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

The author studies only the usual investigations required for watching E.C.C. during the operatory period and directly afterwards. During E.C.C., one must essentially oversee the flow (2,4l/m2 or 70 ml/kg), the arterial pressure (70 torrs) essential factor for myocardiac injection, the C.V.P., where excess is factor of cerebral oedema, the peripheric vascular resistances (P.V.R.) which inform on the level of vasomotoricity. Control of pulmonary capillary pressure (P.C.P.), which is under E.C.C. the reflection of the left ventricular pressure (L.V.P.) is also a capital element of this watching (any elevation of L.V.P. is factor of sub-endocardiac ischemia and of acute pulmonary edema). In post E.C.C., the same parameters will be watched. A cardiac output equal or inferior to 2 l/m2 involve an immediate treatment. The C.V.P. allows adaptation of blood quantity. Calcul of V.P.R. sets treatment of low cardiac output. C.P.C. control allows evaluation of left ventricular efficacity. These datas must be completed by calcul of subendocardiac viability by studying the arterial pressure curves which inform on oxygen supply and demand, and by the contractility index measure (aortic output speed and measure of systolic interval).
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PMID:[Hemodynamic parameters which should be watched during and immediately after extracorporeal circulation]. 1 25

We describe a patient who presented with acute massive pulmonary edema, clinically and on chest roentgenogram. Two hours later the patient became hypotensive and was found to have a low pulmonary capillary wedge pressure (PCWP). The blood pressure returned to normal after administration of fluids. Acute pulmonary edema develops if PCWP rises higher than 25 to 30 mm Hg. In our patient, the elevated PCWP fell to low normal within two hours, when chest roentgenogram and clinical examination still suggested severe pulmonary edema. A phase lag existed between lowering of the pulmonary capillary wedge pressure and clearing of fluid from the alveolar and interstitial spaces in the lungs. At least three different pathogenetic mechanisms in patients with coronary artery disease can produce this phase lag. Transient global ischemia of the left ventricle was thought to be the responsible mechanism in our patient.
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PMID:Cardiac-pulmonary edema and low pulmonary capillary wedge pressure. 50 73

A sharp and unusually high increase in the serum of glutamic-oxalacetic and glutamic-pyruvic transaminase and of lactic-dehydrogenase accompanied the terminal events, acute pulmonary edema with cardiogenic shock, in 2 patients suffering from chronic congestive heart failure caused by dilatative myocardiopathy. Experimental and clinical data raises the possibility that the considerable enzymic increase may be due to the combined effect of chronic stasis and acute ischemia on the liver.
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PMID:[Acute hepatic ischemia and cardiogenic shock in patients with dilated cardiomyopathy]. 208 28

A patient admitted in a Coronary Care Unit with an acute anterior myocardial infarction, is presented. He had initially normal left ventricular function and, on the 11th day he had, suddenly, an acute pulmonary edema. The reason for this episode was detected through imaging techniques--echocardiography and isotopic studies, and consisted on infarct expansion with early evolution for apical aneurysm. Contrast angiography confirmed the presence of a huge aneurysm and two vessels disease. Tallium Scintigraphy showed reversible ischemia beyond necrotic areas. The patient was submitted to aneurysmectomy and received three aorto-coronary bypass. He is now doing well, in class I, NYHA. The discussion emphasizes the actual role of imaging techniques in the diagnosis of infarct expansion and early functional aneurysm. We discuss the prognostic of infarct expansion and the importance of perfusion studies on defining areas of myocardium in jeopardy, enabling a better surgical approach.
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PMID:[Early left ventricular dysfunction in acute myocardial infarct. Evaluation using imaging methods]. 263 14

