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

We evaluated 32 young patients with mitral valve prolapse (MVP) as the only recognized cause of cerebral ischemia. The mean follow-up from the time of the first ischemic event was 8 years. At the time of the follow-up evaluation, 24 patients (75%) had a normal cardiac examination, and 4 had midsystolic clicks; only 1 had the characteristic click-murmur. In 75%, the first ischemic event was stroke. When MVP-associated ischemia was recognized, 44% had recurrent ischemic events. In the mean 4-year period between diagnosis of MVP-associated ischemia and follow-up, 16% had recurrent ischemic events, but none had a new persistent deficit from these events. At the time of follow-up, 63% of patients were taking platelet antiaggregants or anticoagulants. These data suggest a good prognosis for recurrent ischemic events after diagnosis of MVP-associated ischemia.
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PMID:Mitral valve prolapse and cerebral ischemic events in young patients. 653 42

The association between mitral valve prolapse (MVP) and atypical chest pain has been well-described. Numerous theories have been proposed to explain this association. A number of lines of evidence suggest that underlying ischemia may cause chest pain in some patients with MVP. We have recently evaluated 4 patients with chest pain syndromes who had angiographic evidence of MVP and spasm of angiographically normal coronary arteries. The possibility that coronary spasm is the underlying etiology of chest pain in some patients with mitral valve prolapse raises a theoretical argument against beta-blockade in these patients. Three of our patients were successfully treated with calcium channel blockers.
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PMID:Mitral valve prolapse and spasm of normal coronary arteries: report of four cases and review of the literature. 672 Dec 52

Coronary artery aneurysm was demonstrated in 7 patients, whose ages ranged from 38 to 66 years, by selective coronary angiography. Four patients had atypical chest pain probably not caused by cardiac ischemia, 1 patient had aortic stenosis and recurrent bouts of atrial fibrillation, and 2 were evaluated following myocardial infarction and found to have triple vessel atherosclerotic coronary disease. Mitral valve prolapse and varicosities of the coronary venous tree found in one individual suggest that mucoid degeneration which replaces the normal fibrous tissue resulting in weakness of vessel wall may be responsible for the formation of coronary artery aneurysm and varicosities of the coronary venous system. The unsuspected presentation and benign course of these patients are emphasized and the pertinent literature is reviewed.
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PMID:Coronary artery aneurysms. Report of seven cases and review of the pertinent literature. 737 59

Mitral valve prolapse (MVP), which occurs in about 3% of adults, is usually a primary, dominantly inherited condition. MVP may be diagnosed by auscultation of a mid-systolic click and late-systolic murmur that move dynamically with postural maneuvers. M-mode echocardiography confirms MVP by demonstrating late-systolic prolapse and two-dimensional echocardiography reveals leaflet billowing into the left atrium. Echocardiography identifies severe forms of MVP by documenting significant mitral regurgitation, enlargement and thickening of the mitral leaflets and annulus, and loss of leaflet apposition. In contrast to early reports, true "MVP syndrome" as revealed by controlled studies consists of low body weight and blood pressure, minor skeletal abnormalities, orthostatic hypotension, palpitations, and mitral regurgitation that is usually mild. Complications of MVP include progressive mitral regurgitation, infective endocarditis, orthostatic syncope, and possible risks of neurologic ischemia and arrhythmic sudden death. Risk factors we have identified for complications among patients with MVP include older age, male gender, the presence of mitral regurgitation, and possibly, higher weight and blood pressure. The cumulative risk of all complications of MVP by age 75 is from 5% to 10% for affected men and 2% to 5% for affected women. Patients with MVP who have neither a murmur nor Doppler evidence of mitral regurgitation may be reassured that their condition is benign. For other patients with MVP we have shown that oral antibiotic prophylaxis is cost-effective. The presence and severity of mitral regurgitation govern the frequency and intensiveness of follow-up.
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PMID:Recent developments in the diagnosis and management of mitral valve prolapse. 778 75

