Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This investigation was carried out in an effort to analyze the influence of various degrees of ischaemic heart disease (IHD) on cardiovascular and physical performance. Assessment of the severity of IHD was based on observations obtained routinely during exercise tests (ST segment response and systolic blood pressure response). The study group included 926 subjects with known or suspected IHD, who were referred for an exercise testing; 268 females, mean age 54 years (range 19-89 years), and 658 males, mean age 52 years (range 16-88 years). We found that increasing IHD severity was associated with significant reductions of cardiovascular performance. The mean maximum work-load (MWL) was lower in females than in males, and MWL as well as mean maximum heart rate (MHR) and mean maximum change in systolic blood pressure (M delta SBP) decreased with increasing IHD and age. The present results may be used to assess the cardiovascular response to exercise in patients with IHD so that altered responses due to causes other than IHD may be identified. Furthermore the result may prove useful in the adjustment of rate responsive pacemakers (RRP) in patients with IHD.
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PMID:Reference values for bicycle exercise tests in patients with various degrees of ischaemic heart disease. 154 Oct 80

The Copenhagen City Heart Study is a prospective ischaemic heart disease population study designed to evaluate incidence of, and risk factors for, ischaemic heart disease. A random population sample of approximately 20,000 men and women was invited to participate in a health survey, which was carried out in 1976-78. The participation rate was 74%. Systolic (SBP) and diastolic blood pressure (DBP) was measured with the London School of Hygiene sphygmomanometer after 5 minutes in the sitting position. Risk factors were assessed by a questionnaire and non-fasting plasma cholesterol was measured. Information about subsequent death and causes of death was obtained from the Danish Death Register. Follow-up was virtually complete over an observation time of 10 years. Analysis of the independent effect of SBP and DBP measured at entry on the 10 year total and cause-specific mortality was performed using the Cox regression model. Antihypertensive medication and/or diuretic therapy, physical activity during leisure time, economic and educational status, tobacco and alcohol consumption, diabetes mellitus, body mass index, plasma cholesterol levels, age and sex were entered as confounders. Total mortality was increased only in the higher quintiles of SBP. Concerning ischaemic heart disease mortality and cerebrovascular mortality, the risk increased in a graded manner with increasing quintile of SBP and DBP. With regard to cancer mortality, a U-shaped association was observed between quintile of SBP (and DBP) and death rate. With advancing age, the predictive power of SBP on total and cause-specific mortality changed, especially in males, as a pronounced U-shape of the association between BP and mortality appeared. The reasons for this are discussed. The relative risk in subjects receiving antihypertensive medication was 1.7 (CL 1.5-2.0) regarding total mortality, 2.0 (CL 1.5-2.7) regarding ischaemic heart disease mortality, 0.8 (CL 0.5-1.4) regarding cerebrovascular mortality, and 1.3 (CL 1.0-1.7) regarding cancer mortality. This finding is in agreement with clinical trials experiences, and may have an impact on management of high blood pressure.
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PMID:Blood pressure and mortality: an epidemiological survey with 10 years follow-up. 158 31

We studied whether the treadmill exercise test can discriminate between normal and significant narrowing of coronary arteries in patients with hypertrophic cardiomyopathy (HCM) accompanied with chest pain, and we compared the extent of myocardial ischemia during exercise. Thirty one patients with HCM were divided into two groups; 21 with normal coronary arteries and 11 with significant narrowing of coronary arteries. The treadmill exercise test was carried out in both groups. The following parameters were more frequently seen in the group with coronary stenosis. (1) short treadmill time (338, sec vs 542, p less than 0.05). (2) delta SBP less than or equal to 60 mmHg (delta: end point minus rest, 10 cases vs 12, 0.05 less than p less than 0.1). (3) significant delta ST depression (0.17 mV vs 0.05, p less than 0.05). (4) large delta ST/delta HR (3.3 microV.min/beats vs 0.7). delta ST/delta HR greater than or equal to 2.0 was the most useful for differentiating the two groups, and it was 90% in index both sensitivity and specificity for diagnosis of HCM with significant narrowing of the coronary arteries. It was concluded that treadmill exercise induced more severe myocardial ischemia in patients with HCM who had significant narrowing of the coronary arteries than in patients with HCM who had angiographically normal coronary arteries. The delta ST/delta HR was the most useful index for diagnosis of HCM with significant narrowing of the coronary arteries.
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PMID:[Treadmill exercise test in patients with hypertrophic cardiomyopathy with and without coronary artery disease]. 192 99

