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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this study was to assess the hemodynamic response to intravenous atenolol in elderly patients with acute myocardial infarction. We studied 14 elderly men, aged 64-85 years, and 14 younger men, aged 29-48 years, in the early postfibrinolytic phase of acute myocardial infarction. All the patients were in Killip class I. A triple-lumen Swan-Ganz thermodilution catheter was introduced into the right heart chambers. The patients received 5 mg intravenous atenolol over 5 minutes. All hemodynamic parameters were measured before and 10 minutes after atenolol. The hemodynamic characteristics and the location and extent of acute myocardial infarction were the same in both groups before atenolol. The hemodynamic changes after atenolol administration were the same in the two groups, but the stroke volume and cardiac indexes decreased to a greater extent in the elderly (p = .01 and p = .0001, respectively). These results indicate that intravenous atenolol in the early postfibrinolytic phase of acute myocardial infarction is safe in Killip class I elderly patients, although the cardiac and stroke volume indexes decrease, and the increase in the total systemic resistance is more in older than in younger patients.
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PMID:Intravenous atenolol in elderly patients in the early phase of acute myocardial infarction. 145 92

We describe a pulsatile aneurysm in the skin of 16-year-old boy that was found to be a sign of a systemic vascular disease, that is, arterial fibromuscular dysplasia. The patient had aneurysms in the renal, cerebral, coronary, and other arteries; he developed renovascular hypertension and had a cerebrovascular accident and acute myocardial infarction at 17 years of age. This disease has not been previously reported in the dermatologic literature.
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PMID:Aneurysm in the skin: arterial fibromuscular dysplasia. 146 51

The relative efficacy and safety of individual thrombolytic agents, administered alone and with antiplatelet and antithrombotic drugs, in the treatment of acute myocardial infarction are presented. The clinical benefits and risks of treatment choices are discussed in relation to the mechanisms of the formation and prevention of thrombus and thrombolysis. It is concluded that streptokinase, tissue plasminogen activator (t-PA), and anisoylated plasminogen-streptokinase activator complex (APSAC) significantly reduce mortality and improve left ventricular function equally, despite differences in the rate at which they achieve vascular patency, their durations of action, and the extent to which their use is associated with adverse events. The questions of how best to minimize reocclusion/reinfarction, bleeding, and stroke are discussed, with particular focus on the beneficial use of aspirin and the unresolved issue of how best to use heparin.
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PMID:Thrombolytic, antiplatelet, and antithrombotic agents. 147 1

The ECG is useful in diagnosing acute myocardial infarction and unrecognized Q-wave myocardial infarction in the elderly. Unrecognized myocardial infarction and myocardial infarction associated with clinical symptoms have a similar incidence of new coronary events. Ischemic ST-segment depression on the resting ECG is associated with an increased incidence of new coronary events. The ECG is useful in the diagnosis of LV hypertrophy but is less sensitive and less specific than echocardiography in diagnosing LV hypertrophy. ECG LV hypertrophy is associated with an increased incidence of cardiovascular events in the elderly. However, echocardiographic LV hypertrophy is more sensitive in predicting new coronary events, atherothrombotic brain infarction, and congestive heart failure than is ECG LV hypertrophy. The ECG is also useful in diagnosing conduction defects and arrhythmias in the elderly. In the elderly, left bundle branch block, intraventricular conduction defect, Type II second-degree atrioventricular block, and pacer rhythm are associated with an increased incidence of new cardiac events, whereas right bundle branch block, left anterior fascicular block, and first-degree atrioventricular block are not. In the elderly, atrial fibrillation is associated with an increased incidence of thromboembolic stroke and new cardiac events. Premature atrial complexes and paroxysmal supraventricular tachycardia are not associated with an increased cardiac risk. Complex ventricular arrhythmias on the resting ECG are associated with an increased incidence of cardiac events in elderly patients with heart disease but not in elderly patients without heart disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Usefulness of the resting electrocardiogram in the elderly. 147 52

The relationship between cerebro-cardiovascular events (CCE) and work-related factors was examined in a cohort of 899 treated hypertensive men who were aged 50-59 yr and working more than 7 portal to portal hours (PPH). During the follow-up of 2.8 yr (2,513 person-years), 27 cases of CCEs occurred, which were classified into 18 cases of stroke, 7 cases of acute myocardial infarction, and 2 cases of others. Using univariate analysis, it was found that managerial position and long PPH (more than 11 h) were significantly related to CCE (relative risk of 3.0 and 2.2, respectively) as well as risk factors such as emaciation, left ventricular hypertrophy, excessive sleeping hours, obesity, cigarette smoking, and inadequate control of systolic blood pressure. Using Cox proportional hazards general model, both managerial position and long PPH remained independently related to the risk of CCE (hazards ratio and 95% confidence interval, 4.1; 1.7-10.0 and 2.7; 1.1-6.2, respectively), after adjustment for other risk factors. These findings suggested that work-related factors, such as managerial position and long PPH, are independent risk factors of CCE among treated hypertensive male workers in the fifth decade.
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PMID:[Risk factors of cerebro-cardiovascular events in treated hypertensive male workers in the fifth decade]. 151 87

