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 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intra-aortic balloon conterpulsation (IABP) was used to assist 109 patients with extensive myocardial infarcts, unstable angina, cardiogenic shock, and unstable cardiodynamic states after cardiopulmonary bypass over a six year period. Severe vascular occlusion occurred in three patients (3%) which required an above the knee amputation. Each patient had a long history of smoking. Obesity, atherosclerotic disease of the femoral vessels, and extensive coronary artery disease were additional contributing factors. Two of the three patients survived, but both survivors had extensive postoperative myocardial infarctions. A low flow cardiac state and the presence of atherosclerotic changes in the legs must be precipitating factors for the vascular complications. Several possible methods to minimize complications of this nature include 1) angiographic examination of the lower aorta and femoral arteries at the time of cardiac catheterization, 2) frequent monitoring with ultrasound equipment, and 3) use of anticoagulation during and after the period of counterpulsation.
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PMID:Vascular complications as a result of intra-aortic balloon pumping. 31 43

Of the major risk factors for atherosclerosis, high factor VII and fibrinogen levels, genetic predisposition, gender and age cannot be influenced. Reduction of high blood pressure reduces the cerebral but not the coronary vascular risk and correction of dyslipidaemia correlates with cardiovascular risk. Other major risk factors (tobacco consumption, obesity, sedentary lifestyle and diabetes) can also be modified. Aspirin in doses of approximately 300 mg/day may be recommended for the primary prevention of myocardial infarction (MI), but only in those patients with a moderate to high risk of cardiovascular disease. Aspirin reduces the risk of fatal and nonfatal MI by about 50% and also decreases the overall mortality rate among patients with unstable angina. A lower dose of aspirin (150 mg/day) also reduces mortality by 23% in the acute phase of MI. In doses of 300 mg/day, aspirin is useful in the secondary prevention of MI and reduces the overall mortality rate by 15%. Various antiplatelet agents, including aspirin (alone or combined with dipyridamole) and ticlopidine, have proved useful in the prevention of thrombosis in aorto-coronary grafts, provided treatment begins at the latest 6 hours after surgery. The usefulness of antiplatelet drugs has been well established in the prevention of immediate reocclusion following coronary angioplasty, but not in the prevention of late reocclusion. Aspirin and ticlopidine are also beneficial in extracorporeal circulation techniques. In patients with a synthetic cardiac valve prosthesis, antivitamin K-anticoagulants are still indispensable lifelong, but their antithrombotic effect can be reinforced by dipyridamole or aspirin. Diuretics probably provide the best primary protection against cerebrovascular accidents, although medium doses of aspirin may be considered in elderly people at high risk of such accidents. Aspirin (alone or combined with dipyridamole) and ticlopidine may be recommended for the secondary prevention of cerebral ischaemic accidents. Aspirin (with or without dipyridamole) and ticlopidine reinforce the treatment of obliterative arterial disease in the lower limbs.
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PMID:Risk factors, interventions and therapeutic agents in the prevention of atherosclerosis-related ischaemic diseases. 172 14

Clinical and risk factor profile of 101 consecutive female patients subjected to coronary angiography was analysed. Coronary angiography showed single vessel disease (SVD) in 15.8 per cent, double vessel disease (DVD) in 12.9 per cent, triple vessel disease (TVD) in 39.6 per cent and normal coronary arteries (NC) in 30.7 per cent. Risk factor profile in patients with angiographic coronary artery disease (group II) included hypertension (HT) in 52.9 per cent, diabetes mellitus (DM) in 44.3 per cent, post menopausal state in 84.3 per cent, positive family history in 51.4 per cent, obesity in 58.3 per cent, low density and high density lipoprotein ratio (LDL/HDL) more than 3.0 in 58 per cent and smoking in 4.3 per cent. Risk factors in 31 patients with NC (group I) included HT in 29 per cent, DM in 6.5 per cent, positive family history in 45.2 per cent, obesity in 45.2 per cent, post menopausal state in 48.4 per cent, LDL/HDL ratio more than 3.0 in 30 per cent and smoking in none. The clinical presentation in group II was unstable angina in 64.3 per cent, stable angina pectoris in 24.3 per cent, myocardial infarction in 4.3 per cent and atypical chest pain in 2.8 per cent. In group I half the patients presented with atypical chest pain. The other modes of presentation included unstable angina 25.8 per cent, stable angina pectoris in 16.2 per cent and myocardial infarction in 6.5 per cent. Predictive value of exercise electrocardiography (Ex ECG) or exercise radionuclide studies (Ex RNU) was 61.7 and 68.4 per cent respectively. DM, post-menopausal state and LDL/HDL ratio more than 3 were significant risk factors in women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Profile of coronary artery disease in Indian women: correlation of clinical, non invasive and coronary angiographic findings. 189 97

