factors contribute to the complex mechanism of IMI: incomplete closure of the valve is mainly a result of changes in the geometry of the left ventricle, the mitral annulus, papillary muscles and to hemodynamic conditions rather than to muscular dysfunction of the papillary muscles. IMI is assessed mainly by Doppler echocardiography. The adverse prognostic value of chronic IMI following an infarction has recently been described. Regurgitant orifice area (ROA) > 20 mm2 and a resting regurgitated volume > 30 ml or an increase in ROA > 13 mm2 on the treadmill-exercise echocardiogram were identified as relevant predictors of death. The therapeutic implications, both surgical and interventional, are currently under development using annuloplasty coupled, perhaps, to new strategies.
 ...
PMID:Chronic ischemic mitral regurgitation. 1660 93

Takayasu's arteritis (TA) is a primary vasculitis that causes stenosis or occlusion, rarely aneurysm and distal ischemia. This study was undertaken to examine cardiovascular damage using echocardiography and determine the causes of morbid-mortality in Mexican Mestizo patients with TA. Seventy-six patients were studied by transthoracic echocardiography. Left ventricular diameters, parietal thickness, systolic function, and wall motion were analyzed, also, valvular lesions and aorta features were assessed. Thickness of the interventricular septum was 12 mm +/- 3 (8-19), and that of posterior wall was 12 mm +/- 2 (9-18). The average left ventricular diastolic diameter was 47 mm +/- 7 (33-68) and the left ventricular systolic diameter 32 mm +/- 8 (16-64). The left ventricular ejection fraction was of 57 +/- 11%. Left ventricular concentric hypertrophy was found in 28 (50%) of the 56 hypertensive patients. The five-year survival of patients with left ventricular concentric hypertrophy was 80%, compared to 95% in patients without hypertrophy (P = 0.00). Abnormal wall motion was found in 15 patients. Thirty-one patients had aortic regurgitation, 19 had mitral regurgitation, 13 had tricuspid regurgitation, and 10 and pulmonary hypertension. Six patients had aneurysms of ascending aorta and 7 stenosis of descending aorta. Thirteen of 76 patients died (17%), 85% were hypertensive, and 9% also had acute myocardial infarction (AMI). Echocardiography, a noninvasive technique, shows a great utility in detection and follow-up of cardiovascular manifestations in patients with TA. New techniques, more sensitive toward detecting the early stages of left ventricular dysfunction, are promising to limit left ventricular hypertrophy development.
 ...
PMID:Echocardiographic follow-up of patients with Takayasu's arteritis: five-year survival. 1668 16

Patients with acute heart failure syndromes (AHFS) typically present with signs and symptoms of systemic and pulmonary congestion at admission. However, elevated left ventricular (LV) filling pressures (hemodynamic congestion) may be present days or weeks before systemic and pulmonary congestion develop, resulting in hospital admission. This "hemodynamic congestion," with or without clinical congestion, may have deleterious effects including subendocardial ischemia, alterations in LV geometry resulting in secondary mitral insufficiency, and impaired cardiac venous drainage from coronary veins resulting in diastolic dysfunction. It is possible that these hemodynamic abnormalities in addition to neurohormonal activation may contribute to LV remodeling and heart failure progression. Approximately 50% of patients admitted for AHFS are discharged with persistent symptoms and/or minimal or no weight loss in spite of the fact that the main reason for admission was clinical congestion. Accordingly, the assessment and management of pulmonary and systemic congestion in these patients require reevaluation.
 ...
PMID:Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. 1711 94

When dilated cardiomyopathy (DCM) is surgically corrected, intraoperative intracardiac hemodynamic changes and additional ischemia of the disabling myocardium make special demands for anesthesia, prevention of cardiovascular insufficiency, and maintenance of circulatory oxygen-transporting function (COTF). For the development and evaluation of an anesthetic support protocol for patients with DCM, clinical parameters, hemodynamics and oxygen transport was comprehensively analyzed in 50 DCM patients aged 16-68 years in the intraoperative period of surgical correction of myocardial pathology. All the patients underwent implantation of an extracardiac mesh framework in combination, if required, with correction of mitral insufficiency under extracorporeal circulation (EC), drug-induced cold cardioplegia. Analysis of comprehensive clinical studies made it possible to provide scientific evidence and to successfully use the anesthetic support protocol for correcting operations of chronic heart failure in patients with DCM, the basic principles of the support being an effective preoperative preparation of a patient to attenuate the signs of congestive heart failure; preventive intraaortic balloon contrapulsation before surgery; overall monitoring of hemodynamics and oxygen transport; balanced use of anesthetic agents in the doses that exert no cardiosuppressive effect; preload optimization and postload reduction; the minimum use of catecholamines; prevention of arrhythmias; and a reduction in the duration of myocardial ischemia.
 ...
PMID:[Anesthesiological provision of surgical correction of dilated cardiomyopathy in patients with chronic heart failure]. 1718 53

The echocardiographer responsible for the intraoperative evaluation should be familiar with the transesophageal echocardiography (TEE) views of mitral valve morphology as well as the the repair procedure(s) in order to assess postoperative results. The most frequent immediate mitral valve repair failures are a result of extensive valve disease, calcification, suture dehiscence, ischemia, technical misadventures, stenosis, or systolic anterior motion. Systolic anterior motion with left ventricular outflow tract obstruction and an associated posteriorly directed jet of mitral regurgitation is the most common cause of immediate failure after mitral valve repair. The incidence of this potentially devastating complication has decreased dramatically since the introduction of preoperative measures (sliding annuloplasty and anterior leaflet valvuloplasty) in those patients at risk. Intraoperative TEE is extremely valuable in evaluating the competency of the mitral valve following repair. In fact the results of this modality have a predictive valve in determining long-term outcomes in these patients.
 ...
PMID:The role of echocardiography in mitral valve dysfunction after repair. 1734 41

