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)

The Bland-White-Garland Syndrome represents the anomalous origin of the left coronary artery of pulmonary trunk. Only 10% of the patients reach adulthood. Clinical manifestations of the syndrome are angina, dyspnoe, ECG signs of ischemia, myocardial infarction, and death in childhood. We present the case of a 47 year old woman with Bland-White-Garland Syndrome, who was resuscitated from ventricular fibrillation. The only symptom shown in her personal history was progressive dyspnoea in the last 6 months, though mitral insufficiency was known since childhood. On echocardiographic examination, she showed an anterolateral infarction and a mitral insufficiency II. As operation procedure, the ligation of the left main coronary artery and bypass surgery with a left internal mammarian graft to the left descending branch of the left coronary artery was chosen. The mechanism of onset of ventricular tachycardia in our patient is not known. Three pathophysiological mechanisms may be possible: (1) local ischemia caused by the shunt, (2) a reentry circuit in the border zone of myocardial infarction, (3) electrical instability caused by endocardial fibrosis. As local ischemia and reentry circuit were widely excluded, only endocardial fibrosis could induce further ventricular arrhythmia. We therefore intended to implant an AICD to have the most possible safety for our patient. But this, postoperatively was refused by the patient. In analogy to Coronary Artery Disease, the risk for sudden cardiac death postoperatively may be due to three factors: (1) presence of a reentrant circuit, (2) LV-function below 40%, and (3) presence of endocardial fibrosis. Our patient showed a low risk for sudden cardiac death. On electrophysiological study, no ventricular tachycardia could be induced in our patient, indicating the absence of a reentry circuit. LV function exceeded more than 40%. In Holter ECG, only few ventricular premature beats could be registrated, indicating a low risk for sudden cardiac death in the presence of endocardial fibrosis. In the follow-up of fourteen months, the patient remained free from arrhythmic events.
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PMID:[Successful resuscitation of a patient with ventricular fibrillation in Bland-White-Garland syndrome in adulthood. A case report]. 974 68

Optimal management of dyspnea in terminal cancer patients requires an understanding of the responsible pathophysiological mechanisms. This prospective study assessed visual analogue scales (VAS) of shortness of breath (SOB) and anxiety, bedside spirometry, maximum inspiratory pressure (MIP), chest radiography, arterial blood gases, hemoglobin, and electrocardiogram, if indicated, in 100 terminally ill cancer patients. Forty-nine percent of the patients had lung cancer. The median VAS scores for SOB and anxiety were 53 mm and 29 mm, respectively. Spirometry was abnormal in 93% of patients, with 5% having obstructive, 41% restrictive, and 47% mixed patterns. The median MIP was 16 cm H2O. Sixty-five percent of the patients had parenchymal or pleural involvement on chest radiograph. Twenty-nine percent had evidence of cardiac ischemia, recent or current myocardial infarction or atrial fibrillation. Patients had a median of five different abnormalities that could have contributed to their shortness of breath. Only anxiety (p = 0.001), a history of smoking (p = 0.02), and pCO2 levels were statistically significantly correlated with SOB VAS scores. The potentially correctable causes of dyspnea included hypoxia (40%), anemia (20%), and bronchospasm (52%). The finding of very low MIPs suggests severe respiratory muscle weakness may contribute significantly to dyspnea in this patient population. Further studies are needed to confirm this finding and characterize the underlying pathophysiology.
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PMID:Dyspnea in the advanced cancer patient. 1058 52

The most common initial symptom of aortic dissection is chest pain. Other initial symptoms include pain in the neck, throat, abdomen and lower back, syncope, paresis, and dyspnoea. Headache as the initial symptom of aortic dissection has not been described previously. A 61-year-old woman with a history of migraine and arterial hypertension developed continuous bifrontal headache. Two hours later, right-sided thoracic pain and a diastolic murmur were suggestive of aortic dissection that was confirmed by echocardiography and subsequent surgery. The dissection commenced in the ascending aorta and involved all cervical arteries until the base of the skull. Headache as the initial manifestation of aortic dissection was assumed due to either vessel distension or pericarotid plexus ischemia. Aortic dissection has to be considered as a rare differential diagnosis of frontal headache, especially in patients who develop aortic regurgitation or chest pain for the first time.
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PMID:Headache as the initial manifestation of acute aortic dissection type A. 982 52

