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

The differential diagnosis of VTs with LBBB morphology includes several well-defined syndromes. Although the majority of cases are attributable to acquired structural heart disease, including ischemia, prior infarction, or dilated cardiomyopathy, consideration of specific right ventricular processes is essential to proper evaluation and treatment. The approach to older patients or those with evidence for heart disease should begin with an evaluation for coronary artery disease and an assessment of biventricular function. Careful evaluation for bundle branch reentry should be performed during electrophysiological study, especially when there is underlying conduction system disease. Younger patients, those without overt heart disease, or those with isolated right ventricular disease, should receive a complete noninvasive evaluation of right and left ventricular size and function. An abnormal SAECG or identification of intracardiac late potentials suggest right ventricular dysplasia or cardiomyopathy, whereas responsiveness to adenosine and absence of detectable heart disease support the diagnosis of idiopathic right VT. Newer techniques, including MRI, show promise in identifying subtle right ventricular disease not otherwise detectable even in the setting of presumed idiopathic right VT. Following surgical repair of selected congenital heart defects, particularly tetralogy of Fallot, symptoms of recurrent palpitations, near syncope, syncope, or aborted sudden death may be attributable to recurrent VT, and diagnostic electrophysiological study should be considered for these patients. Finally, SVTs with LBBB morphology, particularly cases associated with right-sided or septal accessory pathways, should always be considered in this differential diagnosis.
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PMID:Ventricular tachycardias with left bundle branch block morphology. 773 82

Fibromuscular dysplasia is an uncommon angiopathy that is principally observed in the renal and carotid arteries. Digital ischemia resulting from fibromuscular dysplasia of the forearm arteries is a rare occurrence. This article describes a case of distal radial and ulnar artery fibromuscular dysplasia presenting as paresthesia, claudication, and finger ulceration. Angiography was diagnostic in visualizing the characteristic "string of beads" appearance. In addition to the typical histological findings, we also observed a previously undescribed pathological finding. Surgical management involved resection of the diseased segment and primary anastomosis.
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PMID:Fibromuscular dysplasia of distal radial and ulnar arteries: uncommon cause of digital ischemia. 788 60

We present a 45-year-old male with fibromuscular dysplasia (FMD) of the left brachial artery causing microemboli with digital ischemia. The angiographic diagnosis was medial fibroplasia. Treated with percutaneous transluminal angioplasty (PTA), the corrugated arterial wall was made smooth and production of new thrombi apparently stopped, as 3.5 years after PTA the patient has had no recurrence. Although FMD of the brachial artery is rarely encountered, PTA seems to be an effective treatment as an alternative to surgical interposition grafting.
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PMID:Fibromuscular disease of the brachial artery with digital emboli treated effectively by transluminal angioplasty. 801 31

Abnormally shaped arteries were found in the intestines of 17 of 62 patients (27%) with Hirschsprung's disease. The histological characteristics of abnormal arteries included proliferation of collagen fibers and smooth muscle cells in the adventitia. The incidence of abnormal arteries in each type of aganglionosis was as follows: 25% (13 of 51) in short-segment aganglionosis; 0% (0 of 6) in long-segment aganglionosis; and 80% (4 of 5) in total-colon or extensive aganglionosis. The older the patients were at the time of resection, the higher the incidence of abnormal arteries (< 1 year old, 15%; 1-3 years old, 38%; > 3 years old, 75%). The abnormally shaped arteries were mostly located in the histological transitional zone. These findings suggest the following possibilities: (a) the craniocaudal migration of ganglion cells was interrupted by intestinal ischemia in the presence of abnormal arteries in utero; (b) an ischemic episode caused both the disappearance of neural cells and dysplasia of the artery; (c) the ganglion cells were destroyed by mild ischemia caused by the abnormal arteries; or (d) the tension caused by mechanical expansion resulted in a change in the vascular walls in the transitional zone.
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PMID:Abnormally shaped arteries in the intestine of children with Hirschsprung's disease: etiological considerations relating to ischemic theory. 801 68

Intravascular ultrasonography, balloon angioplasty, stent placement, and endovascular septal fenestration have been used in the evaluation and treatment of vascular complications of acute and chronic aortic dissection in five patients. There were three men and two women with an average age of 52 years (range 39 to 64 years). There were three chronic type A dissections, one acute type B, and one subacute type B dissection. Intravascular ultrasonography was used in all five cases. The three patients with chronic type A dissections underwent unilateral renal artery angioplasty (RA PTA) and stent placement; one patient with an acute type B dissection and associated fibromuscular dysplasia underwent bilateral RA PTA without stent placement. These procedures were performed to ameliorate severe hypertension. The final patient, with a subacute type B dissection, underwent iliac artery stenting to correct severe lower extremity ischemia. During a second intervention, this patient, who also had bowel ischemia and nonresolving acute renal failure, underwent balloon dilatation of a preexisting septal fenestration to augment visceral blood supply and bilateral RA PTA and stent placement in an effort to improve renal function. This patient eventually died of gut ischemia. After RA PTA and stent placement, one patient had a major intrarenal hemorrhage that required coil embolization and transfusion. In the four survivors, RA PTA and stent placement resulted in immediate improvement in blood pressure control. This response has been sustained during follow-up intervals ranging from 8 to 18 months (average 10 months). Intravascular ultrasonography can clearly demonstrate the pathologic anatomy associated with aortic dissection (even when angiography is ambiguous) and is essential for guiding therapeutic endovascular interventions. Further exploration of the efficacy of these endovascular techniques is warranted in this high-risk group of patients with aortic dissection who have appropriate clinical indications.
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PMID:The use of endovascular techniques for the treatment of complications of aortic dissection. 826 33