Mitral valve prolapse (MVP) is usually a primary, dominantly inherited condition. Diagnosis may be made by auscultation of a midsystolic click and late-systolic murmur that move dynamically with postural maneuvers. Echocardiography confirms the diagnosis by demonstrating M-mode late-systolic prolapse and 2-D leaflet billowing into the left atrium. More severe forms of MVP can be detected echocardiographically by documentation of significant mitral regurgitation, enlargement and thickening of the mitral leaflets and anulus, and loss of leaflet apposition. In contrast to earlier reports, the true "MVP syndrome" consists of low body weight and blood pressure, minor skeletal abnormalities, orthostatic hypotension, palpitations and mitral regurgitation of variable degree. Complications of MVP include progressive mitral regurgitation, infective endocarditis, and possible risk of neurologic ischemia, arrhythmic sudden death, and orthostatic syncope. Risk factors for complications among MVP patients include older age, male gender, the presence of a mitral regurgitant murmur, and, possibly, higher weight and blood pressure. MVP patients with neither a murmur nor Doppler evidence of mitral regurgitation may be reassured that their condition is benign. For other MVP patients, the presence and severity of mitral regurgitation govern the frequency and intensiveness of needed follow-up.
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PMID:Mitral valve prolapse. 782 19

Transient ischemic attack (TIA) is defined as "an episode of focal loss of brain function attributed to ischemia that lasts less than 24 hours, is localized to a portion of the brain supplied by one vascular system, has no persistent deficit, and is not attributable to any other cause." Most TIAs are caused by small thromboemboli that originate in atheromatous areas in neck vessels or the heart. Other mechanisms include nonatherosclerotic vascular diseases, mitral valve prolapse, hematologic diseases, and abnormal blood pressure fluctuations. Even in series of fully investigated cases, there remains a group in which no cause can be found. The great majority of TIAs are extremely brief. In one series, 24% ended within 5 minutes, 39% in 15 minutes, 50% in 30 minutes, and 60% in 1 hour.
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PMID:Morbidity and mortality associated with transient ischemic attack (TIA). 1016 48

The purpose of the present study was to determine whether coronary microvascular function is impaired in patients with symptomatic mitral valve prolapse (MVP) and whether ischemia-like ECG, if present, is related to coronary microvascular dysfunction. Twenty chest pain patients with normal coronary angiograms and MVP proven by echocardiogram were included. Both treadmill exercise test (TET) and coronary hemodynamic study were done in each patient. Coronary flow reserve (CFR) was determined by measuring coronary sinus flow (CSF) or great cardiac venous flow (GCVF) both at baseline and after dipyridamole 0.56 mg/kg IV for 4 minutes (maximum). All patients were divided into 2 groups with either negative (TET-) or positive results of TET (TET+). Another 10 subjects with atypical chest pain, normal coronary angiograms, echocardiogram and TET were used as controls. There were no differences in GCVF, either at baseline or after dipyridamole infusion, among the 3 groups. Calculated CFR using GCVF was similar among the 3 groups. However, baseline CSF was higher in the TET+ group (TET- vs TET+ vs control: 77 +/- 24 vs 96 +/- 31 vs 75 +/- 12 ml/min, p < 0.05) and maximum CSF was lower in the TET- group (TET- vs TET+ vs control: 167 +/- 25 vs 219 +/- 85 vs 238 +/- 80 ml/min, p < 0.05). Calculated CFR using CSF was significantly reduced in both the TET- (2.26 +/- 0.4) and TET+ groups (2.31 +/- 0.7) as compared with the control subjects (3.18 +/- 0.95, p < 0.01). There were no differences in any of the hemodynamic parameters between the TET- and TET+ groups. Coronary microvascular function could be impaired in patients with symptomatic MVP. Such impairment, when presented, was probably regional and outside the territory of the left anterior descending coronary artery. However, it was irrelevant to the presence of ischemic-like ECG during exercise.
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PMID:Coronary flow reserve and ischemic-like electrocardiogram in patients with symptomatic mitral valve prolapse. 1088 77