A 37-year-old woman with psoriasis arthropathica associated with aortic regurgitation underwent replacement of her aortic valve. The serum rheumatic factor was negative. HLA-B 27 was demonstrated in HLA analysis. She experienced a sudden onset of dyspnea and cardiac arrest in the hospital. She was hospitalized and found to have severe aortic regurgitation. She had her aortic valve replaced. We paid attention to management of blood pressure not to trigger cardiac ischemia and of skin lesion not to trigger infection and the worsening of skin condition. There are few reports of HLA-B 27 positive psoriasis arthropathica accompanied by aortic regurgitation. However, the present case may suggest that the cardiac study may be required for HLA-B 27 positive psoriasis arthropathica.
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PMID:[Anesthetic management of a patient with psoriasis arthropathica]. 1043 24

This study explores gender differences in symptom presentation associated with coronary heart disease (CHD). In this prospective study, nurse data collectors directly observed 550 patients as they presented to the Emergency Department (ED) of Yale-New Haven Hospital. The final sample included 217 patients (41% women) diagnosed with CHD (acute coronary ischemia or myocardial infarction). Chest pain was the most frequently reported symptom in women (70%) and men (71%). Unadjusted analyses revealed that women were more likely than men to present with midback pain (odds ratio [OR] 9.61, 95% confidence interval [CI] 2.10 to 44.11, p = 0.001), nausea and/or vomiting (OR 2.29, 95% CI 1.19 to 4.42, p = 0.012), dyspnea (OR 1.82, 95% CI 1.05 to 3.16, p = 0.032), palpitations (OR 3.42, 95% CI 1.02 to 11.47, p = 0.036), and indigestion (OR 2.13, 95% CI 1.03 to 4.44, p = 0.040). After adjustment for age and diabetes, women were more likely to present with nausea and/or vomiting (OR 2.43, 95% CI 1.23 to 4.79, p = 0.011) and indigestion (OR 2.13, 95% CI 1.10 to 4.53, p = 0.048). Women (30%) and men (29%) were equally likely to present without chest pain, and dyspnea was the most common non-chest pain symptom. In the subgroup of patients without chest pain, unadjusted analyses revealed that women were more likely to report nausea and/or vomiting compared with men (OR 4.40, 95% CI 1.30 to 14.84, p = 0.013). Although we found some significant gender differences in non-chest pain symptoms, we conclude that there were more similarities than differences in symptoms in women and men presenting to the ED with symptoms suggestive of CHD who were later diagnosed with CHD.
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PMID:Gender differences in symptom presentation associated with coronary heart disease. 1046 75

Pulmonary embolism is the fourth leading cause of pleural effusion. The possibility of pulmonary embolus should be evaluated for all patients who have undiagnosed pleural effusion. The mechanism of pleural effusion caused by pulmonary embolus is usually increased interstitial fluid in the lungs as a result of ischemia or the release of vasoactive cytokines. Approximately 75% of patients with pulmonary emboli and pleural effusion have pleuritic chest pain. The most common cause of pleuritic chest pain and pleural effusion in patients under 40 years old is pulmonary emboli. Pleural effusion resulting from a pulmonary embolus usually occupies less than one-third of the hemithorax. Dyspnea is frequently out of proportion to the size of the pleural effusion. Pleural fluid caused by pulmonary emboli is usually exudative but is occasionally transudative. d-Dimer testing is a good screen for pulmonary emboli. If d-dimer results are positive, then a spiral computed tomograph should be obtained to confirm the diagnosis. Low-molecular-weight-heparin has become the initial treatment of choice for patients with pulmonary emboli and pleural effusion.
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PMID:Pleural effusion due to pulmonary emboli. 1147 Sep 74

