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)

In order to determine the natural evolution of different clinical types of "unstable angina", 167 patients were included in a prospective study. After angiography, 11 (6.5%) were excluded because they had no significant coronary lesions. The remaining 156 were sorted into different groups according to their clinical characteristics and were followed up for a period of 24 months at least. After that follow-up period, mortality and incidence of acute myocardial infarction (AMI) were as follows: angina of recent onset (Class III--IV NYHA): 8.5% (3/35) and 34.2% (12/35). Progressive angina: 7.4% (2/27) and 7.4% (2/27). Intermediate syndrome: 41.6% (10/24) and 37.5% (9/24). Prinzmetal's angina: 10% (1/10) and 10% (1/10). Post acute myocardial infarction angina: 35% (7/20) and 10% (2/20). Acute persistent ischemia: 2.5% (1/40) and 20% (8/40). Comparison of these figures pointed out significant differences (p less than 0.001 for mortality and p less than 0.03 for AMI incidence respectively). We conclude that it is clinically possible to identify different groups within the so-called unstable angina. Such a division not only allows for the creation of more homogeneous groups, but it contributes to a more rational therapeutic approach and also permits identification of high risk prodromes of greater complications, such as myocardial infarction or sudden death.
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PMID:Clinical spectrum of "unstable angina". 26 65

Fifteen patients were studied to detect unrecognized intraoperative ischemia or necrosis in perioperative myocardial infarction (MI) associated with coronary bypass. Simultaneous arterial and coronary sinus blood samples were analyzed for lactate and both total and MB-CPK. Coronary sinus flow measurements were done coincident with sampling in seven patients. Five had perioperative MI diagnosed by positive pyrophosphate scan and electrocardiogram. Although normal initially (mean 19 +/- 5.0%), lactate extraction after thoracotomy, before aortic cross-clamping, became abnormal in 12 patients with more pronounced abnormality in those with perioperative MI (-19 +/- 9.0%). Net efflux of lactate was higher in perioperative MI (mean 0.6 +/- 0.2 vs 0.016 +/- 0.04 mM/L) than in non-MI patients. All patients had detectable total and MB-CPK (mean 295 and 31 IU/L, respectively) and all those with coronary disease had a positive arterial-coronary sinus gradient for MB-CPK (mean 9 IU/L). Perioperative MI patients had a higher gradient than non-MI patients (mean 25 vs 2 IU/L) and with one exception that gradient exceeded 5-7 IU/L. It is concluded that severe ischemia before aortic cross-clamping precedes perioperative MI and may contribute to release of CPK into coronary sinus blood. Improvement in the techniques of anesthesia and intraoperative myocardial preservation are suggested.
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PMID:Coronary sinus blood flow and sampling for detection of unrecognized myocardial ischemia and injury. 30 99

Numerous methods have been used in an attempt to prevent myocardial injury that results from the interruption of aortic flow during cardiac operations. The authors describe a relatively simple means of inducing cardioplegia during coronary bypass surgery by coronary perfusion with cold lactated Ringer's solution through the aortic root. When the results following the employment of hypothermic coronary perfusion for intraoperative cardioplegia were compared with those obtained without its use, the procedure was found to confer a degree of intraoperative myocardial protection and appeared to lead to a decrease in intraoperative myocardial infarction, subendocardial ischemia and intraoperative mortality.
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PMID:Hypothermic coronary perfusion for myocardial protection during aortocoronary bypass. 30 79

A 65 years old woman with an acute myocardial infarction, as it was judged by serial enzyme changes, developed transitory Q waves in V2-V4 and II, III and AVF during the attack of chest pain. These Q waves were not present 12 hours later. It is suggested that these changes represent a focal block in the septal fibers of the left bundle system. This defect could explain the transient right precordial Q waves seen in myocardial infarction or ischemia, as well as the fixed Q waves of many patients without septal infarction at autopsy.
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PMID:Transient abnormal Q waves during acute myocardial infarction. 31 75

Early revascularization following myocardial infarction (MI) is reported to have a high risk of extension of and hemorrhage into infarction with resulting high mortality and morbidity. To evaluate this issue, 80 post-MI patients (aged 32-74 years) with unstable angina pectoris resistant to maximal medical therapy were reviewed. All patients underwent early uncomplicated angiography and subsequent revascularization; 55 (69%) were less than 10 days post-MI, and 25 (31%) were 10-30 days post-MI. Intraaortic balloon pumping was required in 72% for relief of intractable angina or hemodynamic instability. Of the 80 patients, 19% had single vessel disease (VD), 31% double VD, and 50% triple VD. The mortality rate from coronary bypass surgery was 7/80 (8.8%), with four cardiac and three noncardiac deaths. Two patients suffered a perioperative MI (2.5%). At a mean follow-up period of 33 months, there had been only one late death and one recurrent nonfatal MI; 96% of the patients had no significant angina. In patients with continuing ischemia immediately after MI, myocardial revascularization can be safely performed without further injury to the myocardium, and with excellent long-term results.
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PMID:Safe early revascularization for continuing ischemia after acute myocardial infarction. 31 12

There has been clinical evidence that a perfusion defect on a stress image fills in over time. The diagnostic value of initial and 120 min post exercise redistribution thallium-201 myocardial images (RMI) was determined in 120 pts. with suspected coronary heart disease (CAD), all of whom had coronary arteriography. Significant (greater than or equal to 75%) lesions were present in 88 pts. 30 pts. without CAD showed a normal tracer uptake immediately after exercise. Scintigrams taken 120 min after exercise revealed a decrease of 201-Tl concentration in every area of the myocardium. 80 pts. with CAD showed an area of decreased tracer uptake in the initial scans. 120 min RMI in 51 pts. revealed a segnificant increase (p greater than 0.01) of countrate time ratio in previous underperfused area. In 37 pts. persistent defects were present, in every case the defect correlated with the site of a myocardial infarction as determined by the finding of an akinetic area in the left ventricular angiogram. Thus RMI following a single dose of 201 Tl can differentiate between scar- and exercise-induced transient ischemia.
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PMID:[Value of 201-thallium serial myocardial imaging in coronary heart disease (author's transl)]. 31 6

