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

The clinical impression that spinal cord injured and traumatic lower limb amputees are more prone to develop degenerative diseases was investigated by comparing the prevalence of hypertension, ischaemic heart disease, and diabetes mellitus in these two patient groups with the prevalence of these diseases among a group of healthy age-matched controls. Seventy seven spinal cord injured patients and 53 amputees fulfilled the criteria for inclusion in this study. Our results show a significant increased incidence of hypertension and ischaemic heart disease among those with spinal cord injuries compared with their controls; and among the amputees, a significant increased incidence of ischaemic heart disease and of diabetes mellitus.
Paraplegia 1989 Feb
PMID:The prevalence of hypertension, ischaemic heart disease and diabetes in traumatic spinal cord injured patients and amputees. 278

This literature review was conducted to determine: (a) the rate of bleeding (major, minor and fatal) during long term oral anticoagulant therapy (greater than 4 weeks) in various disorders (ischaemic cerebrovascular disease, prosthetic cardiac valves, chronic atrial fibrillation, ischaemic heart disease and venous thrombosis); and (b) the clinical and laboratory risk factors which predispose such patients to bleeding. Using strictly defined methodological criteria, 167 studies were evaluated and classified into 1 of 5 categories based on the strength of the study design, with level I (randomised trials) representing studies which provided the most reliable information and level V (cases series) the least reliable. The risk of bleeding was substantial, and was most marked in patients with ischaemic cerebrovascular disease (29%), ischaemic heart disease (19%) and venous thromboembolism (23%). Major bleeding in venous thrombosis and cerebrovascular disease was frequently associated with an underlying risk factor. In venous thromboembolism these coexisting conditions (cancer, recent surgery and paraplegia) were also predisposing factors for thrombosis. In cerebrovascular disease major bleeding was almost always intracerebral, possibly because of associated hypertension or the cerebrovascular disease per se. We were unable to determine whether bleeding events were concentrated soon after commencing anticoagulant therapy. Haemorrhagic episodes frequently occurred when the prothrombin time (or thrombotest) was within the targeted therapeutic range, but the relationship between bleeding and the level of anticoagulant therapy was properly evaluated in only 1 study (in venous thrombosis) which demonstrated that the risk of bleeding was reduced by using a less intense anticoagulant regimen. In conclusion, the risk of bleeding during oral anticoagulant therapy is substantial. Our analysis was limited by the lack of concise reporting of clinical and laboratory information and we would suggest that future clinical studies report these in greater detail.
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PMID:Risk of haemorrhage associated with long term anticoagulant therapy. 390 38

Survival, mortality rates, and causes of death were determined for 132 myelopathy patients during the 9-year period between April 1973 and March 1982. The average age was 54; 81% were paralyzed by trauma. Average survival was 15 years. Myelopathy mortality was eight times that of the general population for the third decade of life but comparable by the seventh decade. The major causes of death were pulmonary (41 patients- 71% with pneumonia or bronchitis), vascular (37 patients - 54% with ischemic heart disease), gastrointestinal (19 patients - 42% with carcinoma, 32% with peritonitis), and urinary (16 patients - 50% with renal failure and 44% with carcinoma). As survival of myelopathy patients has improved, deaths due to pneumonia, ischemic heart disease, carcinoma, and renal failure have become the major causes of death.
J Am Paraplegia Soc 1983 Jul
PMID:Increasing survival and changing causes of death in myelopathy patients. 661 34

With the advent of rapid autotransfusion, we began to repair aneurysms of the descending thoracic and thoracoabdominal aorta by using an "open" technique, in which a single cross-clamp is placed proximal to the aneurysm to exsanguinate the lower body. To determine whether open distal anastomosis effectively protects against spinal cord injury, we studied 71 consecutive patients (50 men, 21 women) who underwent this procedure beginning in April 1989. The patients ranged in age from 31 to 83 years (mean, 63.3 years). Most patients were hypertensive (n = 61; 86%) and symptomatic (n = 54; 76%). Most had been diagnosed with medial degeneration (n = 45; 63.4%) or aortic dissection (n = 16; 22.5%). Five patients (7.0%) were admitted with aortic rupture. We replaced the entire descending thoracic aorta in 31 (43.7%), the thoracoabdominal aorta in 21 (29.6%), and a segment of the descending thoracic aorta in 19 (26.7%). The average distal ischemic time was 22.4 minutes (range, 11 to 42 minutes). The amount of blood returned through the autotransfusion device averaged 2,099 mL. Eight patients (11.3%) died within 30 days (multiple organ failure, 3; hemorrhage, 2; coexisting ischemic heart disease, 3). Spinal cord dysfunction occurred in 6 patients (8.5%) (lower extremity paraparesis, 4; paraplegia, 2). Renal insufficiency requiring dialysis occurred in 4 patients (5.6%). We believe that the low incidence of spinal cord injury and renal insufficiency in this series may have resulted from the free draining of the intercostal and lumbar arteries during aortic occlusion, which decreases cerebrospinal fluid and central venous pressures.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Graft replacement of the descending thoracic aorta: results of "open" distal anastomosis. 803 22