The individual and combined predictive values of dipyridamole-thallium imaging and exercise testing were compared in a prospective study of 70 patients who had abdominal aortic aneurysms or aortoiliac occlusive disease that required surgical repair. All patients were evaluated clinically by the same cardiologist and had exercise stress testing and dipyridamole-thallium imaging before admission for surgery. Ten patients were excluded from the study because they had evidence of severe ischemia when tested (ST segment depression greater than 2 mm on exercise testing, severe multivessel disease on thallium imaging). The remaining 60 patients were operated on (abdominal aortic aneurysm repair, 40; aortobifemoral repair, 17; femorofemoral graft, 3). The test results were withheld from the surgeon, anesthetist, and cardiologist before surgery. A total of 22 patients experienced major cardiac complications postoperatively (acute pulmonary edema, 17; acute myocardial, infarction, 5; cardiac death, 2). Thallium imaging showed myocardial ischemia in 31/60 patients. Exercise testing was positive (greater than or equal to 1 mm ST segment depression) in 10/60 patients. Dipyridamole-thallium imaging with a high sensitivity and reasonable specificity is the initial test of choice. Exercise testing is a poor screening test because of its low sensitivity. The combination of the two tests gives the highest positive predictive value and the greatest likelihood ratio. Thus patients assessed initially and found to have positive thallium scan results may be further stratified by exercise testing.
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PMID:A comparison of dipyridamole-thallium imaging and exercise testing in the prediction of postoperative cardiac complications in patients requiring arterial reconstruction. 274 1

Congestive heart failure (CHF) is a common clinical problem and in its advanced stage has a poor prognosis. Approximately 400,000 individuals develop heart failure each year (Parmley 1989). CHF can be caused by coronary artery disease such as myocardial infarction, ischemia and hypertension. Should heart failure occur as a result of acute myocardial infarction, a classification tool developed by Killip can be used to assess the degree of CHF. Killip's classification is organised into the following four categories: Class I: no heart failure Class II: mild to moderate failure Class III: acute pulmonary oedema Class IV: cardiogenic shock (Killip, as cited by Benz 1989). This system helps in organising clinical signs and symptoms of heart failure. Due to the fact that CHF is now the most common hospital discharge diagnosis for those over the age of 65, critical care nurses need to be able to recognise complications and intervene rapidly (Parmley 1989) in collaboration with medical staff. The purpose of this paper is first to discuss cardinal signs and symptoms and clinical data associated with CHF. Second, critical care nurses' management of CHF is organised around common nursing diagnoses.
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PMID:Nursing management of congestive heart failure. Part I. 749 86

From January 1987 to January 1992, 11 patients underwent percutaneous transluminal angioplasty (PTA) for subclavian artery (SCA) stenosis before or after coronary artery bypass grafting (CABG) with the internal mammary artery (IMA). There were 8 men and 3 women with a mean age of 57 +/- 7 years. Four patients had PTA 1 to 4 months before undergoing CABG with IMA grafts, because of asymptomatic subclavian murmurs or of neurologic symptoms. Seven patients underwent PTA 2 to 37 months after CABG with IMA grafts, because of recurrent angina. Subclavian artery stenosis was present on the left side in 9 patients, the right side in one patient, and was bilateral in one patient. Ten PTA procedures were successful in 9 patients. All patients with post-CABG angina had reversal of the ischemia. Three complications occurred: 1 femoral artery thrombosis, 1 branchial plexus hematoma after an axillary approach, and 1 acute pulmonary edema after the procedure. Follow-up ranged from 1 to 60 months after PTA (mean 38 +/- 17 months). Nine patients had no angina at follow-up and 2 presented with stable angina (class II) upon exertion. Upper-limb Doppler studies showed no evidence of restenosis in all of these patients, at a mean follow-up of 38 months. Subclavian artery percutaneous transluminal angioplasty is a useful alternative for candidates to IMA bypass grafting with SCA stenosis discovered pre-operatively, and it is the treatment of choice for those presenting with post-CABG angina due to SCA stenosis proximal to an IMA graft.
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PMID:[Results of percutaneous dilatation of subclavian artery stenosis in patients with internal mammary grafts]. 790 85

