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)

Three cases of radiation-related chronic heart disease are reported. All three patients had been treated for Hodgkin's disease with a mantle technique six to ten years earlier. Ten years after radiation treatment, a 34-year-old woman had dyspnea during exercise. Her heart was enlarged, and an ECG showed a RBBB. An echocardiogram showed pericardial effusion. Right-sided catheterization revealed an infundibular stenosis. A 31-year-old man had chest pain nine years after radiation. An ECG showed complete RBBB and an exercise stress test signs of ischemia; a coronary angiogram showed three proximal stenoses; and an echocardiogram revealed pericardial effusion. A 12-year-old boy had angina pectoris six years after radiation; one year later, he suffered an acute posterior infarction. Two weeks later he died suddenly. An autopsy showed a severe fibrotic and calcified narrowing of the proximal part of the left main coronary artery. Regardless of the patient's age, radiation-related cardiac complications must be kept in mind. Echocardiograms and, in cases of chest pain, exercise stress tests should be a part of routine postradiation follow-up.
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PMID:Radiation-related chronic heart disease. 685 89

Systemic arterial pressure was markedly increased in the early phase of cerebral ischemia induced by bilateral carotid artery occlusion (BCAO) in stroke-prone spontaneously hypertensive rats (SHRSP). The elevated level of arterial pressure was gradually returned to the initial level, and hypotension followed in the late phase. Severe neurological symptoms such as "ischemic seizure", dyspnea and coma were developed in the late phase. All SHRSP died within 6 hr after BCAO. The heart rate continued to increase during the brain ischemia. Cardiac arrhythmias, significant increases in plasma levels of creatine phosphokinase (CPK) and CPK-MB isozyme and disruption of myofibrils were observed after BCAO, particularly after the development of ischemic seizure. In contrast, in stroke-resistant SHR (SHRSR) and Wistar-Kyoto rats (WKY), ischemic seizure did not develop, yet all died within 8 hr after BCAO. Arterial pressures were moderately increased and never decreased to below the initial levels during the observation periods. Increases in CPK-MB isozyme activities in plasma from SHRSR and WKY were not detected. Pretreatments with propranolol and reserpine inhibited the increases in heart rate, reduced the frequency of arrhythmias and prolonged the survival time following BCAO in SHRSP. Our results indicate that cardiac dysfunction, which is a consequence of the cerebral ischemia, may be one of the causes of death following BCAO in SHRSP.
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PMID:Cardiovascular responses to cerebral ischemia following bilateral carotid artery occlusion in SHRSP, SHRSR and WKY rats. 687 14

The workup of a patient with chronic ischemic heart disease (IHD) before the selection of medical-surgical or medical therapy depends on multiple objective and subjective factors. These include symptoms, extent of anatomic disease (degree of coronary arteriosclerosis and left ventricular abnormalities), objective evidence of ischemia, extent of left ventricular dysfunction, and recent intercurrent ischemic events. In a minority of patients, a single factor is of overwhelming importance; e.g., the presence of severe left main coronary artery narrowing in a symptomatic patient indicates surgery is a better choice, whereas evidence of advanced left ventricular dysfunction suggests that surgery is likely to be risky and of limited help to the patient. In most instances, multiple factors should be considered before making a recommendation. The patient should be placed in the appropriate clinical subset and the objective factors that are most important in determining survival should be evaluated. Hence, an exercise electrocardiographic study to evaluate symptoms and exercise tolerance in a patient with angina pectoris and radioventriculographic studies with exercise to estimate left ventricular performance in a patient who complains of fatigue and breathlessness are superior to the subjective interpretations of routine clinical examinations. Asymptomatic patients and those with excellent exercise tolerance pose the most difficult decisions. Perhaps serial (even annual) noninvasive evaluation is appropriate in such patients in light of the current uncertainty about how to manage them. Laboratory tests should be used selectively, systematically and sequentially. The high cost of many of the examinations is reason to avoid duplication. When noninvasive evaluation can answer the question being posed and the cost of hospitalization avoided, this should be done. However, there is little reason to perform noninvasive examinations that do not answer the clinical question being asked; hence, in many patients it is appropriate to proceed directly to coronary arteriography rather than to perform a variety of "screening" examinations before this procedure.
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PMID:The reasonable workup before recommending medical or surgical therapy: an overall strategy. 697 29

