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

Atrial fibrillation is the most common atrial tachyarrhythmia. Consideration for the potential conversion of atrial fibrillation and the subsequent maintenance of sinus rhythm may be related to underlying pathology. Typically, extra cardiac factors such as thyroid hyperactivity help to determine initial therapy. Intrinsic cardiac factors may also influence the clinician's decision regarding potential cardioversion and maintenance of sinus rhythm. Some acute events such as pericarditis and the effects of cardiac trauma may resolve and result in spontaneous restoration of sinus rhythm. Other cardiac events such as acute myocardial infarction with or without atrial ischemia, valvular disease, and others may result in the precipitation of atrial fibrillation. The major reasons to consider cardioversion, either medically or electrically, are ventricular rate control, hemodynamic improvement, sense of well being, and the avoidance of embolism. Certain clinical situations (e.g., Wolff-Parkinson-White syndrome) require urgent restoration of sinus rhythm in light of the potential for extremely rapid ventricular rates. It has been suggested that all antiarrhythmic drug administration should be initiated in the hospital setting, but the brief period of drug administration in an inpatient setting does not protect the patient from potential, late-onset proarrhythmic events. Both antiarrhythmic drug therapy and electric cardioversion are useful for restoration of sinus rhythm in both acute and chronic atrial fibrillation. The most important negative aspect of drug conversion of atrial fibrillation may be the potential development of a proarrhythmic drug effect. Although controversial, conversion (medical or electrical) is probably indicated in every patient with the first episode of persistent atrial fibrillation, even if the patient is asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Should every patient with atrial fibrillation have the rhythm converted to sinus rhythm? 788 9

Between April 1992 and October 1993, we combined a modified maze procedure with mitral valve repair (n = 26) or replacement (n = 36) in 62 patients with atrial fibrillation, including 16 patients undergoing reoperation. Associated procedures included aortic valve operation (n = 22), tricuspid annuloplasty (n = 28), atrial plication (n = 10), and others (n = 3). Duration of atrial fibrillation varied from 0.1 to 23 years (average 8.3 +/- 6.4 years), the f-wave voltage ranged from 0 to 0.45 mV (0.16 +/- 0.09 mV), and cardiothoracic ratio varied from 46% to 85% (64% +/- 9%). We modified the maze atriotomies to preserve the sinus node artery and used cryoablation to simplify procedures. Aortic crossclamp time was 142 +/- 25 minutes and cardiopulmonary bypass time 226 +/- 34 minutes. No early or late deaths occurred in a total of 783 patient-months of follow-up. In 52 patients (84%) who regained atrial rhythm, an atrial A-wave was detected in 84% for transtricuspid flow and in 71% for transmitral flow. One patient with sinus rhythm had an episode of transient neurologic ischemia 4 months after mechanical valve implantation. The 10 patients who remained in atrial fibrillation had preoperative fibrillation for a significantly longer time than the rest of the patients with atrial rhythm (14.8 versus 7.2 years p < 0.001) and a larger left atrial dimension (70 versus 58 mm, p < 0.01). Nonetheless, no variable alone could have predicted postoperative rhythm for individual patients. The results suggest that the maze procedure is safe and effective and therefore should be considered for patients with chronic atrial fibrillation undergoing mitral valve operations.
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PMID:Cox maze procedure for chronic atrial fibrillation associated with mitral valve disease. 798 74

We describe the case of a 73-year-old man with cardiac failure due to hypertensive heart disease, chronic atrial fibrillation, prior ischemic stroke and acute ischemia of the left leg probably embolic in nature, in whom transthoracic echocardiography (TTE) detected a large left atrial mass compatible with thrombus. Transesophageal echocardiography (TEE) was performed to better evaluate the atrial mass. TTE showed a mass that was firmly attached to the wall of the left atrium, compact, homogeneous and stationary, indicating a relatively low embolic risk. On the other hand TEE clearly detected a marked motility and echographic unhomogeneity of the atrial mass, suggesting a poorer prognosis and urgent surgical referral due to high impending embolik risk. This case further supports the superiority of TEE to TTE in the assessment of intracardiac masses and, in particular, of embolik risk in a patient with left atrial thrombosis.
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PMID:[Role of transesophageal echocardiography in the evaluation of the potential embolic risk in left atrial thrombosis. Report of a clinical case]. 853 6

