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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The physician who understands the pathophysiology of angina pectoris can apply rational therapeutic measures based on an appreciation of the determinants of myocardial oxygen supply and demand. Most patients with angina secondary to coronary atherosclerosis can be treated conservatively using a systematic approach that includes correction or removal of underlying causes or precipitating factors and the judicious use of sublingual nitroglycerin. In patients with more resistant angina, use of oral or topical nitroglycerin or sublingual isosorbide dinitrite as well as propranolol can be advised. Aortocoronary bypass surgery can offer significant improvement in carefully selected patients with frequent angina poorly controlled by medical therapy. The most important consideration in the treatment of angina is protection of coronary blood flow reserve by primary prevention of the atherosclerotic process itself. All individuals from families prone to coronary artery disease should be evaluated for alterable risk factors, the most important being cigarette smoking, hypertension, and hypercholesterolemia. Considering the high risk of unheralded sudden death in previously asymptomatic patients with coronary atherosclerosis, angina can, in a sense, be considered a fortunate harbinger of coronary stenosis, identifying candidates for secondary preventive measures aimed at retarding the progression of vascular disease. More importantly, angina serves as an index for detecting families at high risk of coronary artery disease, in whom early application of primary prevention may afford a more promising outlook.
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PMID:Angina pectoris. Diagnosis and treatment. 0 83

Blood flow disturbances in the gastrointestinal tract can lead to serious illness. They can be acute or chronic, their cause may be arterial or venous occlusion or hypotonia. Lesions of the gastrointestinal tract caused by ischemia depend on localisation, acuteness and degree of the blood flow disturbance. They may reach from focal and segmental ischemic lesions to extensive necroses of the entire intestinal tubes. The most serious ischemic disease is the embolic and thrombotic occlusion of the arteria mesenterica superior due to previous arterosclerotic damage. Infarction of a large part of the intestines and peritonitis can be the consequence. These patients' only chance of survival is early diagnosis--as a rule exclusively via angiography--and immediate surgery. Chronic occlusion of the arteria mesenterica superior leads to angina abdominalis which mainly occurs after food intake and can last for hours. The reason may also be a general arteriosclerosis. Men are affected more frequently and at a younger age than women. As a consequence of lowered intestinal blood flow these patients suffer from malabsorption and heavy weight loss. Conservative therapy is not effective. These patients, too, will have to be treated surgically after previous angiography. Vascular disease with decreased blood flow as its consequence can be found in a number of inflammatory diseases, in malign hypertensian, in collagen disease and in other more rare diseases as pseudoxanthoma elasticum or Ehlers-Danlos-syndrome. In the case of ischemic colitis arterial and more rarely venous occlusions cause decreased blood flow in the big bowel. A frequent consequence is colitis in the left colon which is characterized by acuteness, pain in the left side of the abdomen and by heavy rectal bleeding. Diagnosis is established by means of endoscopy, barium enema and angiography. Primarily therapy of ischemic colitis is of the conservative type. In severe cases with gangrene and peritonitis the colon has to be resected.
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PMID:[Disorders of the blood circulation in the gastrointestinal tract]. 32 26

Most cardiovascular problems in pregnant women arise from the complications of preexisting chronic conditions (e.g., rheumatic and congenital heart disease) and hypertensive vascular disease. Regular supervision of these patients is essential to detect incipient pulmonary congestion or disturbances of cardiac rhythm. Even if the pregnancy has been uncomplicated, hospital admission 1-4 weeks before the due date is recommended to ensure optimal conditions for labor. Vaginal delivery at term with adequate sedation and use of forceps to shorten the 2nd stage of labor is the perferred mode. Induction of labor may be indicated in hypertensive vascular disease or in cases where adjusting or discontinuing drug therapy calls for precise timing of delivery. Eisenmenger's disease and primary hypertension are potential medical indications for pregnancy termination. The distribution pattern of organic heart disease encountered in pregnant women has changed in the past 20 years, with a decrease in rheumatic and an increase in congenital heart disease. The incidence of chronic rheumatic heart disease in pregnant women fell from 3.5% of all deliveries at Newcastle General Hospital in 1942-51 to 1.1% in 1962-71. Acute pulmonary edema in mitral stenosis is currently a major risk during pregnancy. There is no optimal stage of pregnancy for valvotomy, nor evidence that this procedure induces miscarriage in the early weeks. Pregnancy has become less hazardous in severe forms of congenital heart disease as more patients with these disorders have undergone cardiac surgery prior to pregnancy. Pregnancy is not believed to have any effect on the longterm course of rheumatic heart disease. Patients with aortic stenosis, coarctation of the aorta, primary pulmonary hypertension, Fallot's tetralogy, Eisenmenger's syndrome, and surgically untreated cyanotic lesions require special attention during pregnancy. The outlook for women who become pregnant after an acute cardiac infarction episode depends on the functional state of the heart at the time of pregnancy and the presence or absence of angina pain. There has been a gradual decline in perinatal mortality, especially in cases complicated by rheumatic heart disease.
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PMID:Cardiac disorders. 34 Jan 1

