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

A case of aortic valve stenosis without coronary artery disease was confirmed to have diffuse subendocardial ischemia by exercise Thallium-201 myocardial single photon emission computed tomography. A 72-year-old woman, who had been diagnosed as aortic valve stenosis, was admitted because of chest pain during exercise. In cardiac catheterization findings, the patient angiographically had normal coronary arteries and no asynergy of left ventricular wall motion. The peak flow velocity in continuous wave Doppler echocardiography was about 5.0 m/sec at aortic valve level, providing a pressure drop of 100 mmHg across a stenotic valve with calculating on a modified Bernoulli equation (PG = 4V2). Thallium-201 myocardial SPECT images during exercise showed a transient "dilation and a widespread wall thinning" of left ventricle with apical perfusion defect. Simultaneous electrocardiogram showed further ST depression and the patient had chest pain. In 6 months after aortic valve replacement the patient no longer demonstrated both apical perfusion defect and "wall thinning" in postoperative thallium-201 myocardial SPECT images and also had neither ST depression nor chest pain. Thus; a transient "dilation and wall thinning" of left ventricle in this patient is suspected to be a sign of diffuse subendocardial ischemia.
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PMID:[Diffuse subendocardial ischemia in a patient with aortic valve stenosis without coronary artery disease by exercise 201Tl SPECT]. 157 26

We report a case of unstable angina in an active phase of polymyositis. A 51 year-old man was admitted with a diagnosis of polymyositis and unstable angina with ST elevation on prolonged rest chest pain. Rest anginal attack which had been refractory to conventional antianginal medications was controlled by high dose of glucocorticosteroid. Electrocardiography revealed multifocal premature ventricular contraction. Since silent ischemia on exercise persisted, percutaneous transluminal coronary angioplasty (PTCA) was performed on a stenotic lesion in the left anterior descending artery. Since there was recurrent anginal attack, re-PTCA was carried out at the same site. He was discharged in a good condition. This case is considered to be associated with cardiac involvement of polymyositis because of ventricular arrhythmia, persistent increased serum levels of CPK-MB, and the marked benefits of corticosteroid against unstable angina. In addition, clinical manifestations, coronary arteriographic findings, and increased plasma levels of thrombin-antithrombin III complex suggest that cardiac involvement in polymyositis accelerates intracoronary thrombus formation and/or coronary spasm.
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PMID:[A case of unstable angina pectoris associated with an active phase of polymyositis]. 158 49

We report a case of ischemia of the distal esophagus with secondary odynophagia that occurred as a result of a type III aortic dissection. A 56-yr-old hypertensive male presented with acute chest pain radiating to his back. A dissection of the descending aorta was found to begin just distal to the left subclavian artery and end in the region of the iliac arteries. The patient was treated medically and remained stable, but then developed odynophagia to solids. Upper endoscopy showed erythematous friable esophageal mucosa, and biopsies were consistent with ischemia. Aortography and barium fluoroscopy provided further evidence of foregut ischemia. The patient recovered on oral omeprazole with no residual symptoms. Ischemic compromise of the esophagus secondary to aortic dissection has not been previously described, nor have the associated endoscopic findings. Knowledge of this rare condition may help in the recognition and management of esophageal mucosal ischemia.
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PMID:Foregut ischemia and odynophagia in a patient with a type III aortic dissection. 159 Mar 23

Clinical predictors of in-hospital fatality were assessed in 191 persons admitted to the Yale-New Haven Hospital Intensive Care Unit with a diagnosis of congestive heart failure. In the 17 (8.9%) patients who died, the most important individual predictors among the presenting clinical features were absence of dyspnea, presence of anterior chest pain or jugulovenous distension, and cardiac severity due to ischemia, valvular disease, or arrhythmia. Two important predictors, largely neglected in previous literature, were a prior history of congestive heart failure and a poor clinical response after 24 h of therapy. Multivariable analysis led to the identification of 6 features (age greater than 70 y, prior history of congestive heart failure, jugulovenous distension, chest pain, cardiac severity, and poor early response to therapy) that could be combined into a simple clinical predictive index. The new index identified 5 prognostic groups with fatality rates of 0, 3.5, 7.4, 19.2, and 85.7 percent. An advantage of the clinical index is the identification of a subgroup of patients, with low risk for fatality, who may not need prolonged treatment in an intensive care unit.
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PMID:Response to initial therapy and new onset as predictors of prognosis in patients hospitalized with congestive heart failure. 159 94

