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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Improved understanding of the pathogenesis of symptomatic and silent myocardial ischemia has led to important advances in the prevention and treatment of these syndromes. For example, recognition of the role of platelets in the atherogenic process and of thrombosis in acute myocardial ischemia has led to extensive use of aspirin and thrombolytic therapy, with resultant decreases in mortality. Both nitrates and beta-adrenergic blockers effectively alleviate myocardial ischemia. However, long-term nitrate use is limited by the occurrence of tolerance. beta blockers have been shown to decrease subsequent cardiovascular events in patients with acute myocardial infarction; however, adverse effects are often associated with their use. Calcium antagonists have been shown to be effective in the treatment of stable and vasospastic angina. In patients with coronary artery disease and symptoms resulting from either fixed obstruction or vasospasm, these agents decrease the frequency of angina episodes. The 3 types of calcium antagonists currently available--phenylalkylamine, benzothiazepine, and dihydropyridine derivatives--while chemically a heterogeneous group, share the common property of decreasing depolarization of smooth muscle, albeit to varying degrees. Nonetheless, other characteristics, including varying electrophysiologic effects, distinguish these groups. The novel calcium antagonist amlodipine is effective and well tolerated as an antianginal agent, and offers the advantage of once-daily dosing. Calcium antagonists appear to be well tolerated in patients with concomitant conditions such as diabetes and are effective in commonly coexistent cardiovascular disorders such as hypertension.
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PMID:Emerging options in the management of myocardial ischemia. 790 91

To investigate which time constant of isovolumic left ventricular pressure (LVP) decay is the most sensitive measure in acute myocardial ischemia, the time constant of isovolumic relaxation (IR) was calculated by two different models, the semilogarithmic model assuming a zero of LVP decline (TL) and an exponential model (Texp) with an asymptote (extrapolated baseline pressure to which LVP would fall if decay continued indefinitely), in 10 patients before and during ergonovine-induced vasospastic angina. Two time constants were derived from the exponential method as the times for LVP at peak negative dP/dt to decline by 1/e (Texp (1/e)) and by one half (Texp (1/2)). Three changes in LVP during isovolumic relaxation were analyzed and fitted to the two models described above: the LVP from the peak negative dP/dt 1) to when LVP fell to 5 mmHg above LV end-diastolic pressure (EDP), 2) until 40 msec had passed, and 3) to the LVP level 5 mmHg above LVEDP during coronary spasm. There were significant increases in TL, Texp (1/e) and Texp (1/2) in each period of the LVP during vasospastic angina. However, no significant change in Texp or asymptote was observed during angina. We concluded that TL measured by the semilogarithmic model assuming a zero of LVP decline and Texp (1/e) or Texp (1/2) derived from the exponential model are adequately sensitive for detecting acute myocardial ischemia due to coronary spasm.
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PMID:[Which time constant of left ventricular relaxation is the most sensitive measure in acute myocardial ischemia?]. 793 70

Antianginal effects of monatepil ([(+-)-N-(6,11-dihydrodibenzo[b,e]thiepin-11-yl)-4-(4-fluor ophenyl)-1-piperazinebutanamide]monomaleate, AJ-2615, CAS 10337-41-9), a new calcium antagonist, were evaluated in experimentally induced myocardial ischemia in anesthetized rats and compared with those of diltiazem. Ischemic electrocardiogram change (ST elevation) and reduction of myocardial tissue oxygen tension were induced by intracoronary arterial administration of U-46619 ((5Z,9a,11a,13E,15(S))-9,11-(methano-epoxy)prosta-5,13-di en-1-oic acid) (10 micrograms/kg), a stable thromboxane A2 agonist. The ST elevation induced by U-46619 was significantly prevented by monatepil pretreatment (0.1 mg/kg i.v.), and to a lesser extent by diltiazem (0.3 mg/kg i.v.). Moreover, the decrease in myocardial tissue oxygen tension at the time of ST elevation after U-46619 was inhibited by monatepil pretreatment (0.3 mg/kg i.v.). These results indicate that monatepil exerts a more potent preventive effect against U-46619-induced myocardial ischemic changes than diltiazem and suggest that monatepil has potential for treating vasospastic angina.
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PMID:Preventive effect of monatepil on thromboxane A2 agonist-induced myocardial ischemia in rats. 805 69

For sumatriptan, tightness in the chest caused by an unknown mechanism has been reported in 3-5% of users. We describe a 47-year-old woman with an acute myocardial infarction after administration of sumatriptan 6 mg subcutaneously for cluster headache. The patient had no history of underlying ischaemic heart disease or Prinzmetal's angina. She recovered without complications.
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PMID:Transmural myocardial infarction with sumatriptan. 809 32

We describe a case of variant angina associated with acute myocardial ischemia in an adolescent presenting with severe chest pain and transient ST elevation. Subsequent cardiac catheterization revealed normal coronary anatomy, and the patient has been asymptomatic since discharge on calcium channel blockers. Variant angina is a rare cause of chest pain in adolescents.
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PMID:Variant angina in an adolescent. 811 73