A group of patients with athero-arteriosclerotic vascular disease (coronary heart disease and atherosclerosis of the extremities) have been subjected to platelet antiaggregating-antidyslipidaemic treatment with a chlofibrate-dipyridamol association; a control series was treated with chlofibrate alone. Frequency of angina pectoris, pain intensity and trinitrine consumption ware evaluated in patients with coronary heart disease, claudicometry, oscillometry and thermometry in patients with atherosclerosis of the extremities. The following laboratory parameters were also analysed: cholesterolaemia, triglyceridaemia, prothrombin activity, fibrinogenaemia, uricaemia and tolerance of oral glucose loading. Analysis of the results has shown that the association improved the parameters considered in statistically significant fashion; chlofibrate alone led to significant modifications of coronaropathic group parameters (with the exception of pain intensity) whereas it did not lead to significant changes in parameters evaluated for atherosclerosis of the extremities. All laboratory parameters were modified favourably by the association to a statistically greater extent than by chlofibrate alone. Both the association and chlofibrate were well tolerated.
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PMID:[The clofibrate-dipyridamole combination in the treatment of athero-arteriosclerotic vasculopathy]. 43 77

In an attempt to assess cardiac risk in non-cardiac surgery, 1001 patients over 40 years of age who underwent major operative procedures were examined preoperatively, observed through surgery, studied with at least one postoperative electrocardiogram, and followed until hospital discharge or death. Documented postoperative myocardial infarction occurred in only 18 patients; though most of these patients had some pre-existing heart disease, there were few preoperative factors which were statistically correlated with postoperative infarction. Postoperative pulmonary edema was strongly correlated with preoperative heart failure, but 21 of the 36 patients who developed pulmonary edema did not have any prior history of heart failure. Nearly all of these 21 patients were elderly, had abnormal preoperative electrocardiograms, and had intraabdominal or intrathoracic surgery. In the absence of an acute infarction, bifascicular conduction defects, with or without PR interval prolongation, never progressed to complete heart block. Spinal anesthesia protected against postoperative heart failure but not against other cardiac complication. By multivariate regression analysis, postoperative cardiac death was significantly correlated with (a) myocardial infarction in the previous 6 months; (b) third heart sound or jugular venous distention immediately preoperatively; (c) more than five premature ventricular contractions per minute documented at any time preoperatively; (d) rhythm other than sinus, or premature atrial contractions on preoperative electrocardiogram; (e) age over 70 years; (f) significant valvular aortic stenosis; (g) emergency operation; (h) a 33% or greater fall in systolic blood pressure for more than 10 minutes intraoperatively. Notably unimportant factors included smoking, glucose intolerance, hyperlipidemia, hypertension, peripheral atherosclerotic vascular disease, angina, and distant myocardial infarction.
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PMID:Cardiac risk factors and complications in non-cardiac surgery. 66 58

Between 1950 and 1975, 473 Rochester patients had the diagnosis of rheumatoid arthritis and received aspirin treatment. These patients were followed for an average of 10 years to determine whether they experienced myocardial infarction, classic angina pectoris, sudden unexpected death, or cerebral infarction less often than expected on the basis of age- and sex-specific incidence rates of each event known for the Rochester population. In none of these disease entities, separately, or combined, was the expected number significantly different from the observed. However, when we examined these events separately by sex, observed numbers in males were 30 to 50% less than expected in all four studied end-events. Because the male population was small, none of these differences reached statistical significance. The possible effect of aspirin in the primary prevention of vascular disease in males is discussed in light of the recent similar reported results in secondary prevention.
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PMID:Effect of aspirin on prevention of coronary and cerebrovascular disease in patients with rheumatoid arthritis. A long-term follow-up study. 68 87