Cardiac arrhythmias are very common in the setting of heart failure, with atrial and ventricular arrhythmias often present in the same patient. The risk and the benefit of antiarrhythmic therapies are still a matter of debate. Class I antiarrhythmic drugs should be avoided in patients with heart failure, cardiac ischemia, or previous myocardial infarction. Beta-blocker agents reduce morbidity and decrease mortality in patients suffering from moderate to severe heart failure. Amiodarone may be beneficial in patients with advanced heart failure and increased resting heart rates. This class III drug may be effective to suppress episodes of atrial fibrillation but can also be beneficial in reducing ventricular response by slowing atrioventricular conduction during chronic atrial fibrillation. Implantable cardioverter-defibrillators (ICDs) markedly reduce sudden cardiac death in patients with ventricular tachycardia or ventricular fibrillation. In patients with advanced heart failure, however, the ICD may not markedly extend survival. Recently analyzed data from the Canadian Implantable Defibrillator Study (CIDS), Antiarrhythmics Versus Implantable Defibrillators (AVID) registry, Multicenter Unsustained Tachycardia Trial (MUSTT), and Multicenter Automatic Defibrillator Implantation Trial (MADIT) have consistently shown that it is the sickest patient who benefits the most from ICD therapy. Patients with markedly depressed ejection fraction (<30%), poor New York Heart Association functional class, and advanced age have been identified as those who really need ICD therapy. Studies of implantable cardioverter-defibrillators in patients with moderate to severe heart failure have been launched and will provide necessary answers to the question of whether a reduction in sudden death will translate into a reduction of all-cause mortality. For patients resuscitated from sustained ventricular tachycardia or ventricular fibrillation, an ICD or, in some cases, amiodarone should be considered. Catheter or surgical ablation can be considered for selected patients with ventricular tachycardia.
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PMID:Arrhythmias in Heart Failure. 1109 38

In patients with coronary artery disease (CAD), rate responsive pacing is considered to be contraindicated because an increase in heart rate may increase oxygen demand. Although previous studies have shown no subjective increase in ischemia during rate responsive pacing, data from objective assessment have not been documented. The goal of this study was to determine if there was an increase in ischemia on 201-Thallium (201 Tl) exercise scintigraphy in this mode of pacing in patients with CAD and angina. Eighteen consecutive patients with chronic atrial fibrillation and symptomatic bradyarrhythmias with a pacemaker for more than 6 months participated in the study. In VVI and VVIR modes a symptom-limited exercise 201 Tl scintigram was performed in a single blind randomized crossover fashion. Exercise duration, anginal attacks, use of nitroglycerine (NTG) tablets, blood pressure, and analysis of the scintigrams were assessed during each pacing mode. Fifteen men and three women were included (age 65.9 +/- 4.9 years, LVEF 0.44 +/- 0.07). Four were in Class III angina pectoris, and 14 in class II. The mean exercise duration increased 28% in the VVIR group without an increase in anginal attacks per week or the use of NTG tablets. On scintigrams, no differences were seen between the two groups. One patient was withdrawn from the study because of an increase in angina pectoris (AP) attacks during VVIR pacing. Rate responsive pacing is safe and effective in patients with CAD without an increase in subjective and objective signs of ischemia.
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PMID:The effect of rate responsive pacing in patients with angina pectoris on the extent of ischemia on 201-thallium exercise scintigraphy. 1199 67

Acute mesenteric ischemia secondary to arterial occlusion (AMI) remains a highly lethal condition. To examine recent trends in management and associated outcomes, we examined our institutional experience over a recent 10-year period. All patients treated for AMI between January 1990 and January 2000 were identified (76 patients, 77 cases) and their medical records examined. At presentation, 64% demonstrated peritonitis and 30% exhibited hypotension. The interval from symptom onset to treatment exceeded 24 h in 63% of cases. Etiology was mesenteric thrombosis in 44 patients (58%) and embolism in 32 patients (42%). Thirty-five patients (46%) had prior conditions placing them at high risk for the development of AMI including chronic mesenteric ischemia (n = 26) and inadequately anticoagulated chronic atrial fibrillation (n = 9). Surgical management consisted of exploration alone in 16 patients, bowel resection alone in 18 patients, and revascularization in 43 patients, including 28 who required concomitant bowel resection. Overall, intestinal necrosis was present in 81% of cases. Perioperative mortality was 62% and long-term parenteral nutrition (TPN) was required in 31% of survivors. Peritonitis (odds ratio [OR] 9.4, 95% confidence interval [CI] 1.6, 54.0; p = 0.012 and bowel necrosis (OR 10.4, CI 1.9, 56.3; p = 0.007) at presentation were independent predictors of death or survival dependent upon TPN. We conclude that AMI remains a highly lethal condition due in large part to advanced presentation and inadequate recognition and treatment of patients at high risk.
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PMID:Acute occlusive mesenteric ischemia: surgical management and outcomes. 1252 95