In patients with acute myocardial infarction, intravenous nitroglycerin lowers left ventricular filling pressure and systemic vascular resistance. At lower infusion rates (less than 50 micrograms/min) nitroglycerin is principally a venodilator, whereas at higher infusion rates more balanced venous and arterial dilating effects are seen. Patients with left ventricular failure demonstrate increased or maintained stroke volumes, whereas patients without failure show a decrease in stroke volume. All hemodynamic subgroups show a decrease in left ventricular filling pressures and a reduction in electrocardiographic evidence of regional myocardial ischemia. Longer-term infusions (24-48 hours) have been shown to result in myocardial preservation, as assessed by global and regional left ventricular function and laboratory indices of infarct size. Comparison of intravenous nitroglycerin and sodium nitroprusside reveals increased intercoronary collateral flow with nitroglycerin, in contrast to a decrease with nitroprusside, compatible with a "coronary steal." Short-term administration of intravenous nitroglycerin with or without chronic administration of long-acting nitrates have been found both to reduce short-term mortality and to have long-term beneficial effects on left ventricular remodeling in patients with anterior transmural infarctions. Current clinical practice would utilize intravenous nitroglycerin as initial therapy for patients receiving intravenous thrombolytic therapy and/or acute percutaneous transluminal coronary angioplasty within 4-6 hours of the onset of symptoms of acute myocardial infarction, in order to optimize intercoronary collateral flow until reperfusion can be accomplished. Patients reaching the hospital greater than 6 hours but less than 14 hours after symptom onset can still benefit from intravenous nitroglycerin for 24-48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Role of nitrates in acute myocardial infarction. 152 29

The hemodynamic background associated with the occurrence of paroxysmal atrial fibrillation and flutter (PAF), in patient with acute myocardial infarction (AMI) were evaluated. Sixty-seven of 381 consecutive AMI patients (17.6%) were noted to have PAF in the acute phase of infarction. These 67 patients with PAF (group 1) were compared with 60 randomly selected patients without PAF (group 2). The hospital mortality rate was 25.4% in group 1, and 11.7% in group 2 (p less than 0.01). The hemodynamic variables measured before the onset of PAF in group 1, showed significantly more unfavorable values than those in group 2, which were measured at the time of admission. The 67 patients in group 1 were divided into 50 patients who survived (group S) and 17 patients who died in the hospital (group D). The hemodynamic status in group D demonstrated significantly larger deterioration before the onset of PAF than in group S. Hemodynamic variables were compared before and during PAF in groups D and S, cardiac index (CI) decreased significantly, and stroke index (SI) decreased by 46% in group D, with no decrease in CI and less decrease in SI (28. p less than 0.05) in group S. In conclusion, not only the occurrence of PAF, but the prognosis of patients with PAF is dependent on the severity of hemodynamic disturbance imposed by AMI. Atrial contribution to ventricular filling has great importance in the maintenance of the cardiac output in this patient population.
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PMID:Paroxysmal atrial fibrillation and flutter associated with acute myocardial infarction: hemodynamic evaluation in relation to the development of arrhythmias and prognosis. 153 70

To determine the effects of acute myocardial infarction on the extent and distribution of systolic and diastolic wall stress on the surviving myocardium, coronary artery occlusion was produced in rats, and the animals were killed 1 wk later. After hemodynamic measurements in vivo, the characteristics of cardiac anatomy at end diastole and peak systole were mimicked in vitro by fixing hearts under diastolic conditions or barium-induced contracture. In the presence of infarcts inducing a 48% loss of myocytes, left ventricular failure was documented by increases in left ventricular minimal and end-diastolic pressures and decreases in peak systolic pressure and positive and negative rates of pressure change with time. End-diastolic and end-systolic volumes increased, whereas stroke volume and cardiac output diminished. Ventricular remodeling in diastole consisted of an increase in the longitudinal axis while both longitudinal and transverse mid-chamber diameters were augmented after systolic contraction. Left ventricular chamber volume enlarged by 44% through a 20% augmentation in the longitudinal diameter and increases in the transverse luminal diameter of 13, 21, 32, and 37% in four consecutive sites from the equatorial region to the apex. As a consequence of infarction, systolic thickening of the spared myocardium of the free wall was reduced progressively from the base to the apex. In the interventricular septum of the infarcted heart, systole thickening occurred mostly in the equatorial region and was reduced at the basal and apical portions. The interaction of hemodynamic impairment with the architectural rearrangements of the wall and chamber provoked a 1.9-fold increase in overall stress on the spared myocardium. However, diastolic stress was augmented by 6.8-fold, markedly exceeding the 1.1-fold increase in systolic stress. Thus large infarcts of the rat left ventricle due to left main coronary occlusion lead to a change in shape of the heart from ellipsoidal to cylindrical. The elevation in overall stress may condition the unfavorable long-term outcome of the infarcted heart.
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PMID:Heterogeneity of ventricular remodeling after acute myocardial infarction in rats. 153 7

The occurrence of various forms of severe neurologic events has been increasingly reported in acute myocardial infarction patients receiving thrombolytic therapy. Strokes have long been known to complicate acute myocardial infarction. The recent attention on severe neurologic events has focused primarily on probable cerebral bleeds. The various forms of severe neurologic events that clinicians are confronted with have unique features and characteristics that will be delineated. The incidence of these events and patient risk factors for cerebral ischemia and cerebral hemorrhage will be outlined. Guidelines that should be adopted to minimize the chance of a patient's suffering a severe neurologic event while at the same time maximizing the number of patients who receive this lifesaving therapy are summarized.
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PMID:Prevention of severe neurologic events in the thrombolytic era. 155 77

Following the successful application of thrombolytic therapy for acute myocardial infarction, investigations have proceeded on several different thrombolytic agents as therapy for ischemic stroke. Early clot lysis has been demonstrated following both intra-arterial and intravenous drug administration. Clinical outcomes have been encouraging, but conclusions regarding efficacy must await the completion of randomized clinical trials. Intra-cerebral hemorrhage following thrombolytic therapy for ischemic stroke is not uncommon and may be fatal, and risk factors for this complication have been difficult to identify.
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PMID:Thrombolytic therapy. 155 4


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