Of 18,000 children with organic heart disease evaluated at The Hospital for Sick Children, Toronto between 1940 and 1971, 33 died suddenly and unexpectedly between 1 and 21 years of age. Nine had discrete obstruction of the left ventricular outflow tract and five had muscular narrowing of the left ventricular outflow tract and five had muscular narrowing of the left ventricular outflow tract. Pulmonary vascular disease caused seven sudden deaths, and arrhythmias (usually due to atrioventricular block) caused seven more. Of the five other children who died suddenly three had transposition of the great arteries, one had a complex cyanotic heart defect and one had an anomalous course of the left coronary artery, which originated from the right sinus of Valsalva. With earlier investigation of aortic stenosis, earlier closure of ventricular septal defect to avoid pulmonary vascular disease, better design of artificial pacemakers and better investigation of patients with angina, many of these deaths will be avoided in the future.
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PMID:Sudden unexpected death in children with congenital heart disease. 80 25

Primary hypothyroidism was found to be the cause of hyperlipidemia in 22 patients. The mean age was 46 years, 59% were males, 27% had vascular disease, 14% had xanthomas and 86% had thyroid antibodies. Familial involvement was shown in 3 propositi. All patients were treated with L-thyroxine, 0.05--0.2 mg/day for a mean of 16 months. Combined hyperlipidemia was common (77%), and lipoprotein phenotyping revealed types IIB hyperlipopro-teinemia in 11, IIA in 5, III in 3 and IV in 3 patients. With treatment, normal plasma cholesterol (less than 265 mg/dl) and triglycerides (less than 200 mg/dl) were obtained in 91% and 86%, respectively. The mean maintenance L-thyroxine dose was 0.15 mg/day, but smaller doses often showed marked hypolipidemic effect. The mean +/- S. D. pretreatment fasting plasma cholesterol and triglycerides were 387 +/- 120 and 328 +/-247 mg/dl and on thyroid treatment the mean minimum levels were 205 +/- 46 and 133 +/- 65 mg/dl, respectively (both p values less than 0.005). Hypothyroidism has proved to be a common reversible form of hyperlipidemia. One cardiac patient died and three others had to have their L-thyroxine titrated to prevent angina. Family screening has been of use in case finding for auto-immune disease in 3 families.
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PMID:Hypothyroidism, an important cause of reversible hyperlipidemia. 83 19

A group of 78 patients with severe hypercholesterolemia (-X = 464 mg/dl) and symptoms of vascular disease of the heart, the extremities, or the brain, started a beta-pyridylcarbinol treatment with an average daily dosage of 1.2 g in 1964. In 1976 we could re-examine 12 patients, still on the same therapy. No myocardial infarction has occurred in this group since 1973, only 2 patients have had more attacks of angina pectoris that 1964. In contrast patients discontinuing therapy or replacing beta-pyridylcarbinol by other hypolipidemic drugs had a higher mortality.
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PMID:The treatment of hypercholesterolemia with beta-pyridylcarbinol. Part 5. Report on 16 cases with severe hypercholesterolemia treated for 12 years. 85 28

29 cadaveric renal transplant recipients were assessed clinically for evidence of occlusive arterial disease prior to undergoing blood viscosity studies. Nineteen patients had manifest arterial disease (myocardial infarction, cerebral thrombosis, angina, intermittent claudication, absent peripheral pulses), while ten were free from vascular complications. Patients with arterial disease showed significant elevations of plasma viscosity (p less than 0.005), aggregation of red cells measured both at 37 and 20 degrees C (p less than 0.05), fibrinogen (p less than 0.005), serum triglyceride (p less than 0.01), serum cholesterol (p less than 0.01), erythrocyte sedimentation rate (p less than 0.02), and a significant reduction in the albumin/fibrinogen ratio (p less than 0.005) when compared with those free of disease. Two patients with no apparent vascular disease when investigated were found to have distinctly abnormal blood viscosity factors, and one subsequently developed retinal arterial thrombosis while the other suffered serious damage of the graft within 3 months of viscosity study. When all patients were considered together, significant correlations were found between viscosity of artificial thrombi or aggregation of red cells and fibrinogen level (both p less than 0.05), and serum triglyceride level (both p less than 0.05); and between rigidity of red cells and the parathyroid hormone level (p less than 0.01).
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PMID:Blood viscosity factors and occlusive arterial disease in renal transplant recipients. 110 19


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