Unstable angina is a broad clinical diagnosis that includes patients at different levels of risk for an unfavorable outcome. Although, as in other categories of coronary artery disease, the state of left ventricular function and the extent of coronary artery disease will determine long-term prognosis, recognition of clinical markers of an early unfavorable course may be of value in defining management strategies. This review focuses on the relevance of baseline clinical characteristics and noninvasive data in assessing the prognostic significance of unstable angina in light of its presenting features. Recurrence of chest pain within 48 h after admission carries a reduction in likelihood of survival of about 20% in patients with progressive or prolonged angina. Similarly, ECG changes on admission have a negative prognostic implication, particularly in rest angina, as they predict recurrence of ischemia, myocardial infarction or need for revascularization in 80% of the patients. In variant angina, determinants of prognosis are level of disease activity, as judged by recurrence of pain, ECG changes and use of calcium channel antagonists. Patients with angina after a myocardial infarction who have more than one episode of either angina or silent ischemia in 24 h have a 10% reduction in probability of survival during the 1st year compared with that of asymptomatic patients. An abrupt course, or the rapidity with which symptoms develop, is the main determinant of prognosis in new onset angina. Thus, recurrent angina and ECG changes appear to be relevant prognostic markers in the patient subsets considered; if these are present, early coronary angiography must be performed and revascularization procedures should be considered without delay.
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PMID:Unstable angina: outcome according to clinical presentation. 159 63

As our understanding of the etiology of chest pain of undetermined origin has evolved, the focus for studying this problem has switched from individual subspecialties to a multidisciplinary approach. In the subspecialties of gastroenterology and cardiology, the focus has shifted from organ-specific diagnoses to concepts of altered pain thresholds. Cardiologists began to look for functional causes of ischemia following the recognition that many patients with chest pain had normal coronary arteries. Abnormal responses of the coronary microcirculation to stress were identified in this population, and the concept of "microvascular angina" originated. Further evaluation, however, demonstrated that many of these patients did not have evidence of ischemia. In addition, a significant overlap with esophageal motility disorders was shown, and multiple sensitivities to otherwise nonirritating stimuli, whether in the heart or the esophagus, could be elicited in these patients. This finding led to the concept of abnormal visceral nociception, that is, the "sensitive heart" and the "tender esophagus," both the focus of ongoing clinical research.
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PMID:Microvascular angina and the sensitive heart: historical perspective. 159 66

The objective of the present study was to determine whether the presence of the classical coronary risk factors increases the likelihood of acute cardiac ischemia beyond that expected from clinical presentation and electrocardiogram. Clinical data and reports of classical coronary risk factors were collected prospectively from 1743 patients without clinically obvious coronary disease. Patients were selected from 5773 emergency department patients at 6 hospitals who presented with symptoms suggesting acute ischemia. We used logistic regression to determine the relative risk of each risk factor report for acute ischemia. In women, the presence of classical risk factor reports does not increase the risk of acute ischemia. In men, only diabetes and family history of myocardial infarction significantly increase the risk (p less than 0.05). The relative risks are 2.4 and 2.1, respectively, and are small compared to those conferred by chest pain (12.1), an abnormal ST segment (8.7), or an abnormal T wave (5.3). For a patient presenting to the emergency department, the classical coronary risk factors convey minimal risk for acute cardiac ischemia, especially when compared to the overwhelming importance of the chief complaint and the ECG.
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PMID:Do patients' coronary risk factor reports predict acute cardiac ischemia in the emergency department? A multicenter study. 160 1

