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

A case report of a patient with persistent left anterior hemiblock admitted with acute ischemic heart disease is described. At effort during follow-up evaluation, the patient complained of retrosternal pain when the heart rate was 124 beats/min. No pathological ST-T changes were demonstrated at this time. At 133 beats/min, the precordial pain increased, the QRS axis displayed a marked shift to the right, and ischemic ST-T depression was recorded. In discussing this unreported phenomenon, it is pointed out that left anterior hemiblock does not necessarily represent an anatomical block of the atrioventricular bundle but may simply reflect a relative delay in conduction. In addition, acute ischemia may change the physiological behavior of the system resulting in slower conduction through the posterior rather than through the anterior atrioventricular bundle. The influence of left anterior and left posterior hemiblock on ischemic ST-T changes and on the coronary flow distribution is discussed.
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PMID:Shift from left to right axis deviation during ischemia. 761 50

A twenty year old man presented an acute hematomyelia at T2-T3 level and had electrocardiographic changes suggesting subendocardial and subepicardial ischemia; he also had precordial pain and elevation of the MB fraction of creatine phosphokinase. Neurons providing heart inervation are located at the T2-T3 spinal level. The electrocardiographic changes observed were considered neurogenic in origin and were transient. Although there are experimental reports showing electrocardiographic changes associated with compression of the upper part of thoracic spinal cord, this is the first report to our knowledge, in which an acute spinal injury is shown to be associated with neurogenic changes in ventricular repolarization simulating acute myocardial ischemia.
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PMID:Changes in cardiac repolarization and ventricular conduction in a case of acute hematomyelia. Report of a case. 181 75

In patients with intermittent left bundle branch block (LBBB) it is common to observe T wave abnormalities in the right precordial leads during normally conducted beats. These changes have usually been interpreted as a result of anteroseptal ischemia. More recently it has been suggested that they may be the consequence of an electric phenomena secondary to the abnormal ventricular activation. However, the "benign" character of these abnormalities has never been confirmed by clinical studies. We have studied a group of 10 pts (3 males and 7 females), aging between 23 and 66 years (mean 41 +/- 8) with atypical precordial pain admitted to our institution, because of intermittent LBBB and T wave inversion in the right precordial leads during the normally conducted beats. All patients had normal left ventriculography and coronary angiograms. During the follow-up period (20 to 102 months, mean 4.7 years) they were subjected to serial clinical examinations, 24 hours ECG Holter monitoring echocardiogram and exercise thallium 201 scintigraphy. Within this period of observation, no patient developed symptoms or signs of cardiac involvement while all but three developed a stable LBBB (these three patients have been followed only for a limited period of time). Exercise thallium 201 scintigraphy showed in 4 patients a reversible septal perfusion defect during LBBB. We conclude that T wave abnormalities observed in the normally conducted beats in patients affected by intermittent LBBB have a favourable prognostic significance.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[T-wave changes in intermittent left bundle branch block. Pathogenesis and clinical significance]. 409 15

We report the case of a patient with ventricular tachyarrhythmia, which occurred after atropine was given intravenously for diagnostic purposes. The arrhythmia was accompanied with precordial pain and nitroglycerin promptly reduced both events. On the ECG an elevated ST segment in leads I, aVL, V4, V5, V6 was observed for few hours after the end of the arrhythmia, followed by a pattern of myocardial ischemia. Serum enzymes were repeatedly normal. Spontaneous anginal attacks, usually accompanied with ECG signs of myocardial ischemia and 2nd degree AV block, were often observed by means of 24 hours ECG monitoring (Holter) in the following weeks, in spite of appropriate treatment. Either myocardial ischemia, induced by the increased heart rate following atropine administration, or direct electrophysiologic effects of the drug upon the ventricle muscle (possibly in association with ischemia) could have caused the ventricular arrhythmia.
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PMID:[Hyperkinetic ventricular arrhythmia induced by atropine administration]. 688 46

The syndrome X is a clinical disease characterised by anginous pain with the absence of significant and angiographically visible stenosis of the coronary tree. D. P. M., a 61-year-old woman suffering from biliary lithiasis, underwent cholecystectomy. During the immediate postoperative period, the patient showed difficulty in regaining consciousness and there were electrocardiographic signs of extensive anterior ischemia; prior to the operation only a 1st degree atrio-ventricular block and a positive history of occasional precordial pain had been reported. On the 2nd postoperative day the patient complained of violent retrosternal pain irradiated to the left shoulder. Given that the signs of ischemia had regressed, various instrumental tests were performed: echocardiogram, cycloergometric test, dipyridamole test, cold pressure test, Holter's dynamic ECG, all of which were within the normal; moreover, selective coronarography did not reveal significant stenosis of the coronary tree. The patient was therefore diagnosed as suffering from syndrome X. In the light of the present case, the authors conclusion may be summarised as follows: the diagnosis of syndrome X, which is by definition not easy, may sometimes become critical, as in the present case, since rapid intervention would have enabled prophylactic therapy to be performed to combat surgical stress.
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PMID:[Syndrome X and surgical stress. A clinical case]. 846 70