The fibrinogen and orosomucoid levels in plasma were studied in 249 patients within 24 h after admission to the coronary care unit because of suspected unstable coronary artery disease (CAD), i.e. unstable angina pectoris or non-Q-wave myocardial infarction (MI). Of these patients, 127 were considered to have unstable CAD either because of symptoms and signs of coronary insufficiency at a pre-discharge exercise test (n = 66) or because of the development of a probable or definite non-Q-wave MI (n = 61). The other chest pain patients without objective signs of myocardial ischaemia constituted the control group. A diagnosis of unstable CAD, and the occurrence of obesity or current smoking contributed independently to elevated fibrinogen and orosomucoid levels. In patients with non-Q-wave MI both the fibrinogen and orosomucoid levels were high regardless of obesity and smoking, indicating myocardial necrosis as a prominent cause for the elevation of these acute phase reactants. Obesity and smoking seemed to influence the metabolism of fibrinogen and orosomucoid and change their basal level and/or exaggerate their response to inflammatory stimuli. The increased fibrinogen level in unstable CAD might reflect a hypercoagulable state that contributes toward a progression of coronary lesions.
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PMID:Plasma fibrinogen in unstable coronary artery disease. 272 17

A prospective study of 208 consecutive survivors of acute myocardial infarction was undertaken to determine the differences between Q- and non-Q-wave infarction, concerning data from the history, clinical course, and 6-month follow-up. There were 177 patients with Q-wave infarction and 31 patients with non-Q-wave infarction. There were no significant differences for the following variables: age, sex, diabetes mellitus, smoking, positive family history, hypertension, obesity, previous infarction, history of unstable angina, heart failure or chronic obstructive pulmonary disease (COPD), Killip class in the Coronary Care Unit (CCU), arrhythmias and conduction defects in the CCU as well as drugs used. Patients with non-Q wave infarction had a higher incidence of stable angina before the myocardial infarction and a lower value of creatine kinase (CK) and serum glutamic oxalacetic transferase (SGOT). During the 6-month follow-up, 9 cardiac deaths and 17 reinfarctions occurred, while 74 patients presented angina. There were no differences between the two groups concerning the incidence of cardiac death or angina, but patients with non-Q-wave infarction had a higher incidence of reinfarction at 6 months (p less than 0.001). We conclude that although patients with non-Q-wave myocardial infarction have a lesser degree of myocardial damage, they have a high incidence of early reinfarction which puts them in a high-risk group.
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PMID:Q- versus non-Q-wave myocardial infarction: clinical characteristics and 6-month prognosis. 671 48

A new risk classification for patients undergoing cardiac surgery has been used for the last two years by the anaesthesiologists of the Montreal Heart Institute. The following factors known to be associated with a greater operative morbidity and mortality were selected: (1) poor left ventricular function, (2) congestive heart failure, (3) unstable angina or recent (less than 6 weeks) myocardial infarction, (4) age over 65 years, (5) severe obesity (Body Mass Index greater than 30), (6) reoperation, (7) emergency surgery, (8) other significant or uncontrolled systemic disturbances. Patients with none of the above factors were classified as normal risks; those presenting with one of those selected factors were classified as increased risks, and those with more than one factor were said to carry a high risk. In a prospective study of 500 consecutive open-heart surgery patients classified according to this method, we found that the operated population at normal risk (50 per cent of cases) had a mortality of 0.4 per cent, the patient group with increased risk (32 per cent of cases) had a mortality of 3.1 per cent, and the high risk group (18 per cent of cases) had a 12.2 per cent mortality. Furthermore, 50 deaths following open-heart surgery were assessed retrospectively using the classification; 58 per cent of these patients were classified as high risk, 34 per cent had an increased risk, and only eight per cent were found to be in the normal risk group. Thus, this new risk classification has proven to be a reliable and useful tool for preoperative assessment of patients undergoing open-heart surgery and for teaching purposes.
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PMID:A simple classification of the risk in cardiac surgery. 682 88

