Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute myocardial ischemia is known to cause impairment of both left ventricular systolic and diastolic function. To further investigate these changes as well as their relation to common clinical variables (electrocardiographic [ECG] changes and chest pain), 32 patients were evaluated with Doppler echocardiography during coronary angioplasty. Doppler indexes of left ventricular diastolic function included the ratios of peak early to late and peak early to mean diastolic velocities as well as the ratios of early to late and first third to total velocity integral (one-third filling fraction). All diastolic indexes showed significant impairment by 15 seconds after coronary occlusion (ratio peak early to late filling velocity: 1.11 versus 0.96, p less than 0.01; ratio peak early to mean filling velocity: 1.9 versus 1.7, p less than 0.01; ratio early to late velocity integral: 1.58 versus 1.25, p less than 0.01; one-third filling fraction: 41.2 versus 37.7, p less than 0.01). Left ventricular systolic function was evaluated during coronary occlusion both qualitatively, as assessed by the appearance of a new wall motion abnormality on two-dimensional echocardiography (mean 28.8 seconds), and quantitatively by measurement of systolic percent area change on the two-dimensional short-axis view as well as the Doppler echocardiographic stroke integral index. Systolic indexes did not show significant change until 30 seconds after balloon inflation (percent area change: 42.8 versus 29.2, p less than 0.01; stroke integral index: 11.04 versus 9.36, p less than 0.01). ECGs were performed at 15 second intervals.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty. 295 30

Fifteen patients with severely damaged coronary circulation required temporary intraaortic balloon counterpulsation for pharmacologically uncontrollable chest pain and poor haemodynamic state (hypotension or shock) in connection with the transluminal coronary angioplasty procedure. Twenty-five angioplasties were attempted (1.75 artery stem/patient) with a primary success rate of 96%. Emergency surgery was performed only once (6.6%) and no death occurred after the percutaneous therapeutic procedures. One patient died due to a cerebrovascular accident, two other patients suffered sudden death 1 and 3 months later. Two patients finally required coronary bypass surgery, and one patient a repeated angioplasty. In the follow-up period (mean = 11 months), two patients presented moderate symptoms of stable angina pectoris, and 10 patients (83%) remained in satisfactory condition. Temporary diastolic counterpulsation provided in patients with pharmacologically refractory myocardial ischaemia and hypotension or shock an important protection for performing transluminal angioplasty in a good condition, with improved remaining coronary circulation and haemodynamic state, assuring a favourable hospital survival.
 ...
PMID:Intraaortic balloon counterpulsation and coronary angioplasty in high risk coronary heart patients. 296 Sep 50

In 1,395 patients in the age range 40-74 years participating in a double-blind trial with metoprolol in suspected acute myocardial infarction morbidity and quality of life were assessed during the first 5 years after randomization. During the first 3 months patients were given 200 mg metoprolol daily or placebo. Thereafter the two groups were treated similarly. Mortality during 5 years was 24.2% in patients originally randomized to metoprolol versus 25.7% in patients originally randomized to placebo (p greater than 0.2). No difference was observed regarding reinfarction rate, stroke or occurrence of bypass surgery during the 5-year follow-up. During the first 3 months 10% of patients in the metoprolol group were rehospitalized for various reasons versus 13% in the placebo group. The corresponding figures for 5 years were 59 and 60%, respectively. Among patients surviving 5 years 84% in both groups were on some medication of which beta-blockade was the dominating one. Symptoms of chest pain, dyspnea, claudicatio, smoking habits and working capacity did not differ and neither did quality of life according to the Nottingham Health Profile. We thus conclude that morbidity and quality of life were not significantly affected 5 years after early intervention with metoprolol in patients with suspected acute myocardial infarction.
 ...
PMID:Morbidity and quality of life 5 years after early intervention with metoprolol in suspected acute myocardial infarction. 306 6