In recent years cardiology has opened new chapters in the treatment of acute coronary syndrome (ACS). The acute therapeutic procedures include antianginal, anticoagulant and revascularization therapy. Optimal therapeutic procedure in ACS has two objectives: 1) quick removal of the factors causing ischemia, and 2) prevention of death or myocardial infarction, i.e. reinfarction. Nitrates have been present in pharmacotherapy for more than 150 years. They are used exclusively to efficiently suppress the symptoms, but there is no proof of their positive effect on the disease prognosis. The effect of nitrates is manifested as vasodilatation in the arterial, and particularly in the venous vascular basin (central and peripheral effects) thus increasing the capacity of venous blood. Besides the peripheral effect, nitrates have an important central effect, i.e. they dilate epicardial coronary arteries, both the healthy ones and those damaged by atherosclerosis, in this way increasing the collateral blood circulation. Organic nitrates, although the oldest antianginal drug, play one of the leading roels in the treatment of ACS even today. Beta-adrenergic blocking agents have been used since 1960 in the treatment of arterial hypertension, coronary disease and cardiac arrhythmias, and later their efficacy in the prevention of secondary myocardial infarction was noted. Beta blockers (BB) reduce heart rate, systemic blood pressure and myocardial oxygen requirements, reduce myocardial contractility, thus alleviating precordial pain in ACS, decreasing the rate of threatening infarction, and reducing ventricular arrhythmias. Numerous clinical studies have shown that BB in ACS improve the disease prognosis and play an important role in long-term secondary prevention after myocardial infarction. Antagonists of calcium channel blockers are a group of therapeutic agents successfully used in numerous cardiac and noncardiac indications. Potential benefits of calcium antagonists in ACS are the result of various combinations, such as dilation of coronary arteries and arterioles, reduction of heart rate and myocardial oxygen requirements, and beneficial effect on left ventricular function and elasticity. The use of calcium channel blockers in ACS reduces or prevents the symptoms and accompanying ischemia, but there is no evidence that these agents prolong survival in patients with heart failure. In recent years the treatment of an ACS has significantly changed owing to better understanding of the pathogenesis of the disease as well as progress in medicinal and interventional treatment. Antianginal therapy, which includes nitrates analgesics, calcium channel blockers and antiadrenergic therapy using beta-blockers in treatment of ACS, takes a significant place.
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PMID:[Antianginal and antiadrenergic therapy in acute coronary syndrome]. 1520 97

The arrival of a patient with chest pain syndrome (precordial) to the emergency represents a diagnostic challenge for the physician. Around 6 million persons are seen each year at the Emergency units in the USA. More than half of the patients are admitted for their cardiac evaluation. Its cardiac origin is confirmed in 10 to 15%, and about 15% of them develop myocardial infarction. However, 5 to 10% of patients are dismissed and develop myocardial infarction during the next 48 h. The diagnosis of the infarct is inadvertent and/or patients is not hospitalized in 2 to 8%. The mortality rate is duplicated in none hospitalized patients. Frequently, a conservative observation conduct and/or diagnostic expectation is taken, with the consequent saturation of the intensive care unit that looses its critical character and avoids quick mobilization of the patient with an increase in costs. The clinical judgment, a meticulous clinical history, and careful physical examination play a key role in the differential diagnosis of the precordial pain syndrome; however, pain can be atypical, absent or manifest as an equivalent of pain, which does not exclude the diagnosis of myocardial infarction or ischemia. Likewise, chest pain in the presence of a normal conventional ECG at rest, non-diagnostic or with minimal variations, does not rule out the possibility of a coronary obstruction and does not mean that the pain is not of coronary origin. Other characteristics of the ECG, such as T wave and ST segment alterations, bundle branch block (BBB), LV hypertrophy, interpretation discrepancies, can pose doubts or mistakes in the diagnosis. Although its diagnostic information is essential, other non-invasive laboratory tests are needed, such as the treadmill stress ECG, serial bioenzymatic markers, and myocardial perfusion scintigraphy (SPECT and Gated-SPECT) at rest or under physical or pharmacologic stress. The advantages and disadvantages of the stress ECG, the echocardiography, magnetic resonance and PET are mentioned. The advantages of the SPECT and Gated-SPECT in the diagnosis and prognosis are: 1) great diagnostic objectivity; 2) high sensitivity and specificity; 3) diagnosis does not depend on evolution time of the ischemia and/or infarction, since SPECT diagnoses the initial primary modifications of ischemia; 4) diagnosis is achieved within the established limit of time, in less than 4 to 6 hours. The designed protocols allow to obtain the diagnosis between 30 min and 1:30 h; 5) assesses the myocardium at risk; 6) stratifies the risk and prognosis; 7) defines the site and 8) the involved coronary artery(les); 9) provides the functional significance of the anatomic obstruction; 10) quantifies the ventricular function, i.e., ejection fraction, systolic and diastolic volumes, systolic thickening, ventricular failure signs; 11) provides three-dimensional visualization of the mobility of the left ventricular wall; 12) diagnoses simultaneously the associated presence of ischemia and/or infarction of the right ventricle; 13) its high negative predictive value allows to dismiss immediately and with a great safety margin those patients in whom SPECT revealed normal perfusion; 14) costs are reduced without adversely compromising the safety of the patients. We describe the algorithm used as guideline for the early diagnosis in the presence or absence of ischemic heart disease in the patient with precordial or chest pain syndrome with normal or non-diagnostic ECG at arrival to the emergency ward. It is necessary to modified the clinical educational patterns and to revaluate the advantages and limitations of the clinical history, physical exploration, as well as of the conventional ECG at rest and other diagnostic methods used specifically in relation to the chest pain syndrome with a normal or non diagnostic conventional ECG. SPECT and Gated-SPECT scintigraphy is considered as the best individual and isolated non-invasive test for the diagnostic solution of the precordial syndrome at the Emergency Unit.
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PMID:[Chest pain syndrome in normal or non-diagnostic conventional ECG at the emergency service. Assessment with myocardial perfusion (SPECT) and ventricular function (Gated-SPECT)]. 1521 44

