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)

Among 337 male patients who were hospitalized because of chronic ischemia of the leg, 103 (=30.6%) were shown to suffer from concomitant occlusive vascular disease of supraaortic branches. This was evaluated by simple examination like auscultation, bilateral blood pressure measurements, and palpation of pulses. In 52% the patients history revealed dizziness, hemiparesis and transient ischemic attacks (TIA). Arteriell hypertension promotes supraaortic vascular diseases as is shown by a relative frequency of 0.52 in contrast to 0.39. Combined occlusions of the iliac and femoropopliteal arteries are accompanied by supraaortic vascular disease in 40%, in femoropopliteal occlusion alone in only 20%. If the basic diagnostic approach is improved by directional ultra-sonic examinations of the carotid arteries, approximately 20% of all patients with advanced vascular disease of the iliac and femoropopliteal arteries have to be operated on for cerebrovascular disease.
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PMID:[The frequency of the combination of arterial occlusive disease in supraaortic and leg range. An analysis in the patient population of a vascular surgical department (author's transl)]. 92 53

In the elderly, a transient ischemic attack (TIA) and a hypersensitive carotid sinus reflex (HCSR) often co-exist and can pose a diagnostic challenge. Seven cases are presented. HCSR is a relative condition; besides increased irritability of the receptor or target organs, susceptibility of the nerve center to ischemia probably is induced by a slow heart rate or low blood pressure in any patient with pre-existing occlusive cerebrovascular disease. Dizziness and syncope of this type represent hemodynamic TIA in contrast to thromboembolic TIA. The carotid sinus massage test is recommended for differentiating the two types of TIA; the treatments differ. At present there is no uniform management that can be applied to either TIA or HCSR routinely. Therefore, treatment should be approached on an individual basis, keeping in mind the different pathophysiologic factors operating in the specific patient.
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PMID:The problem of dizziness and syncope in old age: transient ischemic attacks versus hypersensitive carotid sinus reflex. 124 91

Intravenous dipyridamole planar thallium-201 imaging is a safe and effective test for detection and prognosis of coronary artery disease (CAD) in the general population. The relative diagnostic accuracy and side-effect profile of dipyridamole thallium-201 stress imaging in women is not defined. Forty-three consecutive female and 71 male patients who underwent dipyridamole thallium-201 imaging (0.56 mg/kg) within 3 months of cardiac catheterization were studied. Scans were considered abnormal if fixed or reversible perfusion defects were detected. Stenosis severity of greater than or equal to 50% luminal diameter reduction of any artery defined CAD. Overall sensitivity for detection of CAD was 0.87 in women and 0.94 in men; specificity was 0.58 in women and 0.63 in men (p = not significant). Sensitivity for detection of 1-vessel CAD was 0.60 in women and 0.94 in men (p = 0.001). The sensitivity for detection of multivessel CAD (with or without surgical revascularization) was 1.0 and 0.94 in women and men, respectively. Adverse effects were reported in 62% of women and in 38% of men (p = 0.01). There was no significant difference in the incidences of chest pain, headache, nausea, flushing or electrocardiographic changes. The incidences of severe ischemia and dizziness were higher in women. Possible explanations for this difference in adverse effects include gender differences in the volume of distribution of dipyridamole due to varied fat-to-muscle ratios and different subjective nocioceptive sensitivities to the effects of dipyridamole. Overall sensitivity and specificity are comparable between the sexes.
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PMID:Comparison of accuracy for detecting coronary artery disease and side-effect profile of dipyridamole thallium-201 myocardial perfusion imaging in women versus men. 162 2

Dizziness is doubtlessly one of the most common symptoms to arise in ischemia of the brainstem. In such cases the circulatory deficit can not only cause a direct lesion of the vestibular structures but it may also block the compensatory process. There are, however, significant difficulties in establishing whether such dizziness can be attributed to a brainstem insufficiency (BI). In fact, both CAT and NMR provide data only in the case of permanent CNS tissue lesions and tests such as the Doppler examination of neck blood vessels are unable to establish the true state of cerebral blood flow. In order to obtain semi-quantitative data regarding cerebral blood flow 99mTc-HMPAO-S.P.E.T. (Single Photon Emission Tomography) was used in 18 patients suffering from dizziness and for whom there was strong indication that the underlying cause could be vascular. There was a discrepancy between the Doppler and S.P.E.T. findings in 50% of the cases. CAT, however, proved negative in all but one of the cases. These data indicate that Doppler testing of the neck blood vessels can provide useful information regarding the status of the cerebral-afferent vessels but that these cannot be correlated to the level of cerebral blood flow. On the other hand, with S.P.E.T., in 15 of the 18 patients, it proved possible to identify significant alterations in cerebral blood flow in the absence of any permanent tissue lesions as those revealed by CAT and NMR. In the light of the present results cerebral S.P.E.T. appears to be a highly valid tool when, faced with dizziness for which a vascular origin is suspected, one must evaluate cerebral prognosis and therapy.
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PMID:[Use of SPECT in the diagnosis of vertigo syndromes of vascular nature]. 209 69