The purpose of this study was to evaluate the significance of increased Tl-201 uptake by the lungs after oral dipyridamole testing. In conjunction with myocardial perfusion scintigraphy, intravenous dipyridamole has been recently approved as an alternative to exercise for the evaluation of coronary artery disease in patients who cannot adequately exercise, and it will largely replace oral dipyridamole testing. This study contributes to the understanding of the significance of increased lung thallium uptake during pharmacologic stress testing. Oral dipyridamole, 400 mg, was administered to 192 patients undergoing Tl-201 imaging for clinical indications. Mild adverse effects occurred in 31% of patients (chest pain, nausea, headache, or flushing). Dipyridamole had minimal hemodynamic effects. The lung/heart thallium activity ratio was determined in 152 patients. These were subdivided into four groups according to the presence or absence of ischemia, transient myocardial perfusion defect, or scar as indicated by a fixed myocardial perfusion defect. In 61 patients without transient myocardial perfusion defect or fixed myocardial perfusion defect (group 1), the lung/heart thallium activity ratio was 0.39 +/- 0.01 (mean +/- SEM). In 31 patients without transient myocardial perfusion defect but with fixed myocardial perfusion defect (group 2), the lung/heart thallium activity ratio was higher, 0.44 +/- 0.02 (P less than 0.05). In 27 patients with transient myocardial perfusion defect but no fixed myocardial perfusion defect (group 3) and in 33 patients with both transient myocardial perfusion defect and fixed myocardial perfusion defect (group 4), the lung/heart thallium activity ratio was 0.51 +/- 0.03 and 0.52 +/- 0.03, respectively, both significantly higher than either group 1 or group 2 (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Significance of increased Tl-201 uptake by the lungs in patients undergoing oral dipyridamole-thallium myocardial imaging. 161 45

A 48-year-old black man had his first attack of chest pain on exertion, radiating to both arms, in December 1982 (angina pectoris). It was undoubtedly preceded by a period of asymptomatic coronary atherosclerosis of unknown duration. The first anginal attack was followed by three to four similar episodes over the next four months. The attacks became more prolonged, frequent, and severe thereafter (so-called "pre-infarct" angina), and six days later the patient showed signs of having developed actual myocardial necrosis. The patient underwent saphenous vein coronary artery bypass surgery but could not be weaned from the pump. He died late on the day of surgery. He was found at autopsy to have severe old three-vessel coronary artery disease with the myocardial changes that would be expected from the severe global ischemia to which this heart was undoubtedly subjected. Several basic and important differences between this sort of a circumferential subendocardial infarct and a transmural infarct are discussed, as is the basis for the striking subendocardial hemorrhage.
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PMID:Acute circumferential subendocardial infarction. 162 59

Forty-nine patients admitted for assessment of chest pain underwent coronary angiography, planar Thallium 201 myocardial scintigraphy after submaximal exercise (TE) and transoesophageal atrial pacing (TAP). Early hypofixation with redistribution after 4 h indicated ischaemia. The criterion for a myocardial infarction (MI) was a fixed perfusion defect. Coronary angiography was carried out in all patients. Sixteen patients (group 1) had no MI and over 50% narrowing of at least one main coronary vessel. Ischaemia was noted in 10 of the 16 patients during exercise, and in 14 of the 16 patients during atrial pacing. The sensitivity for the prediction of coronary stenosis was 62% for TE and 87% for TAP. Nineteen patients (group 2) had had a previous MI. Reversible ischaemia was noted in 10 of the 19 patients during exercise, and in 11 of the 19 patients during TAP. Four of 14 patients with normal coronary arteries (group 3) had a reversible ischaemia with TE, and three of these same patients developed a positive scan with TAP. The respective specificities were 71% and 78%. Comparison of segmental hypoperfusion after TE and TAP gave identical results in 72 of the 80 segments studied in group I (90%), and in 88 of the 95 segments studied in group 2 (92%). The localizing value of TAP was good in left anterior descending (12 out of 18) and right coronary disease (16 out of 19), but poor in left circumflex stenosis (3 out of 9) misclassified as right coronary disease in four patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of thallium myocardial scintigraphy after exercise and transoesophageal atrial pacing in the diagnosis of coronary artery disease. 162 70


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