A 73-year old woman presented with mild paraparesis and hypesthesia of the legs. Furthermore, she complained dizziness, fainting and dyspnea. There was a history of peripheral artery disease, diabetes mellitus, arterial hypertension and chronic atrial fibrillation. Five years ago she had breast cancer with removal of the left mamma and additional radiation therapy. Cardiac catheterization at that time demonstrated no significant coronary stenoses. A contrast-enhanced CT-scan excluded lumbal spinal metastases. Instead, a subtotal occlusion of the abdominal aorta was noticed, but was initially interpreted as a chronic thrombosis because there were no typical symptoms and only moderate pain. About 24 hours later the patient developed an acute ischemic syndrome of the legs with progressive paraparesis, cold and pale legs in combination with acidosis and hyperventilation. Color-coded duplex ultrasound showed only a small turbulent flow in the ilial arteries, highly suspicious of a complete occlusion of the distal aorta. Angiography revealed an acute total occlusion of the infrarenal aorta without collaterals. During surgical intervention, complete obstruction of the abdominal aorta above the bifurcation was confirmed. Subsequent embolectomy was performed and an embolus consisting of several layers of different age was extracted. After successful surgical intervention with subsequent clinical improvement, the patient's clinical condition deteriorated a few day later. She died on day 9 after surgery from a complete ischemia of the small intestine and the colon ascendens.
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PMID:[Atypical Leriche syndrome]. 1265 74

We report three cases of symptomatic acute carotid thrombosis occurring after carotid artery stenting (CAS). CASE 1: A patient presented with crescendo transient ischemic attacks on the second day after CAS. Ultrasound images demonstrated incomplete in-stent thrombosis due to plaque protrusion. The urgent surgical procedure consisted of stent removal and carotid thromboendarterectomy. CASE 2: A case of complete thrombosis of a carotid stent occurred 4 days after implantation in a patient with essential thrombocythemia diagnosed by chance. The surgical strategy included stent removal and carotid thromboendarterectomy. CASE 3: Cardiac multiple embolisms in a patient with chronic atrial fibrillation caused concomitant leg ischemia and acute carotid stent occlusion 2 hours after CAS. Cerebral reperfusion was established by embolectomy, without removing the stent. At the same time, the right leg ischemia was resolved by a thromboembolectomy with a Fogarty catheter. These three cases demonstrate that acute thrombosis after carotid stenting can be managed successfully with emergent surgical intervention. Thromboendarterectomy with stent removal or in selected cases, simple thromboembolectomy, can minimize neurologic sequelae in patients suffering from acute post-stenting carotid thrombosis.
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PMID:Surgical management of acute carotid thrombosis after carotid stenting: a report of three cases. 1627 59

Cholesterol crystal embolization (CCE) can result in end-organ ischemia. Retrospective review of clinicopathologic data. The first patient was anticoagulated with coumadin for chronic atrial fibrillation and presented subacutely with a solid mass. The second patient suffered from coronary artery disease post-angioplasty/stenting and presented with acute pancreatitis and pancreatic cystification. CCE should be considered in patients with significant vascular disease, arrhythmias or vascular manipulation who present with a pancreatic mass.
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PMID:Cholesterol crystal embolization presenting as either solid or cystic pancreatic lesion. 2097 33

This report describes a case of acute mesenteric ischemia due to acute superior mesenteric artery (SMA) thromboembolism in a patient with chronic atrial fibrillation despite optimal anticoagulation therapy. The patient underwent SMA angiography and endovascular revascularization for acute mesenteric ischemia. We initially tried endovascular thrombolytic therapy for the thromboembolism of SMA, but it did not achieve complete revascularization. Therefore, we performed a percutaneous aspiration thrombectomy, which led to complete revascularization and successful treatment of acute mesenteric ischemia without any additional procedures.
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PMID:Successful percutaneous aspiration thrombectomy for acute mesenteric ischemia in a patient with atrial fibrillation despite optimal anticoagulation therapy. 2346 42


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