Nisoldipine, a new dihydropyridine calcium antagonist, was examined for its dose-related haemodynamic effects using exercise-induced changes in aortic blood flow as measured by Doppler ultrasound. Following a two-week placebo run-in, 24 patients with stable angina pectoris were assigned double-blind to one of three groups receiving doses ranging from 2.5-20 mg/day over 8 weeks, given once or twice daily. Doppler studies identified the low dose group as responding less well at the placebo phase compared to the other two groups. There was an overall improvement in percentage change of peak velocity and stroke distance with exercise at all doses, with a dose of 5 mg/day giving optimal benefit in both variables (P less than 0.05) and no additional benefit being seen on twice-daily dosage. Six patients reporting increased chest pain exhibited a significantly worse rise in peak velocity and a fall in stroke distance to exercise (P less than 0.05) whilst on active drug compared to those who responded favourably. Doppler ultrasound can be of benefit in the haemodynamic assessment of new drugs, the recognition of non-responders and the optimization of therapeutic regimes.
 ...
PMID:Use of exercise Doppler for non-invasive haemodynamic optimization of dose and identification of poor responders to an oral anti-anginal agent. A double-blind dose-finding study of nisoldipine. 307 61

A group of 12 internists, members of a university-affiliated hospital, designed and implemented protocols for the general inpatient management of four medical problems (chest pain, stroke, pneumonia, and upper gastrointestinal hemorrhage). Hospital charges for the 63 cases were compared with charges generated by 64 controls who had been patients admitted to the same physicians with the same diagnoses during the same period of the preceding year, before the project was begun. A group of nonparticipating internists was similarly evaluated during the two time periods to control for changes in practice patterns extraneous to the intervention. Adjustment was made for inflation (6%) and differences in case mix. The program resulted in a 15% reduction in total average charge generated by the cases. Sizeable reductions were achieved in utilization of EKGs (34.8%), x-rays (15.4%), laboratory testing (20.4%), and drugs (11.4%). Given the prevailing attitude that health care costs are too high and that many services are unnecessary, the benefit of altering physician behavior by using standards established by them for themselves could be substantial, especially with the threat of more restrictive and less sympathetic modes of controlling costs.
 ...
PMID:Inpatient management protocols to reduce health care costs. 308 2

Three hundred fifty patients in an observation unit attached to an emergency department received diagnostic workup of nine critical diagnostic syndromes (abdominal pain, flank pain, headache, possible cerebrovascular accident, chest pain, dizziness or syncope, head injury, seizure, multiple trauma). The decision to hospitalize for acute care after observation for 11.1 +/- 3.9 hours was examined. The objective diagnosis-related group (DRG) criteria for admission were compared retrospectively with the physician's clinical judgment of need for hospitalization. Clinical outcome was used to establish the correctness of the decision to hospitalize. Clinical judgment was compared with objective DRG criteria for reliability in predicting the presence of serious pathology necessitating acute care hospitalization; respective values were sensitivity, 100% vs 76%; specificity, 86% vs 80%; positive predictive value, 75% vs 62%; and negative predictive value, 100% vs 89%. The difference between the sensitivity of the two admission criteria was highly significant (P less than 10(-8); chi 2, 26.12). We conclude that the physician's clinical judgment outperforms DRG objective criteria in identifying which patients with critical diagnostic syndromes need acute care hospitalization for emergency medical or surgical therapy.
 ...
PMID:Decision to hospitalize: objective diagnosis-related group criteria versus clinical judgment. 313 51

Blood pressure (BP) and heart rate (HR) responses to isometric hand grip, exercise with the cybex arm ergometer, and cybex fitron cycle ergometer were recorded for 19 stroke subjects and 19 control subjects matched by age and gender. Mean age in both groups was 66 years. There was no significant difference in the resting HR (controls: 69 +/- 10, patients: 70 +/- 11 beats per minute) and BP measurements (systolic--controls: 140 +/- 17, patients: 135 +/- 21; diastolic--controls 80 +/- 8, patients: 75 +/- 11mmHg). There was also no significant difference in either the mean HR (controls: 79 +/- 10, patients: 81 +/- 12 beats per minute) or BP (systolic--controls: 174 +/- 23, patients: 165 +/- 27; diastolic--controls: 98 +/- 15, patients: 92 +/- 14) response to exercise. With the arm ergometer test, the control group attained a significantly higher maximum systolic (190 +/- 23 mmHg) and diastolic blood pressure (102 +/- 15mmHg) than the stroke group (systolic 165 +/- 23; diastolic 91 +/- 10mmHg). During the leg ergometer exercise test, results were similar in both groups except that work completed was significantly higher for the control group (3592 +/- 1162kg) than for patients (2512 +/- 1348kg). None of the patients reported symptoms of dizziness, fainting, or chest pain. Prescribed exercise in stroke patients under supervision and within patient tolerance was found to be safe.
 ...
PMID:Cardiovascular responses to acute exercise in patients with cerebrovascular accidents. 319 Apr 17