The antihypertensive and haemodynamic effects of labetalol were compared with those of prazosin both at rest and during bicycle exercise in 38 moderate to moderately severe hypertensive patients (supine DBP 95 to 119 mmHg when untreated). Following a two week open placebo phase to establish baseline BP and baseline exercise performance, patients were randomly and double-blindedly assigned to receive labetalol or prazosin. Drug dose was titrated from 100 to 400 mg labetalol twice daily, or from one to 10 mg prazosin twice daily at weekly intervals until BP was controlled (supine DBP less than or equal to 90 mmHg with at least a 10 mmHg decrease from baseline). Eighteen labetalol and twenty prazosin patients achieved BP control and were subsequently reexercised to fatigue on a bicycle ergometer. The mean changes from baseline for heart rate and rate pressure product (heart rate x SBP) were reduced only in the labetalol group; the difference between the labetalol and prazosin groups was significant (P less than 0.01) both at rest and during exercise. This haemodynamic profile of labetalol may be important in selecting a vasodilating antihypertensive for patients with concomitant ischaemic heart disease.
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PMID:The effects of labetalol and prazosin on exercise haemodynamics in hypertensive patients. 204 Oct 34

Although not unanimously accepted, high-dose fentanyl anesthesia has been associated with hemodynamic stability and little derangement of myocardial oxygen balance. This apparent inconsistency inspired us to investigate the effects on cardiac function and myocardial metabolism of stepwise increasing doses of fentanyl, accumulating to 15, 30, and 50 micrograms.kg-1, with the least possible interference from other drugs. Subjects were unpremedicated patients with ischemic cardiac disease scheduled for coronary artery bypass grafting or major vascular surgery. In an initial study employing succinylcholine for muscle relaxation, we found that heart rate (HR), coronary sinus blood flow (CSF) and coronary vascular resistance (CVR) remained unchanged, while systemic arterial pressure (SBP), rate-pressure product (RPP), coronary perfusion pressure (CPP) and left ventricular work (LVW) decreased. Myocardial uptake of oxygen (MVO2) and free fatty acids (FFA) both decreased in a dose-dependent manner. Arterial lactate concentration and myocardial lactate uptake both increased. These findings opposed the postinduction myocardial ischemia noted by some other investigators. In most of these studies pancuronium bromide had been used for muscle relaxation. Since the latter agent has been claimed to increase cardiac work, a second group of correspondingly diseased patients was studied in which succinylcholine was replaced by pancuronium bromide. In this group HR, RPP, CSF and MVO2 all increased at the lowest dose of fentanyl and HR additionally also at 30 micrograms.kg-1. The cardiac index was higher in the pancuronium group at the lowest and middle dose steps of fentanyl. Lactate uptake decreased with higher doses of fentanyl and relative myocardial lactate extraction declined.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Muscle relaxants change myocardial metabolism in patients with ischemic heart disease during high-dose fentanyl anesthesia. 230 42

The influence of age on the nocturnal fall in blood pressure (BP) was examined in essential hypertensive patients as well as normal subjects. BP was monitored every 5 min for 24 hr by means of a finger volume oscillometric device. Average daytime BP was similar in the 3 age groups [young: less than 40 (years), n = 49, average daytime systolic BP (ASBP) = 132 +/- 20 mmHg, average daytime diastolic BP (ADBP) = 82 +/- 17 mmHg; adult: 40 less than or equal to less than 60, n = 110, ASBP = 127 +/- 19 mmHg, ADBP = 86 +/- 13 mmHg; old: 60 less than or equal to, n = 33, ASBP = 131 +/- 17 mmHg. ADBP = 83 +/- 11, mean +/- S.D.]. The nocturnal fall in BP was observed in all age groups and its amplitude (delta BP = average daytime BP - average nighttime BP) in the old patients (delta SBP = 13 +/- 11 mmHg, delta DBP = 10 + 8 mmHg) was similar to that in the young patients (delta SBP = 11 +/- 8 mmHg, delta DBP = 10 +/- 8 mmHg). The results suggests that information on the nocturnal behavior of BP is valuable in treating aged essential hypertensives to prevent cerebral and/or myocardial ischemia during sleep.
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PMID:Similarity in amplitude of the nocturnal fall in blood pressure in old and young patients with essential hypertension. 277 19