To determine the importance of different methods of myocardial protection for combined aortic valve replacement and coronary revascularization, we analyzed the records of 82 consecutive patients who underwent the combined procedure between 1973 and 1978. Sixty-three (77%) had angina and 63 (77%) were in New York Heart Association Functional Class III or IV. Moderate to severe left ventricular impairment was present in 59%, and the mean number of diseased vessels was 1.9 per patient. Group I consisted of 18 patients with intermittent ischemia, almost all of whom had operation between 1973 and 1976. Group IIa consisted of 24 patients operated on between 1973 and December, 1976, with coronary perfusion, and Group IIb had 18 patients in whom a similar technique was used in 1977 and 1978. Group III consisted of 22 patients operated on in 1977 and 1978 in whom cold chemical cardioplegia was used. The early mortality (less than 30 days) for Group I was 50% and for Group IIa 29%. There were no deaths in Group IIb and Group III. The incidence of perioperative myocardial infarction was 21% in Group I, 6% in Group IIa, 11% in Group IIb, and zero in Group III. The incidence of cardiogenic shock requiring prolonged inotropic support and intraaortic balloon counterpulsation was significantly less in Group III (9%) than in Group IIb (50%) (p less than 0.05). If other manifestations of myocardial injury, such as perioperative infarction and cardiogenic shock requiring intraaortic balloon counterpulsation or inotropic support, are taken into consideration, cold chemical cardioplegia appears to provide better myocardial protection than coronary perfusion of the fibrillating heart.
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PMID:The importance of myocardial protection in combined aortic valve replacement and myocardial revascularization. 31 12

A fully automated Ecg recording and interpretation system (Hewlett Packard HP 5) consisting of a central computer and two peripheral units was evaluated during a four-month period. Ecgs were transmitted via public telephone lines, as was the report from central station to peripheral recording and print-out unit. Within a few seconds after recording and print-out unit. Within a few seconds after recording and transmission a preliminary report is available in printed format. The transmitted Ecgs are stored at the central computer and are being retrieved and evaluated manually there. Three cardiologists read the tracings and furnished final reports. 468 Ecgs were thus compared in our test time of 10 days for statistical evaluation with the following results: 1. 73.1% of all statements were read correctly by the computer. 2. There is a large range of diagnostic accuracy between 0% and 100%. 3. The evaluation of Ecg changed by cardiologists reflects the individual experience of the controllers regarding the Ecg statements as well as computer-dependent possibilities like modification etc. of Ecg. 4. As an example the diagnosis "myocardial infarction" is compared with other Ecg computer programs by means of a quality index calculated from sensitivity and specificity: HP 5 with 158.5 points reaches a similar level as the Pipberger program with 162.6 and the Bonner with 159.5 points. 5. Referring to false negative results this program is acceptable in all diagnostic groups with ca. 8%, except conduction defects with 17.7%. 6. Referring to false positive results the diagnostic groups myocardial infarction/ischemia and conduction defects are not satisfactory with 36.5% and 23.4%. 7. In all the tested system seems to be very useful in routine Ecg interpretation of bigger hospitals.
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PMID:[Fully automatic computer-analysis of electrocardiograms in clinical routine (author's transl)]. 36 40

Evidence is mounting that three drugs that inhibit platelet function--aspirin, dipyridamole, and sulfinpyrazine--have an antithrombotic effect in humans. Particularly in men, aspirin is beneficial in controlling transient ischemic attacks and stroke, and there is evidence that it may be effective in preventing thrombotic and embolic complication of hip surgery. It abolishes symptoms in peripheral ischemia associated with thrombocytosis and spontaneous platelet aggregation and may prove effective in coronary artery disease. When combined with oral anticoagulants, aspirin is more effective than oral anticoagulants alone in preventing systemic embolism in patients with prosthetic heart valves. Dipyridamole in combination with oral anticoagulants reduces the incidence of systemic embolism after prosthetic heart valve replacement. Sulfinpyrazone reduces the incidence of sudden death in the first year after myocardial infarction, decreases the incidence of arteriovenous shunt thrombosis in patients undergoing chronic hemodialysis, and when combined with anticoagulants, may be effective in reducing the frequency of episodes in recurrent venous thrombosis.
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PMID:Antiplatelet drugs in thromboembolism. 38 46

Altered regional mechanical myocardial performance is an early, sensitive marker of myocardial ischemia, and can be estimated in man with reasonable accuracy. Identification, localization and quantification of abnormalities in mechanical performance can be used to predict the presence of coronary artery disease. Testing techniques that have little or no effect on diagnostic efficiency must be replaced with more sensitive indicators of ischemia. If experimental data are validated by findings in human subjects, accurate identification of regional wall motion changes during test conditions should prove to be a powerful marker of ischemia. To be of value, a diagnostic test must strongly increase the frequency of identification of subjects with a high probabilty for the presence of coronary artery disease in an otherwise low-prevalence population, and of those with known disease who are at the highest risk for complications including myocardial infarction or death.
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PMID:Mechanical function of the heart and its alteration during myocardial ischemia and infarction. Specific reference to coronary atherosclerosis. 38 87


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