Modified exercise testing within three weeks of an acute myocardial infarction has been shown to be both a safe and feasible means for identifying patients at greater risk for subsequent cardiac events. An abnormal ECG and symptomatic response to exercise correlates with a higher morbidity and mortality. An ST-segment depression as well as angina are associated with a higher risk of recurrent ischemia and death. Elevation of the ST segment as well as inappropriately high heart rates and early development of fatigue and dyspnea are seen in patients with compromised left ventricular function. Exercise-induced premature ventricular contractions raise the possibility of increased sudden death. Patients identified to be at increased risk can be considered for more intensive medical or surgical treatment to reduce their morbidity and mortality. Patients considered to be at low risk can be spared needless invasive studies and unwarranted restriction of their physical activity. Patients may also accrue psychological benefit from these stress-test procedures.
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PMID:Exercise testing soon after uncomplicated myocardial infarction. Prognostic value and safety. 723 Mar 77

For purposes of a study conducted in the townships of Nordenham and Brake, a self-administered questionnaire was used to detect suspect cases of coronary heart disease (angina pectoris, suspected myocardial infarction). The inquiry revealed for "typical" and "atypical" (extended range of criteria) angina pectoris a percentage of 10.8 (N = 898) for males aged 30-64 and of 15.4 (N = 1207) for females. There were no essential differences by the place of residence of the test persons. The question for the presence of pain suggesting myocardial infarction was answered "yes" by an average 7.6% of men and 4.6% of women, with highest percentages for both sexes in Nordenham. In test persons whose answers in respect of the presence of angina pectoris were positive, the frequency of ECG signs of ischemia (Q and Q-S anomalies, ST-T changes) at rest exceeded those in persons who did not mention cardiac complaints by a factor of 1.8. Specific ECG changes were most frequently found in test persons suffering from angina pectoris and pain suggesting myocardial infarction. In persons suffering from angina pectoris, symptoms of chronic bronchitis were present twice as often as in those who had no cardiac complaint. Dyspnea occurred less often in cases of chronic bronchitis than those with coronary heart disease.
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PMID:[Results of a questionnaire study on coronary disease and its relation to electrocardiographic changes and respiratory symptoms in a North German population]. 730 34

Thirty-six patients with coronary artery disease were studied by first-pass radionuclide angiography to assess the effects of myocardial revascularization on exercise-induced myocardial ischemia. The radionuclide studies were performed in the 30 degree right anterior ablique position, at rest and during exercise, 1 to 3 days preoperatively and 10 to 14 days postoperatively. The mean population age was 53 years; the mean number of grafts placed was 4.0 per patient. Fifteen normal male volunteers were tested by rest and exercise radionuclide angiography to serve as normal control subjects. In all exercise radionuclide studies, progressive upright bicycle exercise was performed to symptoms of fatigue, dyspnea, or chest pain. The parameters of ejection fraction (EF), end-diastolic volume (EDV), and regional wall motion (RWM) were determined. Twenty-nine of the 36 patients had postoperative coronary arteriography that was correlated with radionuclide determinations. The results showed that in the normal subjects with maximal exercise the mean EF rose, the mean EDV increased 19%, and there was no exercise-induced regional wall motion dysfunction (ERWMD). In the patients with coronary artery disease prior to operation, the mean EF fell significantly, the mean EDV rose 24%, and 26 of 36 patients had ERWMD. After operation, the mean EF of the group rose, the EDV increased only 15%, and only two of 36 patients continued to show ERWMD. Of the eight patients who demonstrated on abnormal response postoperatively, seven had what was considered to be inadequate revascularization, and in one there was no explanation. The data demonstrate that myocardial revascularization does improve ventricular function by abolishing exercise-induced evidence of ischemia (decreased EF, increased EDV, and ERWMD) as assessed by radionuclide angiography. Failure to abolish the exercise-induced functional instability suggests incomplete revascularization.
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PMID:Improvement in left ventricular function after myocardial revascularization: assessment by first-pass rest and exercise nuclear angiography. 736 32