48 patients with chest pain or unexplained heart failure were examined with exercise test, systolic time intervals, apexcardiogram and left- and right-sided heart catheterization including coronary arteriography. The 23 patients with ischemic heart disease (IHD) and 19 patients with congestive cardiomyopathy (COCM) could as groups be separated by several of the parameters. Two major patterns of change were present when using the whole range of parameters, probably reflecting that the heart and circulation had compensated for left ventricular dysfunction in different ways in IHD and COCM. Comparing patients with the same ejection fraction (EF), preejection-period index (PEPI) pre-ejection-period/left ventricular ejection time (PEP/LVET) and systolic blood pressure/left ventricular end systolic volume index (SBP/LVESVI), were all more abnormal in patients with COCM than with IHD at most EF levels. The best separation between the diseases was obtained using exercise capacity in combination with PEP/LVET. The correlations between invasive and noninvasive parameters underlined that no single parameter can satisfactorily characterize the circulatory function in patients with individual differences in preload, afterload, pulse rate, cardiac volumes, compliance and contractility. No or poor correlations were found between exercise capacity and the different function parameters used.
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PMID:Different patterns of hemodynamic abnormalities in patients with ischemic heart disease compared with patients with congestive cardiomyopathy. 371 97

The haemodynamic dose-response effects of intravenous penbutolol, a newer beta-adrenoceptor antagonist with intrinsic sympathomimetic activity but without cardioselectivity, were evaluated in 10 patients with angiographically documented coronary artery disease. Following four logarithmetically cumulative i.v. boluses (0.5-4 mg dosage range) there was a log linear increase in plasma penbutolol concentration; the levels achieved (51 +/- 8 to 219 +/- 19 ng/ml) were in the therapeutic range (12 to 250 ng/ml). Penbutolol resulted in a linear decrease in heart rate (maximum delta HR - 4 beats/min; P less than 0.01); there was a small increase in pulmonary artery occluded pressure which reached its maximum at the lower doses (maximum delta PAOP + 1 mm Hg; P less than 0.01). The resting cardiac output, blood pressure and calculated systemic vascular resistance were unchanged. During 4 min steady-state supine bicycle exercise there was attenuation of exercise cardiac output (delta C.I. - 0.6 1 min-1 m-2; P less than 0.01) and systolic pressor response (delta SBP - 13 mm Hg; P less than 0.01) compared with control observations without change in other measured or derived variables. The haemodynamic profile of penbutolol compared favourably with other beta-adrenoceptor antagonists previously evaluated under similar conditions in patients with ischaemic heart disease. Over the i.v. dose-range evaluated penbutolol attenuated exercise-induced angina with a relatively modest depression of cardiac performance; the small change induced in resting haemodynamic variables may, in part, have been contributed to by the intrinsic sympathomimetic activity of penbutolol.
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PMID:Haemodynamic dose-response effects of i.v. penbutolol in angina pectoris. 631 39

Comparative analysis of coronary arteriography and exercise ECG recordings of 33 patients with ischaemic heart disease is presented. Linear regression was found between the increase of heart rate (HR) as well as increase of systolic blood pressure-heart rate product (SBP X HR) and the level of ST-segment depression developing during exercise. A significant correlation was established between the slope of the regression line (i.e. 'm' coefficient of y = mx + b) expressing the rate of change of ST-segment depression and the degree of coronary artery disease confirmed by arteriography. The average value of 'm' coefficients differed significantly according to the number of diseased vessels (P less than 0.01-0.001). The ratio of maximal ST depression and maximal HR (STmax/HRmax) measured at the end of the exercise indicated reliably the severity of coronary artery disease and is suggested for everyday practice.
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PMID:Quantitative evaluation of exercise-induced ST-segment depression for estimation of degree of coronary artery disease. 673 38

In order to study the circulatory changes induced by maximal atrial pacing in coronary patients, coronary sinus blood flow (CBF) measured by continuous thermodilution, lactate extraction coefficient (K), arteriovenous difference in oxygen (AVO2 diff), and aortic blood pressure (BP) were measured at basal state and at maximal heart rate (HRmax) in 11 patients without coronary disease (group I) and in 28 patients with severe coronary lesions, divided into two groups according to the absence (group IIa) or the presence (group IIb) of chest pain and ST-segment depression at HRmax X K was inverted in group IIb (24 +/- 17% vs -23 +/- 39%, p less than 0.001), but remained unchanged in group I and group IIa. Despite similar HRmax, percent increase in CBF was significantly lower in group IIb (54 +/- 34%), than in group I (113 +/- 54%, p less than 0.01). This contrasts with the higher values of the product of heart rate times systolic blood pressure (HR X SBP) as well as of diastolic blood pressure (DBP) in group IIb. The decrease in coronary resistances was lower in group IIb than in group I (p less than 0.001), and also lower than in group IIa (p less than 0.05). The ratio MVO2 X CBF/systolic BP X HRmax was significantly lowered only in group IIb (p less than 0.001) confirming the imbalance between myocardial oxygen supply and oxygen demand. In coronary patients, myocardial ischemia induced by atrial pacing is related to an insufficient increase in CBF, well evidenced by continuous thermodilution.
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PMID:Coronary hemodynamic data in ischemic heart disease according to ischemic behavior during pacing. 683 82


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