Dizziness as defined herein will include an illusion of motion caused by various degrees of ischemia to the vestibular pathway or its interconnecting pathways. "Syndrome," such as the lateral medullary syndrome, denotes a macroinfarct, while a microinfarct or an area of incomplete infarct (where there may develop an incomplete degeneration of the neural tissue secondary to the arteriolar microatheromatous stenosis) may cause only one neurologic deficit, such as dizziness per se as the only symptom. However, the latter may presage a larger and more debilitating neurologic deficit. The transcranial Doppler, used to track sequentially the larger basal arteries of the brain, specifically the vertebrobasilar arterial system, is an addition to noninvasive diagnostic methods of separating vascular problems from other causes of dizziness.
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PMID:Vascular dizziness and transcranial Doppler ultrasonography. 250 61

We describe the case of a 23 years old male, who suffered a 45 bullet wound in the arm and upper right hemithorax. He walked after his injury and 10 minutes later presented dizziness, cough and tachycardia. On admission a minor haemothorax was seen on a chest X ray, but the bullet was not seen. Even without symptoms, an X ray of abdomen showed the missile lying above the left sacroiliac joint. A chest tube was placed, the patient had an excellent recovery and was discharged a week later. After several months he presented hemoptysis and a moderate pain on his right chest and was treated as an acute bronchitis. Six months after his initial injury he developed a florid picture of acute pulmonary embolism (chest pain, dyspnea, hemoptysis, tachycardia, severe cough). A new chest X ray was done and the bullet was shown lying in the right chest. A pulmonary arteriography located it in a lower basal branch. Through a posterolateral thoracotomy the slug was obtained. The recovery was uneventful and he has remained well since. We discuss the possible mechanisms to explain the entrance of the bullet into the vascular system and conclude that in cases of gunshot wounds: a) An exit wound must be always searched for; if not found exploratory X ray are mandatory, b) If the bullet is not found, specially after thoracic injuries, bullet embolism should be contemplated, c) If there are signs of regional ischemia arteriography is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Embolism caused by a bullet. Report of a case and review of the literature]. 265 26

A 27-year-old woman presented with ischemia of the left arm and dizziness together with acute lateral wall myocardial ischemia. Physical examination showed narrowing of the arteries to the head and neck and upper limbs suggesting Takayasu's arteritis. Angiography demonstrated pulmonary and systemic involvement. There was complete occlusion of the right upper lobe pulmonary artery and a large collateral artery from the circumflex coronary artery which anastomosed with the right bronchial artery. This anastomotic channel has not to our knowledge been described Takayasu's arteritis.
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PMID:Coronary artery to bronchial artery anastomosis in Takayasu's arteritis. 288 33

Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease of unknown cause that is characterized by a hypertrophied, nondilated, hypercontractile left ventricle. Its etiology and pathogenesis remain undefined but the three principal factors implicated are a genetic predisposition, a hypersensitivity to catecholamines, and an abnormal calcium metabolism. The hypertrophy typically involves the intraventricular septum to varying degrees, but may also involve the apex or free wall and even be concentric. The disease occurs in either an obstructive or a nonobstructive form depending on whether an intraventricular pressure gradient can be demonstrated at rest or on provocation. The gradient and obstruction to outflow is usually seen in patients with asymmetric septal hypertrophy (ASH) and anterior motion of the mitral valve during systole (SAM). Abnormal left ventricular diastolic function characterized by inadequate filling and impaired relaxation has been shown to be very important in both the obstructive and nonobstructive forms of the disease. In addition, inadequate coronary vasodilator reserve as a result of small vessel disease, microvascular spasm, and/or low capillary density per unit myocardial mass has been implicated as an important cause of ischemia in patients without coronary artery disease. HCM is a disease of young adulthood with relatively slow progression; young patients are often asymptomatic, whereas older patients are more limited by dyspnea, angina, dizziness, or syncope. Supraventricular tachyarrhythmias occur in 30% of patients, and high-grade ventricular arrhythmias occur in over 75%. The annual mortality is 3-5%. The common mode of demise is sudden cardiac death. Therefore, the primary objectives of treatment are the amelioration of symptoms, the control of arrhythmias, and the prevention of sudden death. Beta-adrenoreceptor blocking agents decrease myocardial contractility and oxygen demands and increase ventricular volume; therefore, they are most useful in patients with the obstructive form of HCM. Calcium channel antagonists enhance left ventricular relaxation, relieve microvascular spasm, and improve coronary filling and therefore are the agents of choice in patients with diastolic dysfunction. The ability of the calcium channel antagonists to decrease contractility makes them valuable in patients with obstructive HCM. Arterial vasodilators, diuretics, nitrates, and inotropic agents should be avoided because they can increase the intraventricular gradient. Myomyectomy is reserved for those patients with the obstructive form of HCM whose symptoms are refractory to medical therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Hypertrophic cardiomyopathy: current views on etiology, pathophysiology, and management. 331 Jun 37

Although a decrease in systolic blood pressure (BP) occurring during treadmill exercise is often a sign of severe left ventricular dysfunction, the prevalence and significance of postexertional hypotension is unclear. The postexercise systolic BP response to maximal treadmill exercise was analyzed in 781 asymptomatic volunteers, aged 21 to 96 years (mean 51 +/- 16) from the Baltimore Longitudinal Study on Aging. Fifteen subjects (1.9%) had a postexercise decrease in systolic BP of at least 20 mm Hg from preexercise sitting values, to a level of 90 mm Hg or less. The prevalence of postexercise hypotension was 3.1% (14 of 449) in subjects younger than 55 years, but only 0.3% (1 of 332) in those older than 55 (p less than 0.01). Before exercise these 15 subjects demonstrated a slight orthostatic decrease in systolic BP of -1.7 +/- 4.8 mm Hg compared with an increase of 5.3 +/- 5.1 mm Hg in age-matched control subjects (p less than 0.001). The lowest systolic BP averaged 78 +/- 9 mm Hg (range 62 to 90) and occurred between 4 and 9 minutes after exercise in 80% of cases. All but 3 episodes were symptomatic, with dizziness dominant. In only 2 subjects was the hypotension associated with vagal symptoms and bradycardia. Compared with control subjects, subjects with postexercise hypotension had higher maximal heart rates (184 +/- 15 vs 173 +/- 11 beats/min, p less than 0.05), but showed no difference in exercise tolerance or systolic BP at submaximal or maximal effort. Postexercise ST-segment abnormalities suggesting ischemia occurred in one-third of the hypotensive subjects but none of the control subjects (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prevalence and significance of postexercise hypotension in apparently healthy subjects. 371 41

Cardiac and noncardiac side effects were studied in 293 consecutive patients referred for nonexercise stress thallium imaging with intravenous dipyridamole. Six minutes after the initiation of infusion, there was a mean 9-beat/min increase in heart rate and a mean 12-mm Hg decrease in systolic blood pressure. The largest increase in heart rate exceeded 20 beats/min in only 13% of patients and the largest decrease in systolic blood pressure exceeded 20 mm Hg in 31%. Noncardiac side effects were headache (11%), lightheadedness or dizziness (5%) and nausea (4%). Only 9 patients required intravenous aminophylline for relief of noncardiac side effects: severe headache in 7 and nausea in 2. Cardiac side effects included chest pain in 76 patients (26%), of whom 70% were given aminophylline for relief of symptoms. Sixty patients (20%) had ischemic ST-segment depression and 56 (19%) had arrhythmias (ventricular in 50 and atrial in 6). There were no deaths, myocardial infarctions or sustained arrhythmias due to dipyridamole administration. Among 62 patients also undergoing cardiac catheterization, side effects except for arrhythmias were unrelated to the number of vessels with coronary artery disease. Intravenous dipyridamole is safe for nonexercise stress testing and has few serious side effects. However, the possibility of ischemia requires careful selection of patients and monitoring of vital signs and the electrocardiogram during the test.
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PMID:Safety of intravenous dipyridamole for stress testing with thallium imaging. 381 27


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