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

To elucidate the characteristics of acute myocardial infarction, preinfarct angina and postinfarct angina in diabetic patients, we compared 51 diabetics and 73 non-diabetics who had myocardial infarction and angiographically-proven coronary artery stenosis. There was no statistical difference between these 2 groups with respect to age, sex, histories of smoking, hypertension and hypercholesterolemia, and hemodynamic parameters. Mean of the number of diseased vessels and of the jeopardy scores were higher in diabetics than in non-diabetics (2.4 vs. 1.9, p < 0.01; 7.2 vs. 5.7, p < 0.02, respectively). The absence of preinfarct angina (59 vs 32%, p < 0.01) and typical chest pain of myocardial infarction was more frequent in the diabetic group than in the non-diabetic group (43 vs 15%, p < 0.005). Congestive heart failure was more common in diabetics than in non-diabetics (45 vs 14%, p < 0.005). Though there was no difference in the frequency of postinfarct angina between the 2 groups (54 vs 52%), painless myocardial ischemia during treadmill exercise tests was more frequent in diabetics than in non-diabetics (75 vs 30%, p < 0.025). Compared to diabetic patients with typical chest pain of myocardial infarction, diabetics without typical chest pain had preinfarct angina less frequently (82 vs 41%, p < 0.01), but had diabetic neuropathy (71 vs 43%, p < 0.05) and retinopathy (67 vs 32%, p < 0.025) more frequently. We concluded that diabetic patients with myocardial infarction frequently lack 1) preinfarct angina, and 2) typical chest pain of myocardial infarction. 3) They often suffer from congestive heart failure, 4) frequently accompanied by painless myocardial ischemia during exercise stress tests. Therefore, special attention should be paid for the management of diabetic patients with specific neuropathy and retinopathy.
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PMID:[Characteristics of acute myocardial infarction, preinfarct angina and postinfarct angina in patients with diabetes mellitus]. 130 56

Several studies in the past have shown the long-term beneficial effects of beta-blockers in congestive heart failure. Despite the interest in this mode of therapy, their clinical application has been limited due to their negative inotropic effect. A subset of the heart failure patients do not show any improvements with standard beta-blocker therapy. Carvedilol, a new, non-selective beta-blocking agent with concurrent alpha-blocking properties, was evaluated in 17 patients with chronic heart failure secondary to ischaemic heart disease. All had resting left ventricular ejection fraction less than or equal to 45% and were maintained on diuretic therapy. Acute haemodynamic measurements were made after intravenous carvedilol (2.5-7.5 mg) and also after chronic therapy for 8 weeks (carvedilol 12.5-50 mg b.d.). Radionuclide ventriculography, ambulatory intra-arterial blood pressure monitoring and right heart catheterization were performed before and after 8 weeks of chronic therapy. Twelve patients completed the study and 5 were withdrawn. Symptomatic and haemodynamic improvement was demonstrated in 11 of the 12 patients after 8 weeks of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Can intravenous beta blockade predict long-term haemodynamic benefit in chronic congestive heart failure secondary to ischaemic heart disease? A comparison between intravenous and oral carvedilol. 135 Apr 92

Several studies have demonstrated the long-term beneficial effects of beta-blockers in the treatment of congestive heart failure. Despite interest in this mode of therapy, clinical application of beta-blockers has been limited due to their negative inotropic effect. A subset of the heart failure patients do not show improvements with standard beta-blocker therapy. Carvedilol, a new nonselective beta-blocking agent with concurrent alpha-blocking properties, was evaluated in 17 patients with chronic heart failure secondary to ischemic heart disease. All had resting left ventricular ejection fraction less than or equal to 45% and were maintained on diuretic therapy. Acute hemodynamic measurements were made after administration of intravenous carvedilol (2.5-7.5 mg) and after chronic therapy for 8 weeks (12.5 to 50 mg b.i.d.). Radionuclide ventriculography, ambulatory intra-arterial blood pressure monitoring, and right heart catheterization were performed before and after 8 weeks of chronic therapy. Twelve patients completed the study (five were withdrawn). Symptomatic and hemodynamic improvements were demonstrated in 11 of the 12 patients after 8 weeks of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Can intravenous beta-blockade predict long-term hemodynamic benefit in chronic congestive heart failure secondary to ischemic heart disease? A comparison of intravenous with oral carvedilol. 137 53