Hydatic cardiac cyst (HCC) is a rare anomaly, characterized by wide spectrum of clinical presentations. Its diagnosis took large benefit from echocardiography progress. We aimed in this study to analyse epidemiologic aspect of HCC, as well as its diagnostic data, with special emphasize on echocardiography. Observations of 8 patients, admitted between 1991 and 2000 has been reviewed. Age average was 30 years (13 to 59). Main symptoms consisted of chest pain (62.5%) and dyspnea (35%). Chest X-Rays showed cardiac silhouette anomaly in 4 cases. Electrocardiogram showed sub-epicardical ischemia in 5 patients. HCC diagnosis was established by transthoracic echocardiography in all cases. It was located inside a cardiac chambers (n = 5), the interventricular septum (n = 2), and the pericardium (n = 1). HCC relation with adjacent cardiac structures was well defined by transoesophageal echocardiography performed in 7 cases. All patients underwent surgery with good immediate results. All patients were events free, with a mean follow-up of 25 months.
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PMID:[Cardiac hydatid cyst (report of 8 cases)]. 1189 34

Older men and women with coronary artery disease and silent myocardial ischemia detected by 24-hour ambulatory electrocardiograms (ECGs) have a higher incidence of new coronary events than those with no silent ischemia. The prevalence of clinically unrecognized MI detected by routine ECGs in older persons varies from 21 to 68%. Atypical symptoms associated with acute MI in older persons include dyspnea and neurologic and GI symptoms, as well as chest pain. Older persons with clinically unrecognized MI have a similar or higher incidence of new coronary events and mortality compared with those with recognized MI, which suggests that an aggressive diagnostic and therapeutic approach may be beneficial in these patients.
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PMID:Silent MI. Prevalence and prognosis in older patients diagnosed by routine electrocardiograms. 1254 68

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

Cardiac cysthydatid is rare pathology and is seen in 0.5 to 2% of echinococcal infections. It is found in the left ventricle most frequently and then in the right ventricle. We present a case with a ruptured cysthydatid at the right atrium's interatrial septum and multiple cysthydatids localized at the outer surface of the left ventricle's apex, which necessitated a synchronized coronary revascularization with our diagnosis and surgical procedure modalities. Our patient was a 61-year-old man with complaints of fever, dyspnea, tachycardia and chest pain, which began 2 months before admittance. An echocardiography in our clinic revealed a 4.7 x 1.7 centimeter, pediculled, going in and out to tricuspidal inflow, cystic mass adherent to the interatiral septum in the right atrium, which prompted immediate hospitalization. He was in New York Heart Association Class II. His electrocardiography (EKG) showed ischemia at inferior and lateral surfaces, so we performed a coronary angiography and determined a severe stenosis at the proximal part of the left anterior descending artery. His EKG showed ischemia at the inferior and lateral surfaces, so we performed a coronary angiography and determined a severe stenosis at the proximal part of the left anterior descending artery. His preoperative biochemical parameters were normal, and cysthydatid serology tests were negative. With these results,l we planned a synchronized surgical procedure for coronary artery disease with multiple cardiac cysthydatids. During operation, after the right atriotomy, a fragile cystic mass with a ruptured image and dimensions of 5 x 2 x 2 centimeters, originating from the interatrial septum and in a conglomerate form, was resected and extirpated. The left atrium was not involved. Then, 3 masses with dimensions of 2 x 2 centimeters, which were not diagnosed with the echocardiogram, at the epicardial surface of the left ventricle apex were excised. The defected part of the left ventricle was repaired with teflon felt supports for rupture prophylaxis. Then, a left internal mammary artery graft, which was prepared at the beginning of the operation, was anastomosed to LAD. The patient didn't have any additional problem during the postoperative period, and he was discharged at 1 week after surgery. To avoid recurrence, the patient was prescribed albendazole as a prophylaxis for the duration of 2 months. Histopathology confirmed the diagnosis of cysthydatid. Patients with cardiac cysthydatid can be asymptomatic or can cause minimal nonspecific symptoms for years. The condition can be lethal if not diagnosed and treated. The primary treatment for cysthydatid is surgery. Echocardiography is an important diagnostic method for cysthydatid. Serological tests can produce negative results if the immune responses of the patient is not sufficient, so it must be remembered in the endemic places for echinococcus.
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PMID:Synchronized coronary revascularization and multiple cardiac cysthydatid operation. 1498 38


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