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)

Restoration of coronary blood flow in the ischemic myocardium is absolutely needed to prevent irreversible cellular damage but on the other hand may have potentially hazardous consequences. Since thrombolysis during myocardial infarction is designed to salvage a maximal number of myocardial cells threatened by ischemia, a concommitant intervention which reduces cellular damage due to reperfusion will improve the net result of such procedure. The adjunctive use of ACE-inhibitors with thrombolytic therapy early during acute myocardial infarction offers theoretic advantages. This article summarizes the results indicating that ACE-inhibitors do play an important role in cardioprotection in the acute phase of myocardial ischemia followed by reperfusion. Probably, their effect on bradykinin breakdown is at least partly responsible for this effect.
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PMID:Early ACE-inhibition in myocardial infarction. Possible role of bradykinin. 146 86

Twenty-seven patients with acute myocardial infarction (AMI), in whom infarct-related coronary artery was occluded and thrombolytic therapy or PTCA were performed, were studied. Reperfusion confirmed by immediate coronary angiography was achieved in 24 patients. Reperfusion arrhythmias (RA) occurred in 19(79.2%) of the patients, including ventricular arrhythmias in 13 (54.2%). Ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) developed in 2(8.4%), and accelerated idioventricular rhythm in 5(20.8%); the latter showed a reliable indicator of coronary artery recanalization. Transient sinus bradycardia or AV block occurred in 10 (66.7%) of the 15 patients with inferior-posterior MI, which was an indicator of recanalization of coronary artery and salvage of myocardium in inferior-posterior MI. The occurrence of RA was not correlated with the duration of ischemia; ventricular RA was not related to the location of AMI and the occurrence and severity of ischemic arrhythmias before reperfusion. The patients with RA were treated with ordinary antiarrhythmic therapy, VF and sustained VT in 2 patients were converted by electric defibrillation. No death related to RA occurred. RA couldn't be prevented by lidocaine.
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PMID:[Reperfusion arrhythmias in acute myocardial infarction]. 147 86

To assess the initial and long-term results of 149 percutaneous transluminal coronary angioplasty (PTCA) procedures performed within 1 month of an acute myocardial infarction (AMI), 83 of them because of recurrent ischemia (post-infarction angina) after thrombolytic therapy with initial reperfusion success in the AMI (100 lesions attempted) (group I) and 66 PTCAs (69 lesions) performed during the acute phase of the AMI (group II). Mean age was 56 +/- 14 and 127 (85%) patients were male. Although successful dilation was obtained in 151 (89%) of the 169 attempted lesions, (96[96%] in group I vs 55[78%] in group II), clinical success was obtained in only 123 (82%) (76[92%] vs 64[77%] in both groups, respectively). Late occlusion occurred in 14 (9%) of the 151 lesions successfully dilated (6[6%] and 8[15%], respectively) and reinfarction was documented in 7 (5%) patients (5[5%] and 2[3%]). One patient in group I underwent coronary bypass surgery. There were 4 (3%) hospital deaths (1[1%] and 3[4%]) in group I and II, respectively). Event-free (no occurrence of death, AMI, coronary surgery, repeat PTCA or angina recurrence) survival rate was 76%, 73% and 67% in group I versus 62%, 57% and 40% in group II, at 1, 2 and 4 years respectively. During follow-up, 1 (1%) patient of the group I and 4 of the group II died. At last follow-up, 63 (78%) of the 81 patients alive vs 33 (67%) of the 59 patients in the group I and II respectively remained asymptomatic. In conclusion, in our experience elective PTCA performed in the subacute phase after an AMI provides better initial and long-term outcome than that performed in the acute phase. Therefore, the procedure would be delayed whenever possible.
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PMID:[Elective coronary angioplasty in recurrent ischemia after successful fibrinolysis in myocardial infarction. Comparison with results of angioplasty in the acute phase]. 147 9

Thirty patients with severe pump failure (Killip's degree III or more) complicating acute myocardial infarction (MI) underwent emergency coronary bypass grafting (CABG). Average age was 66 years old and CABG was performed 2.6 days after the onset of MI. The patients were divided into two groups according to the mechanisms that can bring about severe pump failure: 19 patients had large MI alone (G-I). The other 11 patients had severe ischemia occurring either at areas distant from the site of coronary occlusion or in the previous area at risk (G-II). To estimate the ventricular wall motion quantitatively, the left ventricular wall was divided into 17 segments. Each segment was graded on a four-point scale: akinesis, 3; severe hypokinesis, 2; hypokinesis, 1; normal 0. Wall motion score was estimated by summing the number of asynergic segments score. In G-I, Cardiac index (CI (l/min/m2)) increased from 2.03 +/- 0.91 to 2.68 +/- 0.73 and pulmonary wedge pressure (PCWP (mmHg)) decreased from 28 +/- 5 to 15 +/- 5, 72 hours after the surgery (p < 0.01). In G-II, CI increased from 2.17 +/- 0.78 to 3.17 +/- 1.01 and PCWP decreased from 29 +/- 6 to 13 +/- 5 after the surgery (p < 0.01). There was no difference in preoperative and postoperative hemodynamics between two groups. The wall motion score at the risk area did not change postoperatively (from 16 +/- 7 to 17 +/- 9 in G-I, from 15 +/- 8 to 11 +/- 5 in G-II).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Emergency coronary artery bypass grafting in patients with severe pump failure complicating acute myocardial infarction]. 149 Nov 91