Fibromuscular dysplasia is a nonatherosclerotic, noninflammatory vascular disease that usually involves medium- and small-sized arteries. It is most commonly observed in the renal, carotid, and intracerebral arteries, although it has been reported in other arterial beds. The most common form is characterized by medial fibrosis, with or without smooth muscle cell hyperplasia, which can result in luminal narrowing and turbulent flow. There is often a secondary aneurysmal degeneration of the artery, which may or may not be associated with thrombosis or obstruction of flow. This accounts for the typical "string-of-beads" appearance seen on arteriography. We describe a patient who presented with ischemia of the right hand secondary to fibromuscular dysplasia of the brachial artery. Subsequent studies also demonstrated fibromuscular dysplasia in the other brachial artery as well as mild involvement of the right renal artery. The patient was treated on the symptomatic side with dilatation of proximal lesions, resection of the thrombosed segment, and reconstruction with a reversed saphenous vein graft. Distal pulses were fully restored postoperatively. Pathologic examination confirmed the arteriographic and clinical diagnosis of fibromuscular dysplasia. The salient features of this case are reviewed in addition to the other cases reported in the literature.
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PMID:Bilateral brachial artery fibromuscular dysplasia. 826 96

We here report a case of monozygotic female twins, only one of whom had congenital bilateral perisylvian syndrome (CBPS). The affected girl had all of the essential and some additional diagnostic criteria according to Kuzniecky et al. [1993]; her twin sister was completely normal both clinically and neuroradiologically. This observation may contribute towards our understanding of the etiopathogenetic mechanisms of cortical dysplasia in CBPS: fetal brain ischemia or hypoxia in only one twin seems to be a reasonable explanation in this particular case.
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PMID:Discordant clinical and neuroradiological features of congenital bilateral perisylvian syndrome in monozygotic female twins. 891 60

In 1992, Brugada and Brugada described a syndrome characterized by right bundle branch block pattern with ST elevation in leads V1 through V3 and a history of sudden death due to polymorphic ventricular tachycardia or ventricular fibrillation. Since these patients had no evidence of cardiac disease, these findings were ascribed to a distinct clinical entity. Further experience has shown that this same pattern may be mimicked by patients with right ventricular dysplasia, acute ischemia of the right ventricle, other infiltrative cardiomyopathies, as well as tricyclic drug overdose. The pathogenesis of these changes may be due to loss of the dome configuration in the transmembrane potential of right ventricular epicardial cells, which would result in a voltage gradient producing ST elevation. Other explanations involve delayed conduction in a dysplastic right ventricle. The clinical importance of this syndrome is that it calls attention to patients at risk for sudden cardiac death. In addition, these observations have sparked the interest of basic electrophysiologists relative to the relationship of these ECG waveforms and malignant ventricular arrhythmias. Finally, the clinician must exclude other organic diseases before diagnosing this entity.
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PMID:Is the Brugada syndrome a distinct clinical entity? 908 84

An 8-year-old girl presented with fibromuscular dysplasia of the intracranial vessels manifesting as ischemic stroke. Neuroimaging showed infarction of the right putamen and ipsilateral frontal white matter. Angiography revealed "string of beads" sign involving the terminal portion of the right internal carotid artery and the horizontal segment of the ipsilateral middle cerebral artery. She was treated conservatively. Magnetic resonance angiography at 2 months post ictus showed similar findings in the middle cerebral artery but improvement of the stenosis of the internal carotid artery. Her neurological deficits had almost resolved. Fibromuscular dysplasia should be part of the differential diagnosis of ischemia in children.
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PMID:Childhood ischemic stroke caused by fibromuscular dysplasia of the intracranial artery--case report. 925 54

Schimke immunoosseous dysplasia (SID) is an autosomal recessive spondyloepiphyseal dysplasia that was first described by Schimke et al. [1971: Lancet 2:1088-1089]. It is associated with premature arteriosclerosis and cerebral ischemia; however, the cerebral vascular abnormalities causing ischemia have not been described [Spranger et al., 1991: J Pediatr 119:64-72; Ehrich et al., 1995: Clin Nephrol 43:89-95]. Based on magnetic resonance angiography (MRA) and magnetic resonance venography (MRV), we now report on 2 girls with SID who have cerebral ischemia associated with moyamoya phenomenon. In addition, one patient also has an absent or occluded left transverse sinus and diffuse aortic narrowing. This is the first characterization of the cerebral vascular abnormality found in SID and raises the possibility that cerebral moyamoya may represent another major manifestation of the underlying genetic defect in SID.
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PMID:Schimke immunoosseous dysplasia complicated by moyamoya phenomenon. 967


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