Nitrates are commonly used in the therapy of congestive heart failure (CHF). They exert beneficial hemodynamic effects by decreasing left ventricular filling pressure and systemic vascular resistance while modestly improving cardiac output. The improvement in left ventricular function caused by nitrates is the result of combined reduction in outflow resistance and mitral regurgitation, while decreased pericardial constraint and subendocardial ischemia may also contribute to the process. With continuous nitrate administration, complete arterial tolerance develops, while venous tolerance appears to be only partial. The major mechanism of tolerance is loss of vascular smooth muscle sensitivity to nitrates. An increase in total blood volume occurring during the first few hours of an acute administration may partly contribute to tolerance. The importance of reflex neurohumoral activation is controversial; although it may contribute to tolerance in CHF, its role does not appear to be major. Chronic continuous nitrate therapy in CHF improves submaximal and maximal exercise tolerance. In combination therapy with hydralazine, isosorbide dinitrate reduces mortality, although to a lesser extent than the angiotensin converting enzyme inhibitor enalapril. Intravenous or sublingual nitrates are first-line agents in the therapy of acute pulmonary edema. In severe CHF, refractory to standard medical therapy, a short course of intravenous nitroglycerin, with or without inotropic agents, can help break the vicious spiral of CHF. Because tolerance occurs without nitrate-free intervals and until an optimal schedule of administration is determined, it makes good sense to include a nightly nitrate-free interval when prescribing nitrates for CHF in order to maintain maximal benefit during the hours of activity.
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PMID:Nitrates in congestive heart failure. 794 67

From January 1987 to January 1992, 11 patients underwent percutaneous transluminal angioplasty (PTA) for the treatment of subclavian artery stenosis before or after coronary artery bypass grafting (CABG) using the internal mammary artery (IMA). There were 8 men and 3 women, with a mean age of 57 +/- 7 years. Four patients had PTA 1 to 4 months before undergoing CABG with IMA grafts, because of either asymptomatic supraclavicular murmurs or neurologic symptoms. Seven patients underwent PTA 2 to 37 months after CABG with IMA grafts, because of recurrent angina. Subclavian artery stenosis was on the left side in 9 patients, the right side in 1 patient, and bilateral in 1 patient. Ten PTA procedures were successful in 9 patients. All patients with post-CABG angina had reversal of the ischemia. There were three complications: one femoral artery thrombosis, one brachial plexus hematoma after an axillary approach, and one acute pulmonary edema after the procedure. Follow-up after PTA ranged from 1 to 60 months (mean, 38 +/- 17 months). Nine patients had no angina at follow-up and 2 had stable angina (class II) upon exertion. Upper-limb Doppler studies showed no evidence of restenosis in any of these patients at a mean follow-up of 38 months. Subclavian artery PTA is a useful alternative to IMA bypass grafting in patients with subclavian artery stenosis discovered preoperatively, and it is the treatment of choice for those presenting with post-CABG angina due to subclavian artery stenosis proximal to an IMA graft.
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PMID:Transluminal angioplasty of the subclavian artery in patients with internal mammary grafts. 810 60

Acute and subacute extrapyramidal movement disorders are rarely reported in uremic patients. We report three such cases with basal ganglia lesions. All three had advanced renal failure with high serum creatinine levels. One of the patients had a history of ischemic heart disease and acute pulmonary edema with hypoxemia. Another patient had experienced arterial hypotension during previous hemodialysis. The third had prominent metabolic acidosis. One of the patients developed generalized dyskinesias, whereas the other two developed gait disturbances. Neuroimaging studies in all three cases showed bilateral changes in the basal ganglia. The natural history was self-limiting with gradual improvement. Diminution of the basal ganglia lesions was demonstrated on follow-up imaging in two of the three cases. We conclude that acute or subacute movement disorders with bilateral basal ganglia lesions may occur in uremia. Hypoperfusion with global brain ischemia and selective vulnerability of the basal ganglia to uremic toxins may account for these lesions.
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PMID:Acute movement disorders with bilateral basal ganglia lesions in uremia. 982 21


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