Cardiac risk factors were evaluated in 48 persons (39 males, 9 females) with quadriplegia or paraplegia, resident in a specialized spinal injury hospital and seen 0.3 +/- 0.7 years after their spinal injury. The majority of the patients reported being extremely active physically prior to injury. Limited activity in the hospital involved the use of ergometers, pulleys, and weights; however, the majority of subjects expressed a wish for more exercise. Serum lipid profiles showed a relatively normal total cholesterol (mean 4.58 +/- 0.77 mmol/L), a very low high-density lipoprotein-cholesterol (0.91 +/- 0.27 mmol/L), a relatively normal low-density lipoprotein-cholesterol (2.86 +/- 0.68 mmol/L) and high triglycerides (1.89 +/- 0.88 mmol/L). Resting blood pressures were normal. The percentage of smokers (25%) was similar to the percentage of smokers in the general population, but many had quit smoking subsequent to hospitalization. Family histories and diet gave no evidence of increased cardiac risk. We conclude that individuals who sustain a spinal injury do not have a large inherent risk of cardiac events. In persons with paraplegia, cardiac problems develop mainly from the cumulative impact of reduced physical activity and a resulting adverse lipid profile. There may also be a reactive deterioration in other aspects of personal lifestyle, such as cigarette smoking after leaving the hospital. In high-level lesions, factors such as hypertension and a poor stroke volume with compensatory tachycardia may increase cardiac work rate during attempts at ambulation, further predisposing an individual to myocardial ischemia and cardiac arrest.
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PMID:Cardiac risk factors immediately following spinal injury. 823 48

Maintenance of cardiovascular stability during thoracoabdominal aneurysm repair remains a formidable challenge. Transesophageal echocardiography (TEE) has been shown to be an excellent method for detecting myocardial ischemia and assessing left ventricular volume. We examined the utility of TEE in a group of 17 patients from an overall series of 33 patients who underwent thoracoabdominal aneurysm resection between 1988 and 1992. The mortality rate was 9%, whereas the incidences of myocardial infarction and paraplegia were 13% and 6%, respectively. Intraoperative management was significantly altered by TEE data in nine patients. Two patients were noted to have mitral valve insufficiency, and one had transient ischemia-induced regional wall abnormalities. In six patients, Swan-Ganz-derived filling data failed to identify severe hemodynamic alterations that were noted on TEE. Five patients were hypovolemic and hyperdynamic, whereas one was in florid congestive heart failure. Further investigation is warranted to prospectively validate this technique.
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PMID:Transesophageal echocardiography for hemodynamic management of thoracoabdominal aneurysm repair. 835 12

The dissection is termed Type A according to the Stanford classification, if the ascending aorta is involved. It is termed type B, if the ascending aorta is not involved. Most patients with Type A aortic dissection die from intrapericardial rupture with cardiac tamponade, free pleural rupture, massive aortic regurgitation, or coronary or cerebral malperfusion (ischemic heart disease or stroke). Most patients with Type B dissection die from free pleural rupture or renal or visceral vascular complications. The resultant compromise of various aortic branches (inomunate, carotid, subclavian, spinal, renal, superior mesentric, or iliac arteries) results in a wide variety of symptoms and signs (shock, dyspnea, stroke, paraplegia, anuria, abdominal pain or extremity ischemia).
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PMID:[Pathophysiology and complications of aortic dissection]. 896 89

Due to the increased prevalence of ischemic heart disease and hypertension reported in individuals with chronic spinal cord injury (SCI), we investigated whether subjects with low level SCI (paraplegia), without apparent evidence of coronary artery disease, exhibit normal baroreceptor and autonomic function. Eighteen males participated in this study: seven normotensive with paraplegia, five hypertensive with paraplegia and six normotensive non-SCI controls. The Valsalva maneuver was performed by maintaining a pressure of 40 mmHg over 15 s and R-R intervals (RRI) and arterial blood pressure were measured continuously. Phase IV of the Valsalva maneuver was determined by linear regression analysis between RRI and systolic pressure, with a final slope calculated. The power spectra for RRI and blood pressure variability parameters were also analyzed, in addition to the index alpha, a frequency domain estimate of the overall gain in baroreceptor control of the RRI-arterial blood pressure. The normotensive subjects with paraplegia were found to have an impaired baroreceptor response when compared with age-matched, non-SCI controls. In addition, the levels of both the low frequency and high frequency spectral components of RRI and the index alpha were reduced in these individuals at rest. These cumulative findings strongly suggest that the integrity of the sinoaortic baroreceptors, as well as efferent parasympathetic function, may be compromised in otherwise apparently healthy individuals with chronic paraplegia.
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PMID:Baroreceptor sensitivity response to phase IV of the Valsalva maneuver in spinal cord injury. 961 1

A 65-year-old patient with ischemic heart disease and hypertensive nephropathy had paraplegia develop after elective coronary artery revascularization caused by anterior spinal infarction. Spinal complications are rare after coronary artery bypass grafting. The possible mechanisms of spinal cord injury are discussed, and the relevant literature is reviewed.
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PMID:Anterior spinal artery syndrome after elective coronary artery bypass grafting. 1207 9

A 65-year-old patient with ischemic heart disease and severe diabetes mellitus underwent minimally invasive direct coronary artery bypass grafting under general combined with epidural anesthesia. Paraplegia developed after surgery and the diagnosis of anterior spinal artery syndrome was made based on the patient's neurological condition and magnetic resonance imaging findings. Paraplegia following epidural anesthesia is a rare but recognized complication and this complication should be taken into account, especially in patients at risk, when considering epidural analgesia techniques in the minimally invasive cardiac surgery.
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PMID:Anterior spinal artery syndrome after minimally invasive direct coronary artery bypass grafting under general combined epidural anesthesia. 1587 63


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