In 809 patients with a recent myocardial infarction, morbidity during 5-year follow-up was assessed. The overall 5-year mortality rate was 33% (39% in patients with larger infarcts and 26% in patients with smaller infarcts) as judged from maximum serum enzyme activity (p less than .001). In terms of morbidity, no significant association with estimated infarct size was observed. Patients with smaller infarcts tended to have a higher reinfarction rate and were rehospitalized more often, whereas a similar proportion of patients with large and small infarcts developed stroke. Among survivors, chest pain tended to be more common in patients having smaller infarcts, whereas symptoms of dyspnea and claudicatio intermittens were similar in both groups, as were smoking habits, work capability, and varying forms of medication. We thus conclude that during a 5-year follow-up after acute myocardial infarction, mortality, but not morbidity, was related to the original infarct size.
 ...
PMID:Morbidity during five years after myocardial infarction and its relation to infarct size. 322 49

Left ventricular (LV) function in 62 patients presenting with chest pain typical of angina was studied non-invasively at rest and at maximum-tolerated supine exercise using the continuous-wave Doppler technique of transcutaneous aorto-velography (TAV). The signals were analysed to derive peak velocity (Vp), systolic velocity integral [an index of stroke volume or stroke distance (Sd)], and minute distance (Md; index of cardiac output = Sd X heart rate). Comparison was made with results obtained from 66 normal volunteers. The percentage change in stroke distance with exercise (% delta Sd) was significantly related to the resting ejection fraction (EF) calculated from left ventriculography (r = 0.84), and was below 6% (lowest value observed in normal volunteers) in all of the 23 patients with coronary artery disease (CAD) whose EF was below 60%. No significant difference was observed in the % delta Sd between normal individuals and the 12 patients presenting with chest pain but who had normal coronary arteriograms. However, the % delta Vp, delta % Sd and % delta Md in the 50 patients with CAD were significantly lower than the normal individuals and the 12 patients with normal coronary arteriograms. Lower TAV measurements were observed with exercise, rather than at rest, with increasing number of coronary arteries with significant stenoses and the presence of history of myocardial infarction (linear trend p less than 0.003). These results suggest that Doppler recording of aortic blood velocity with exercise is a clinically useful non-invasive technique for studying LV performance in patients with CAD.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Non-invasive assessment of left ventricular function in coronary artery disease by Doppler stress testing. 329 51

The morbidity and mortality during a 5-year follow-up in patients admitted to the coronary care unit with chest pain presenting an initial suspicion of acute infarction, but in whom the diagnosis could not be confirmed, is reported. They were divided into four groups: Possible myocardial infarction (29%), angina pectoris (24%), chest pain of uncertain origin (32%), and nonischemic cause of chest pain (15%). The overall 5-year mortality rate was 13.3% and did not differ substantially between the four groups. During the 5-year follow-up a confirmed myocardial infarction developed in 28% and 22% among patients with the diagnosis possible infarction and angina pectoris, respectively, and in about 10% of the remaining patients. Stroke developed in 4% of patients with possible infarction and in 2-3% in the remaining subgroups. In all, 59% of the patients were rehospitalized for a mean duration of 30 days in hospital. Among survivors at 5 years, 54% reported chest pain equivalent to angina pectoris and 25% had chest pain daily. A high prevalence of angina pectoris, a high frequency of rehospitalization due to chest pain, and a high consumption of cardiovascular drugs could be found in all four groups.
 ...
PMID:Long-term morbidity in patients where the initial suspicion of myocardial infarction was not confirmed. 336 71


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>