We studied 266 consecutive patients with acute myocardial infarction to assess the significance of electrocardiographic "mirror images". Ninety-four (group A) had anterior wall and 132 (group B) had inferior wall infarction. Thirty-one group A patients had stenosis of the right coronary artery greater than 85% in diameter (subgroup A1), and 63 either had a normal right coronary artery or less than 85% stenosis (subgroup A2). Of group B patients 62 had greater than 85% stenosis of the left anterior descending (subgroup B1) and 70 had a left anterior descending or less than 85% stenosis (subgroup B2). ST-segment depression was significantly greater in depth and duration in subgroup A1 than A2 (p = 0.02) and in subgroup B1 than B2 (p = 0.02, p = 0.01, respectively). Left ventricular ejection fraction was lower in subgroup A1 than A2 (p less than 0.001) and in B1 than B2 (p less than 0.001). There was a strongly positive correlation between depth and duration of ST-segment depression and the Gensini index (r = 0.78, 0.84) for anterior and inferior infarction, respectively. In conclusion, increased depth and duration of ST-segment depression opposite the infarct are indicative of ischemia, and are related to the extent of coronary artery disease, the degree of stenosis of the vessels supplying the opposite wall and of left ventricular dysfunction.
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PMID:Correlation of reciprocal ST-segment depression after acute myocardial infarction with coronary angiographic findings. 151 54

Extensive clinical research has demonstrated that the administration of indium-111 antimyosin antibodies is useful in the diagnosis of acute myocardial infarction. It is specific for acute myocardial necrosis, as opposed to ischemia or chronic infarction, and therefore identifies patients who have had an acute MI. It is most useful in patients whose ECGs are indeterminate for the diagnosis of acute myocardial infarction (eg, left bundle branch block or permanent pacemaker) or those with inconclusive CK or CK-MB. Diagnostic accuracy and safety of antimyosin imaging has been established. This new cardiac imaging agent holds great potential for future clinical use in the diagnosis and management of patients with known or suspected acute myocardial infarction. Presuming FDA approval, the critical care nurse will see antimyosin used as an innovative and viable alternative in the diagnosis of acute myocardial infarction. Critical care nurses need to continually increase their knowledge of technologic advances and clinical applications for their own professional development, as well as to provide accurate information to patients and their families. In the area of nuclear cardiology, this includes antimyosin imaging and other state-of-the-art imaging techniques such as magnetic resonance imaging, positron emission tomography and computed tomography.
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PMID:Indium-111 antimyosin antibody imaging: a promising new technique in the diagnosis of M.I. 152 57

Of 150 consecutive patients with sustained monomorphic ventricular tachycardia (VT) (n = 116) or ventricular fibrillation (VF) (n = 34) late after acute myocardial infarction, 17 had reproduction of their sustained monomorphic VT during exercise testing. Data from these patients (group I) were compared with data from patients without exercise-induced VT (group II). No statistical difference was found between groups I and II with relation to age, sex, number of vessels with greater than 70% stenosis, left ventricular ejection fraction, number of previous myocardial infarctions, inducibility during programmed stimulation and total mortality during follow-up. In group I, only 1 patient (6%) developed ST depression during exercise compared with 47 patients (35%) in group II (p less than 0.01). After a 34-month mean follow-up, 6 patients in group I (35%) and 18 patients in group II (13%) died suddenly (p = 0.02). It is concluded that sustained monomorphic VT is reproduced during exercise in only 11% of patients with spontaneous late sustained monomorphic VT or VF. Electrocardiographic findings do not support ischemia as a triggering mechanism of exercise-induced sustained monomorphic VT. Patients with exercise-induced sustained monomorphic VT have a high incidence of sudden death.
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PMID:Incidence, pathophysiology and prognosis of exercise-induced sustained ventricular tachycardia associated with healed myocardial infarction. 152 40