In order to develop simple technique of combination of transesophageal echocardiography (TEE) and transesophageal pacing, to create algorithm and protocol of transesophageal stress-echocardiography, and to study possible complications and methods of their elimination we examined 39 subjects (mean age 50 +/- 7.2 years) with suspected ischemic heart disease (IHD), 22 patients with arterial hypertension, 11 patients with episodes of ischemic changes on 24 hour ECG. In 11 patients with high blood pressure (BP) and 2 patients with frequent ventricular extrasystoles veloergometry was contraindicated, and in 3 patients veloergometry was not informative due to complete left bundle branch block. We suggested a device for simultaneous transesophageal echocardiography (TEE) and transesophageal pacing which consisted of transesophageal multiplane ultrasound cardiological transducer and electrode for transesophageal pacing. During test pacing frequency was increased stepwise from 120 140 and to 160 beats per min until appearance of ischemia or achievement of submaximal heart rate (HR). During intubation of esophagus HR and systolic BP increased from 80.2 +/- 11.5 to 102 +/- 12.5 b/min and from 130 +/- 23.6 to 149.1 +/- 17.5 mm Hg, respectively. Magnitude of double product rose from 104.4 +/- 29.4 to 149.4 +/- 32.3. This served as additive stress factor, facilitating more precise diagnosis of IHD. As a result various derangements of regional myocardial contractility were revealed in 14 patients (36%). These derangements were accompanied with ischemic ECG changes in 72% and with mitral regurgitation - in 43% of cases. The test was stopped prematurely in 1 patient because of paroxysm of reciprocal atrioventricular tachycardia. Simplicity of the proposed device, lack of complications allow to recommend it for clinical application. Anatomical proximity of esophagus and the heart, average 20 mm Hg elevation of BP, rising cumulative myocardial oxygen requirements augment reliability of the method in diagnostics of IHD.
 ...
PMID:[Novel diagnostic possibilities of transesophageal stress echocardiography with electrical atrial pacing]. 1826 Aug 88

Intracoronary infusion of autologous bone marrow cells (CTX) has been shown to improve myocardial function in post infarct patients and in patients with chronic ischemic cardiomyopathy. Whether CTX affects exercise-induced changes in cardiac deformation and mitral regurgitation (MR) in patients with end stage heart failure has not been studied. In this small pilot study, eleven patients with chronic ischemic cardiomyopathy, ejection fraction (EF) <25%, no inducible ischemia and heart failure class NYHA III underwent CTX. Symptom-limited bicycle exercise echocardiography was performed pre- and 4 months post CTX and maximum systolic strain (msyepsilon), peak systolic strain rate (psysr) and effective regurgitant orifice of MR (ERO) were determined. There were no complications related to the procedure. The overall clinical benefit of CTX was limited with a trend towards improvement (NYHA 3.0+/-0.1 pre and 2.7+/-0.2 post CTX, p=0.06). The EF did not improve after CTX. The wall motion score index (WMSI) did not change at rest but decreased significantly during exercise (1.48+/-0.16 vs. 1.44+/-0.17, p=0.01). In conclusion, CTX may improve cardiac deformation and MR during exercise in patients with severe chronic heart failure when viable areas are targeted.
 ...
PMID:Cell therapy for severe chronic heart failure: the Luxembourg experience. 1833 21

Congenital generalized lipodystrophy, also known as Berardinelli-Seip syndrome, is a very rare hereditary syndrome that is characterized by an almost complete absence of adipose tissue from birth. Cardiac involvement seems to have substantial influence in the long-term prognosis. Herein, we report an apparently unique case of congenital generalized lipodystrophy with cardiac sequelae. A 17-year-old woman, diagnosed in childhood with Berardinelli-Seip syndrome, presented with severe epigastric pain that was secondary to previous myocardial infarction. The patient had ischemia, dilated cardiomyopathy, and congestive heart failure, but no coronary artery disease. She was discharged from the hospital in stable condition after 3 days of medical treatment. To our knowledge, this is the 1st reported case of congenital generalized lipodystrophy with dilated cardiomyopathy, congestive heart failure, severe mitral regurgitation, and inferior myocardial infarction as cardiac sequelae of this syndrome--but without evidence of coronary artery disease or cardiac hypertrophy. In addition to discussing this patient's case, we present diagnostic and therapeutic approaches to Berardinelli-Seip syndrome.
 ...
PMID:Dilated cardiomyopathy and myocardial infarction secondary to congenital generalized lipodystrophy. 1861 89

During the last three decades, the most prevalent surgical mitral valve disease in Scandinavia has changed from the sequelae of rheumatic fever to the mitral valve pathologies related to ischemic heart disease. Also, the total number of patients in need of a mitral valve procedure is increasing. For several of the patients with ischemic mitral valve disease, the natural prognosis of their disease is dismal. However, there are several uncertainties as to whether or not a surgical procedure can improve the life expectancies of these patients. Also, the procedures of choice for patients with ischemia related "functional mitral valve disease" is a long standing controversy. In this issue of "Scandinavian Cardiovascular Journal" we present the rationale and protocol for the "MoMIC" trial, a randomized multicenter study aiming to clarify whether revascularization alone or a combined revascularization and mitral valve annuloplasty is the treatment of choice for patients with ischemia related moderate mitral regurgitation.
 ...
PMID:Mitral valve surgery--a Scandinavian perspective. 1885 Apr 85


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>