The distribution of serum lipoprotein(a) [Lp(a)] concentration among Japanese male adults was evaluated using non-parametric methods. The following results were obtained. 1) Among healthy male adults undergoing a medical checkup, Lp(a) showed a highly skewed distribution towards the low level. The distribution could be regarded as a power normal distribution with the power order of 1/2. The median of Lp(a) level was 14.1 mg/dl (the 25th percentile was 6.2 mg/dl and the 75th percentile was 26.7 mg/dl). 2) The values of serum Lp(a) in subjects with vasospastic angina distributed at a higher level than for subjects with normal coronary arteries as diagnosed by coronary angiography. 3) The observed serum Lp(a) concentration moved to a higher range as the number of branches with significant stenosis on the coronary angiography increased. 4) Serum Lp(a) was one of the risk factors for ischemic heart disease. Its odds ratio when the cut-off value was set at 26.7 mg/dl or 30 mg/dl was 2.52 and 2.94, respectively. Information on the distribution of serum Lp(a) concentration is useful for estimating the coronary atherogenic factor.
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PMID:Distribution of serum lipoprotein(a) levels--a non-parametric analysis. 825 1

Complex demodulation of the T wave permits tracking of susceptibility to ventricular fibrillation under the clinically relevant conditions of acute myocardial ischemia and reperfusion. To facilitate the processing and to increase the applicability of the methods, we have developed algorithms and applied mathematical transformations that can be carried out with a personal computer. The program is self-contained and menu driven and transforms the data into a three-dimensional graphic display of magnitude of alternans (mV x ms), time in the cardiac cycle, and duration of the assessment. It is suitable for investigations with diverse experimental procedures such as coronary artery occlusion and release, autonomic interventions, behavioral stress testing, and drug administration. Our methodology may be employed in clinical conditions such as postmyocardial infarction. Prinzmetal's angina, and the long QT syndrome, wherein T wave alternans has been reported in body surface leads. Ultimately, T wave alternans analysis with use of the personal computer system may help guide therapeutic interventions.
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PMID:Personal computer system for tracking cardiac vulnerability by complex demodulation of the T wave. 833 97

A patient with vasospastic angina who developed myocardial ischemia following ethanol ingestion but not after exercise was described. Myocardial ischemia was evidenced by electrocardiograms (ECGs) and thallium-201 scintigrams. The blood acetaldehyde level after ethanol ingestion was abnormally high. The time course and severity of myocardial ischemia coincided with those of the blood ethanol and acetaldehyde level. Coronary arteriography showed ergonovine maleate-induced coronary vasospasm at the left anterior descending coronary artery. ECG changes similar to those induced by ethanol ingestion were observed at the same time. These findings suggest that the high blood acetaldehyde level might be responsible for the development of coronary vasospasm and myocardial ischemia in this patient.
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PMID:Ethanol-induced myocardial ischemia: close relation between blood acetaldehyde level and myocardial ischemia. 850 80

Myocardial perfusion and fatty acid metabolism may be unpaired in the patients of vasospastic angina (VSA), because abnormal regional wall motion of left ventricle has been shown in some cases of VSA without apparent history of myocardial infarction. To study the clinical utility of 123I-BMIPP scintigraphy in diagnosis of myocardial ischemia in VSA, both 123I-BMIPP (rest) and 201T1 (exercise) SPECT were performed in the 20 patients of VSA diagnosed by coronary angiography. Defect scores were calculated visually from the 17 segments of myocardial images and were compared with patient's anginal history, period from last attack, numbers of attack, left ventricular (LV) ejection fraction and severity of regional LV wall motion abnormality. 123I-BMIPP SPECT images showed decreased tracer uptake in 14 cases of 20 (70%) VSA patients. Exercise 201T1 SPECT images showed decreased tracer uptake in 3 cases of 20 (15%) of patients. Severity of regional LV wall motion abnormality was correlated with defect score of BMIPP. Though total defect score of BMIPP did not correlate with patient's anginal history, number of symptoms and LV ejection fraction, correlated inversely with period from last attack. It was suggested that 123I-BMIPP myocardial SPECT images in VSA patients showed "memories" of myocardial ischemic damages induced by vasospasm. In summary, 123I-BMIPP myocardial SPECT images could be a useful test for diagnosis and evaluation of VSA.
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PMID:[Assessment of myocardial fatty acid metabolism in patients with vasospastic angina using 123I-BMIPP myocardial SPECT]. 852 32

The authors give a short account about the significance, basic rules in regulation of intracellular (cytosolic) calcium homeostasis, distribution of calcium channels in different organs and characteristics of L channels in cardiovascular system. The different types of calcium channel blockers (dihydropyridines, phenylalkilamines, benzothiazepines), their similarities, dissimilarities (cardio, -vascular selectivity) are discussed. Differences in calcium homeostasis, in sympathetic innervation between vascular smooth- and heart muscle in briefly disputed. The basic role of endothel cell dysfunction in development of ischemic heart disease, the possible mechanisms (potential anti-remodeling, antifissuring, antiischemic, cardioprotective, sympaticolytic effects) of different calcium antagonists in the treatment of patients with ischemic heart disease are reviewed. Potential adverse effects of calcium channel blockers (proischemic, proarrhythmic, procongestive, prohaemorrhagic effects) are also mentioned. Finally the up-date preventive and therapeutic indications of different calcium channel blockers in the clinical management of patients with stable, unstable angina pectoris, silent myocardial ischemia, vasospastic angina, acute myocardial infarction is shortly reported.
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PMID:[Calcium antagonists and ischemic heart disease]. 892 61


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