Cerebrovascular events have high mortality and morbidity, especially in the elderly. Ischemia is the main cause and 30% of the ischemic events are embolic and of cardiac origin. The clinical picture is not always typical of the type of stroke, but diagnosis of the mechanism of the event determines treatment. Transesophageal echocardiography (TEE) is a sensitive procedure more appropriate for diagnosing emboli of cardiac origin than transthoracic echocardiography (TTE). We therefore compared TEE and TTE in the determination of the source of emboli in 65 patients with ischemic stroke but without significant atherosclerotic changes in their carotid arteries, and compared these findings with those in 50 patients without stroke. 68% of the patients had potential sources of emboli according to TEE, compared to only 15% according to TTE. In the control group only 24% had potential sources of emboli by TEE. The findings were: clots in the left atrium, severe aortic atheroma, patent foramen ovale with paradoxical shunt, spontaneous echocardiography contrast, vegetations and mitral valve prolapse. The study showed that TEE is better than TTE in detecting the etiology of embolic stroke in those with normal carotid arteries, thus determining appropriate management.
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PMID:[Diagnosis of cerebral embolism by transesophageal echocardiography]. 1090 99

During recent 8 years, combined procedures of valve surgery and coronary artery bypass grafting (CABG) were performed in fifty-five patients at Omiya Medical Center. AVR (31 cases), MVR (12 cases), MVP (8 cases), DVR (1 case), TVR (1 case), TAP (2 cases) were performed with the average of 2.0 bypass graftings in this series. Five patients died due to organ ischemia (3 cases), cerebral embolism and heart failure. Organ ischemia occurred in dialysis patients and the results of combined surgery in dialysis patients were unsatisfactory (3/5 cases, mortality rate is 60%). On the other hand, the results of combined surgery in non-dialysis patient is reasonable (2/50 cases, mortality rate is 4%). Before the combined surgery in dialysis patient, careful analysis of surgical risk including organ ischemia is needed and avoiding the prolonged perfusion time is important to achieve a successful surgical result.
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PMID:[Results of valve surgery combined with CABG]. 1093 79

Early treatment of acute myocardial infarction (AMI) can improve the rate of coronary patency, salvage myocardium, and ultimately save lives; thus, rapid recognition of patients at a higher risk of developing AMI is very important. The clinical history in patients with documented AMI is sometimes atypical, and the initial cardiac enzyme levels often are within the normal range. Moreover, the typical ST-segment elevation is often absent on the initial electrocardiogram in patients who subsequently sustain an AMI. Stress-induced segmental wall motion abnormalities (SWMAs) in coronary artery disease patients can be readily detected by conventional two-dimensional echocardiography. Moreover, echocardiography is the only technique available that allows real-time assessment of stress-induced reduction in systolic wall thickening, a highly specific sign of myocardial ischemia. Echocardiography for the diagnosis of acute ischemia is most helpful in subjects with a high clinical suspicion but nondiagnostic electrocardiograms. Under these circumstances, reversible SWMA confirms the diagnosis of acute coronary syndrome. The location of regional SWMAs correlates well with the distribution of the artery involved and pathological evidence of infarction. A trained eye can easily recognize cardiac causes of acute chest pain other than coronary diseases such as aortic stenosis, hypertrophic cardiomyopathy, mitral valve prolapse, pericarditis, and aortic dissection. When echocardiography is performed soon after the patients arrival at the emergency department (ED) or during a chest pain episode, SWMAs are detected in 90-95% of transmural infarctions and in 80-90% of nontransmural or subendocardial infarctions, and the specificity of echocardiography is approximately 80-90%. Although stress echocardiography performed in the ED and interpreted at a distance through the use of telemedicine has the potential of being convenient, in our opinion, any form of stress echocardiography should be performed in the echocardiography laboratory only after an AMI has been completely ruled out. The detection of jeopardized myocardium early after AMI can identify patients at a higher risk to develop subsequent events. In conclusion, echocardiography is cost effective in the triage of patients presenting with acute chest pain when performed soon after ED admission or during a chest pain episode. However, echocardiography must be readily available, expeditiously performed, and skillfully interpreted. The clinical use of stress echocardiography in acute coronary syndromes has been greatly improved with the introduction of digital and second harmonics technology and further enhanced by the availability of contrast agents.
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PMID:Diagnostic and prognostic use of stress echo in acute coronary syndromes including emergency department imaging. 1097 25


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