Congestive heart failure (CHF) is a common manifestation of hypertension, coronary artery disease, and dilated cardiomyopathy. The Framingham study showed that the incidence of CHF increases twofold with each decade of age. The presence of CHF increases the age-adjusted death rate 5.5-fold for women and 8-fold for men, and it increases the sudden death rate 5.5-fold in both men and women. Ventricular arrhythmias are a common accompaniment of CHF. Ambient ventricular premature complexes occur in most of these patients, and nearly one half of all CHF patients will have nonsustained ventricular tachycardia on a 24-h ambulatory electrocardiographic (Holter) recording. In addition, low left ventricular ejection fraction (LVEF) predicts inducible sustained ventricular tachycardia on electrophysiologic study. One-year mortality increases with worsening New York Heart Association (NYHA) Functional Class and decreasing LVEF. As the overall yearly mortality increases, the proportion of patients who die of arrhythmias decreases. The precise mechanism of death is frequently difficult to assess. Nonarrhythmic causes of death include CHF, shock, electromechanical dissociation, and myocardial rupture. Arrhythmic causes are most commonly due to ventricular tachycardia/ventricular fibrillation. Bradycardic events (asystole or heart block) are usually associated with progressively worsening CHF. Noncardiac causes that may confuse classification include pulmonary embolus and cerebrovascular accident. Because many patients have ischemic heart disease as the etiology of the CHF, a recurrent ischemic event can likewise make classification difficult. Overall, approximately one half of all deaths in CHF are arrhythmic and one half are nonarrhythmic.
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PMID:Clinical significance and management of arrhythmias in the heart failure patient. 139 10

In 26 patients (mean age at death 68 +/- 9 years) who had undergone amputation (at mean age 63 +/- 12 years) of 1 or both lower extremities due to severe peripheral arterial atherosclerosis, the amounts of narrowing at necropsy in the 4 major (left main, left anterior descending, left circumflex, and right) epicardial coronary arteries were determined. During life, 15 of the 26 patients (58%) had symptoms of myocardial ischemia: angina pectoris alone in 1, acute myocardial infarction alone in 5, and angina and/or infarction plus congestive heart failure or sudden coronary death in 9. Twelve of the 26 patients (42%) died from consequences of myocardial ischemia: acute myocardial infarction in 5, sudden coronary death in 3, chronic congestive heart failure in 3, and shortly after coronary bypass surgery in 1. Grossly visible left ventricular necrosis or fibrosis, or both, was present in 21 patients (81%). Of the 26 patients, 24 (92%) had narrowing 76 to 100% in cross-sectional area of 1 or more major coronary arteries by atherosclerotic plaque. The mean number of coronary arteries per patient severely (> 75%) narrowed was 2.3 +/- 1.0/4.0. Of the 104 major coronary arteries in the 26 patients, 60 (58%) were narrowed > 75% in cross-sectional area by plaque. The 4 major coronary arteries in the 26 patients were divided into 5-mm segments and a histologic section, stained by the Movat method, was prepared from each segment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amounts of coronary arterial narrowing by atherosclerotic plaque at necropsy in patients with lower extremity amputation. 141 37

Introduction of the automatic implantable cardioverter defibrillator (AICD) has dramatically affected the surgical treatment of malignant ventricular tachyarrhythmias. The authors continue to perform electrophysiologically directed subendocardial resection (SER) of left ventricular (LV) scars in selected patients, and we revascularize (CABG) those patients undergoing AICD implantation who have significant myocardial ischemia. In an attempt to define the optimal role of each procedure, this report analyzes our 8-year experience with 348 consecutive patients treated surgically for these arrhythmias (SER since 1983 and AICD since 1986). All patients undergoing SER had organized ventricular tachycardia (VT) as a result of myocardial infarction, and most had LV aneurysms; of those undergoing AICD or AICD/CABG, 60% had VT, 15% had ventricular fibrillation, and 25% had both or were noninducible. The thirty-day mortality rate was 1.5% (3/197) for AICD, 5.4% (5/93) for AICD/CABG, and 8.6% (5/58) for SER; these mortality figures are not significant different. Late deaths in all groups were predominantly due to congestive heart failure, and actuarial survival as well as freedom from sudden death was similar between the groups at 4 years. Recurrent VT occurred in 167 of 282 (59%) of long-term survivors of AICD or AICD/CABG during follow-up and in nine of 53 (17%) of those with SER. Forty-eight per cent of survivors of AICD or AICD/CABG required antiarrhythmic medications, whereas only 11% of those with SER required antiarrhythmics. Long-term survival in each group is much higher than that reported for comparable patients with severe LV dysfunction treated medically. In those patients with organized VT and LV aneurysm who are judged able to survive the procedure, SER offers a high likelihood of cure rather than simple prevention of sudden death.
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PMID:Strategies in the surgical treatment of malignant ventricular arrhythmias. An 8-year experience. 141 80