We experienced a rare case of perforated duodenal ulcer that occurred at seven years after heart-kidney transplantation. This patient is reported here together with a discussion of the etiology, the selection of treatment, and perioperative management. The patient was a 46-year-old man who presented with precordial pain. In 1995, he had undergone simultaneous heart and kidney transplantation in the United States and had been on long-term immunosuppressive and corticosteroid therapy. His precordial pain started from May 24, 2002. He was examined at our hospital on May 27 and underwent emergency surgery with a diagnosis of upper gastrointestinal perforation. A 4-mm perforation was observed on the anterior wall of the duodenal bulb and panperitonitis was also present. Patch closure of the perforation was performed by pulling the omentum over the defect. Perioperative management consisted of his usual immunosuppressants together with antacid therapy. The postoperative course was good and he was discharged on hospital day 15. In this patient, the mechanism of perforation was assumed to involve sudden irritation combined with poor circulation in the duodenum and tissue ischemia, as well as a decrease of mucosal protective factors based on long-term corticosteroid therapy. Perforated duodenal ulcer is a rare problem after heart transplantation. Because the time that elapses after perforation is an important determinant of the prognosis, early diagnosis and appropriate surgical repair are essential.
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PMID:Perforated duodenal ulcer at seven years after heart-renal transplantation: a case report. 1536 55

The objective of this report is to document the effects of an aerobic training program on myocardial perfusion, and endothelial function abnormalities, and on the relief of angina in a patient with microvascular myocardial ischemia. A 53-year-old female patient exhibited precordial pain on effort and angiographically normal coronaries. Her symptoms had been present for 4 yrs despite pharmacologic treatment for the control of risk factors, with myocardial perfusion scintigraphy revealing an extensive reversible perfusion defect. She was submitted to aerobic training for 4 mos, obtaining significant improvement of the anginal symptoms. Additionally, after the aerobic training program, scintigraphy revealed the disappearance of the myocardial perfusion defect, with a marked improvement of endothelium-dependent vasodilatory response and an improved quality-of-life score. These results suggest that aerobic training can improve endothelial function, leading to a reduction of ischemia and an improved quality-of-life in patients with microvascular myocardial ischemia.
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PMID:Improved endothelial function and reversal of myocardial perfusion defects after aerobic physical training in a patient with microvascular myocardial ischemia. 2053 Nov 60

Dextrocardia with situs inversus occurs in approximately one in 10,000 individuals of whom 20% have primary ciliary dyskinesia inherited as an autosomal recessive trait. These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population. We report what is, to our knowledge, the first case of total triple-vessel coronary revascularization by percutaneous stent implantation in a 79-year-old woman with situs inversus dextrocardia. We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques. The case also highlights that the right precordial pain may represent cardiac ischemia in this population.
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PMID:Triple-vessel percutaneous coronary revascularization in situs inversus dextrocardia. 2063


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