Angina pectoris and asymptomatic myocardial ischemia are part of the spectrum of coronary heart disease. Not the presence or absence of angina determines the future of the patient, but repeated ischemia and the progression of the coronaropathy. This progression is neither linear with time, nor is the moment of plaque rupture foreseeable. Silent myocardial infarctions increase with age and are very frequent in diabetics. In patients without neuropathy but with asymptomatic myocardial ischemia the central pain threshold is higher than in patients with angina pectoris. The best noninvasive test for the detection, localization and estimation of extension of myocardial ischemia, be it pain-free or symptomatic, is 201-thallium scintigraphy, combined with the exercise ECG. The fight against all amendable cardiovascular risk factors and pharmacotherapy are the first steps, if asymptomatic myocardial ischemia is suspected. Augmented dyspnea on effort and rhythm disturbances are indicators of advanced multivessel heart disease. Under these circumstances coronary angiography is indicated, and further treatment should follow the generally accepted rules such as for patients with angina pectoris.
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PMID:[Asymptomatic ischemia--an important part of the spectrum of coronary disease]. 748 31

A sixty-two-year-old woman with chronic dermatomyositis (DM) receiving steroid monotherapy developed coronary artery stenosis. She had lung fibrosis and complained of dyspnea, but no ischemia was suggested by electrocardiogram. Ateriographic findings and clinical symptoms of coronary artery disease in DM have not been previously reported.
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PMID:Coronary artery disease in dermatomyositis. A case report. 763 23

Congestive heart failure affects over 2.3 million Americans; approximately 400,000 new cases are diagnosed yearly in this country. Congestive heart failure is a complex disorder with a poor long-term prognosis. The major causes of congestive heart failure are ischemia, infarction, and idiopathic cardiomyopathy. Patients often present with dyspnea and a low exercise tolerance. In congestive heart failure there may be an alteration in preload, afterload, and contractility of the heart. Many compensatory mechanisms occur to support the failing heart. Cardiac symptoms slowly develop and eventually systemic symptoms develop. The cornerstones of pharmacologic therapy are cardiac glycosides, diuretics, and angiotensin-converting enzyme inhibitors.
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PMID:Current trends in the primary care management of chronic congestive heart failure. 806 52

This study was undertaken to determine whether patients with silent ischemia (SI) (a positive thallium stress test without chest pain) have nonchest-pain symptoms that might serve as "anginal equivalents." Two hundred ninety-four individuals on completing a stress test were requested to score ten symptoms on a questionnaire (0 absent; 3 severe). Forty-three with a positive test had pains (chest, back, arm, and/or jaw) (no SI), whereas 93 with a positive test did not (SI). Patients with SI and patients without SI did not differ as to age, gender, or clinical features (including presence of diabetes or a history of myocardial infarction), but patients with SI were less likely to report a history of effort-related chest pains. Patients with SI exercised longer and had a higher peak heart rate. Patients were comparable with respect to myocardial ischemia (ST segment depression, double product, thallium lung uptake, and positive thallium scintigrams) and severity of coronary disease. Patients with SI complained less of weakness (p < 0.02) and tended to have lower overall symptom scores (4.2 +/- 0.3 vs 5.4 +/- 0.6), but breathlessness was comparable for both groups. On multivariate analysis, no nonanginal symptom was associated with SI. Only absence of a history of chest pain with activity and longer exercise time were related to SI. Patients with SI have similar clinical features as those with angina but tend to be less symptomatic with myocardial ischemia even for symptoms other than chest pain.
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PMID:Symptoms of patients with silent ischemia as detected by thallium stress testing. 816 17


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