With intravenous thrombolysis mortality of acute myocardial infarction can be significantly reduced, not only in the first hours after the onset of symptoms, but also up to 24 hours. The open infarct related coronary artery is important concerning long-term clinical outcome. If thrombolysis can be administered within the first three to six hours, limitation of infarct size and preservation of left ventricular function contribute to an impressive reduction in mortality. Long-term assessments of clinical outcome have surprisingly shown that the prognosis is much more dependent upon patency of the infarct related artery than from the time to treatment. Since a correlation is suspected between the degree of residual stenosis and the clinical course, recurrence of ischemia, reinfarction, hemodynamic instability and death, and the fact that mortality is highest within the first three days after thrombolysis the emphasis of numerous investigations has been on possibilities of PTCA in the acute stage of myocardial infarction. The application of interventional techniques was tested at different times within the progression of myocardial infarction. PTCA can be applied as primary, direct therapy without thrombolysis, immediately and during intravenous thrombolysis, following successful pharmacological recanalisation, as rescue-PTCA for failed thrombolytic therapy, delayed and as a prophylactic measure up to until days after the infarction or later when accompanied by careful observation of the patient, when limited to few indications with spontaneous or stress-related angina pectoris, hemodynamic instability or predetermined angiographic criteria. Important results have been gathered by the larger studies of the last few years, TAMI, ECSG, and TIMI as well as by numerous smaller investigations, about the pathophysiology and treatment of myocardial infarction. Despite different study design, the three larger trials have come to the same conclusion regarding PTCA and rt-PA thrombolysis, early PTCA is without advantage compared to a deferred treatment; the acute results are usually worse and the clinical course more complicated. It must be mentioned however, that major problems still remain unresolved: primary or direct angioplasty, PTCA in combination with non-fibrin specific plasminogen activators, as well as rescue-PTCA after failed thrombolysis. Specially, 90 minutes after thrombolysis 23 to 44% of the coronaries are still occluded, depending on the plasminogen activator, and there is no non-invasive procedure to detect this patient-group and to advise further treatment. Due to the high mortality rate within the first three days attempts of treatment are concentrated on this time-span.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[PTCA in acute myocardial infarct: primary, immediate, delayed or elective?]. 154 50

Inferior ST-segment elevation during anterior wall acute myocardial infarction (AMI) due to left anterior descending (LAD) coronary artery occlusion is unusual and was not previously investigated. This study tested the hypothesis that inferior ST-segment elevation during anterior AMI predicts a specific angiographic morphology that satisfies 2 necessary conditions: (1) mass of ischemic anterior wall myocardium is relatively small, resulting in a weaker anterior injury current and less reciprocal inferior ST-segment depression; and (2) there is concomitant inferior wall transmural ischemia that further shifts the inferior ST segments upward. The study group consisted of 42 consecutive patients with anterior AMI undergoing angiography at 4.1 days (range 0 to 14). Coronary angiograms were examined for 3 features: (1) site of LAD artery occlusion (a distal obstruction implying a smaller mass of ischemic anterior wall myocardium), (2) LAD artery extension onto inferior wall of left ventricle (termed a "wrap around" vessel), and (3) collateral flow from LAD artery to inferior wall. The latter 2 features would be expected to contribute to inferior wall transmural ischemia. Acute inferior ST-segment elevation (sum of ST-segment deviation in leads II, III and aVF greater than or equal to 3.0 mm) was seen in 7 patients (16%). A greater number of LAD artery branches proximal to the site of occlusion was significantly correlated with less inferior ST-segment depression (r = 0.59, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Implications of inferior ST-segment elevation accompanying anterior wall acute myocardial infarction for the angiographic morphology of the left anterior descending coronary artery morphology and site of occlusion. 843 Jun 54

The influence of intravenous thrombolysis on both prevalence of ventricular late potentials and incidence of late arrhythmic events was evaluated in 174 consecutive patients surviving a first acute myocardial infarction; 106 patients (61%) received thrombolysis (group A) and 68 (34%) had conventional therapy (group B). In group A, 18 patients (17%) had late potentials compared with 23 (34%) in group B (p less than 0.05); mean left ventricular ejection fraction was not different (0.50 +/- 0.09 vs 0.50 +/- 0.10; p = not significant [NS]). Of 63 patients who underwent coronary arteriography because of postinfarction ischemia, 28 (44%) had a closed infarct-related artery; of these, 11 (39%) had late potentials compared with 3 of 35 (9%) with a patent artery (p less than 0.01). Mean left ventricular ejection fraction was not significantly different between the 2 groups (0.49 +/- 0.09 vs 0.53 +/- 0.09; p = NS). At a mean follow-up of 14 +/- 8 months, 8 of 161 patients (5%) had a late arrhythmic event; 6 of 8 (75%) with and 28 of 153 (18%) without events had late potentials (p less than 0.001). In group A, 4 of 99 patients (4%) had events compared with 4 of 62 (6%) in group B (p = NS, relative risk 1.6). Of 24 patients with anterior wall AMI and left ventricular dyskinesia, 6 events occurred. In this group of patients, a higher rate of events was observed (25%); 3 of 16 (19%) treated with thrombolysis had an event compared with 3 of 8 (37%) treated conventionally (p = NS, relative risk 2.6).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Influence of thrombolysis on signal-averaged electrocardiogram and late arrhythmic events after acute myocardial infarction. 155 14


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