The analysis of beat-to-beat spontaneous oscillations of heart rate variability is a recent and noninvasive approach capable of providing important information on neural mechanisms controlling cardiovascular function. In particular, with spectral analysis of RR variability, two major components can be detected at low (LF, approximately 0.1 Hz) and high (HF, approximately 0.25 Hz) frequency. They have been demonstrated to be appropriate indices of, respectively, sympathetic and parasympathetic modulations of heart period. In control subjects, at rest, LF is slightly predominant over HF. In post myocardial infarction patients there is a predominant LF and a diminished HF that suggests an alteration of sympatho-vagal balance with a predominance of sympathetic tone. This approach, by providing indices of sympathetic and vagal neural regulatory outflows, appears adequate to evaluate several pathophysiological conditions such as ischemic heart disease, hypertension or congestive heart failure, which are characterized by important alterations of neural regulatory mechanisms.
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PMID:Power spectral analysis of RR variability. 142 89

Emergency aortic valve replacement with double aorto-coronary bypass surgery was performed to treat severe intractable congestive heart failure in an 82-year-old man. Mild circumflex and left anterior descending artery lesions were present and the pressure gradient across the aortic valve was 80 mmHg despite a low cardiac output. The preoperative anteroseptal akinesia seen by two-dimensional echocardiography was normalized after surgery. Thus, even in patients with segmental left ventricular dysfunction, tight aortic stenosis might be present when concomitant mild ischemic heart disease is present.
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PMID:Segmental asynergy of the left ventricle in a case of tight aortic stenosis associated with mild ischemic heart disease. 143 18

Moricizine, a recently approved phenothiazine antiarrhythmic agent, is reported to be associated with a low frequency of congestive heart failure. A 61-year-old man with a history of congestive heart failure and ischemic heart disease began taking moricizine 250 mg every 8 hours to suppress his monomorphic sustained ventricular tachycardia. After five doses he became progressively short of breath and was in pulmonary edema. Moricizine was discontinued, intravenous diuretics were administered, and the patient's clinical status stabilized. Twelve hours later, however, he developed polymorphic ventricular tachycardia and was not successfully resuscitated. Despite claims as to its safety, limited data strongly suggest that moricizine, like other antiarrhythmics, may be detrimental in patients with preexisting ventricular dysfunction, and should be prescribed with caution.
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PMID:Exacerbation of congestive heart failure secondary to moricizine. 143 2

Although the technique of laparoscopic cholecystectomy has increasing appeal, physiologic data to support the safety of this procedure are lacking. We studied the cardiovascular changes in 16 patients undergoing laparoscopic cholecystectomy, using impedance cardiography as a noninvasive means of continuous monitoring of cardiac output. Serial measurements of mean arterial pressure (MAP), heart rate (HR), intraperitoneal pressure and expired carbon dioxide tension (PECO2) were also recorded. Results revealed a decrease of 30 percent (p < 0.001) in cardiac index and 5 percent (p = 0.089) in HR, along with increases of 15 percent (p < 0.001) in MAP and of 79 percent (p < 0.001) in the calculated total peripheral resistance index. This elevation in afterload could lead to both an increase in myocardial oxygen consumption and to the potential risk of myocardial ischemia and possibly infarction or congestive heart failure, or both, in patients who are susceptible. The data suggest that patients with a history of cardiac disease should have preoperative cardiac evaluation and be closely monitored during laparoscopic cholecystectomy, as in any other extensive operation.
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PMID:Cardiovascular changes during laparoscopic cholecystectomy. 144 34


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