Risk factor profile of 142 patients with normal epicardial coronary arteries (86 males, 56 females, mean age 47 +/- 11 years) out of 1,508 consecutive patients undergoing coronary angiography was analysed. The mode of presentation in these patients was old or recent myocardial infarction (16.1%), unstable angina (12.0%), angina on effort (43.7%), atypical chest pain (8.5%), and anginal equivalent (19.7%). One or more stress test was positive in the majority (88%) of patients. Though the majority (39.5%) of patients had one risk factor, multiple (two or more) risk factors were not uncommon. Risk factor profile in patients with normal coronaries included hypertension (45.7%), dyslipidemia (33.8%), obesity (19.7%), positive family history of coronary artery disease (18.3%), cigarette smoking (16.1%), and minor risk factors (hyperuricemia, sedentary life style, Type A personality, oral contraceptive intake -15.4%). The mechanism of myocardial ischemia in patients with normal coronary arteries is not fully understood. We conclude that approximately one tenth of patients with clinically manifest coronary artery disease and one or more conventional risk factors do not have atherosclerotic changes in their epicardial coronary arteries as seen on coronary angiography.
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PMID:Profile of coronary risk factors in patients with manifest ischaemia and normal coronary arteries. 779 18

Since 1980, the operative risk in all our cardiac surgical patients has been assessed before surgery. In light of reports of changes in cardiac surgical populations, we reexamined our practice and risk classification. The purpose of this study was to compare the surgery performed, the characteristics of the patients operated upon and the hospital mortality in our institution in two epochs ten years apart. In 1989-90, the 2029 consecutive cardiac surgical patients who had the same operations as the 500 patients of a 1980 study in our institution were prospectively stratified using our risk classification based on the number of risk factors (RFs) present: normal-risk patient = no RF, increased risk = 1 RF, high risk > or = 2 RFs. These two cohorts of patients were compared. From 1980 to 1990, the proportion of high-risk patients tripled whereas the proportion of normal-risk patients diminished by one third and the proportion of increased risk remained unchanged. The incidence of the following RFs increased: poor left ventricular function, advanced age, emergency surgery, reoperation and other systemic disorders. In coronary artery surgery patients, the incidence of unstable angina/recent myocardial infarction and of obesity also increased. In noncoronary artery surgery patients, the incidence of heart failure increased while obesity remained unchanged. The difference in hospital mortality among the three risk classes was significant within both study periods. The mortality in each risk class and total mortality did not change between 1980 and 1990.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A simple classification of the risk in cardiac surgery: the first decade. 844 63

Results obtained with intra-aortic balloon pumps (IABPs) at Harbor-UCLA Medical Center from 1990 to 1995 were reviewed to analyze the indications for its use as well as the incidence and types of vascular complications that occurred. Of 86 patients (53 men and 33 women) in whom pumps were used, 66 underwent coronary bypass, 14 underwent valve replacement, and 6 underwent both coronary bypass/valve replacement. Thirteen (15%) deaths occurred (8 coronary bypass patients, 4 valve replacement patients, and 1 coronary bypass/valve replacement patient). The indications for IABP were broadly classified as prophylactic or inability to wean. Prophylactic IABP placement preoperatively occurred in 35 (41%) patients for profound ventricular dysfunction (27 patients), compelling coronary anatomy including critical left main disease (7 patients), and unstable angina (1 patient). Inability to wean occurred in 51 (59%) patients. Three patients (3.5%) developed major vascular complications resulting in limb ischemia. All three underwent thrombectomies, fasciotomies, and above-knee amputations; two patients subsequently died. Vascular reconstruction was performed in two patients as a direct result of their vascular process. All three vascular complications occurred in women. Besides gender, there was no difference between IABP patients with or without vascular complications in terms of age or presence of diabetes, hypertension, smoking history, obesity, or known peripheral vascular disease. These results indicate that IABPs are effective both prophylactically and intraoperatively in patients who would not otherwise survive cardiac surgery.
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PMID:Intra-aortic balloon pump: indications and complications. 954 76

Acute coronary syndromes (ACS) such as unstable angina, myocardial infarction, or sudden ischemic death evolve from coronary thrombosis consequence of atherosclerotic plaque disruption. Plaque stabilization is an important therapeutic strategy in the prevention of ACS. Coronary risk factors include age, male sex, cigarette smoking, hypertension, dislipidemia, diabetes mellitus, insulin resistance and/or hyper insulinemia, obesity, sedentary lifestyle, stress, and the morning surge of sympathetic activity. New risk factors are emerging such as high homocystein, inflammation, and some kinds of infection. Control of blood pressure and cholesterol clearly reduce the risk of coronary events and mortality although the effects of antihypertensive therapy have been less than expected. The benefits of smoking cessation, moderate alcohol consumption, low-dose aspirin prophylaxis, estrogen-replacement therapy in postmenoposal women have also been shown.
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PMID:[Risk factors and prevention of acute coronary syndrome]. 979 37


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