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)

Almost 2 billion passengers embark on international and domestic air travel each year. An increasing number of travelers will have cardiovascular disease as the population continues to age and our ability to treat cardiac disease improves. Guidelines for safe air travel in this population vary and are supported by few concrete data from randomized trials. Although the overall risk for clinically significant myocardial ischemia and arrhythmia during flight seems to be low in the population with stable cardiovascular disease, certain groups may be at increased risk. In-flight venous thrombosis is an increasingly recognized potential complication of prolonged air travel. Travelers with cardiovascular disease may be at increased risk for venous thrombosis as a result of depressed ejection fraction or immobility. This case-based review describes the risks of air travel in a 65-year-old man with known cardiovascular disease. After reviewing the limited data on safe air travel after myocardial infarction and the common complications after both percutaneous intervention and coronary artery bypass grafting, we provide recommendations on safe air travel after myocardial infarction. We discuss the safety of both preflight screening and the in-flight environment with regard to pacemakers and implantable automatic defibrillators. We also review the literature on in-flight venous thrombosis and provide recommendations to prevent in-flight deep venous thrombosis.
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PMID:Evaluation and management of the cardiovascular patient embarking on air travel. 1526 71

There are significant associations between moderate increases in serum homocysteine and three cardiovascular diseases: ischemic heart disease, deep vein thrombosis and pulmonary embolism, and stroke. An association between the presence of abdominal aortic aneurysm and elevated homocysteine plasma levels has been indicated. Although chronic systemic hypertension is the most common factor predisposing the aorta to dissection, homocysteinemia has never been known as the risk for aortic dissection except for that with Marfan syndrome. Homocysteinemia is suggested to be the risk for aortic dissection in Marfan syndrome and spontaneous cervical artery dissection. Reduced fibrillin-1 deposition into the extracellular matrix is found not only in Marfan syndrome but also in isolated ascending aortic aneurysm and dissection. The reduced matrix deposition produces a mild form of weakness of elastic tissue, which predisposes to ascending aortic aneurysm and dissection in patients who do not have the Marfan syndrome. The defect in fibrillin-1 leads to: (1) formation of elastin that is abnormally aggregated and more easily degraded by matrix metalloproteinases than is normal elastin; (2) upregulation of the synthesis of matrix metalloproteinases; (3) progressive destruction of connective tissue by these enzymes; (4) development of thoracic aortic aneurysms. Homocysteine causes premature breakdown in the arterial elastic fibers by activation of the elastolytic activities. Irreversible homocysteinylation of long-lived proteins should lead to cumulative damage and progressive clinical manifestations, and fibrillin-1 is seen as the paradigm of extracellular connective tissue proteins that are specially susceptible to homocysteine (and presumably homocysteine thiolactone) attack. The authors hereupon propose a novel hypothesis that homocysteine plays an important role in development of aortic dissection and that homocysteinemia is one of the risk factors for aortic dissection.
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PMID:Homocysteinemia is a risk factor for aortic dissection. 1578 May 1

Oral anticoagulant therapy remains one of the most frequent options for treatment and prevention in patients with arterial and venous thromboembolism. Clinical guidelines have been updated in recent years by various associations such as the American Heart Association (AHA), the American College of Cardiology (ACC) and the European Society of Cardiology (ESC), as well as organizations in several other countries. The authors present a review of therapy with vitamin K antagonists, focusing on their mechanism of action and metabolism, as well as on the fundamentals of such therapy. Clinical recommendations for the most frequent indications are described. One of the most important issues is the use of these drugs for atrial fibrillation therapy, which is a common indication. Prosthetic valvular disease is a compelling indication for anticoagulation, for which there is a broad consensus. Ischemic heart disease is another indication described for oral anticoagulation. Several practical issues in cardiac patients are discussed. These include the appropriate initial dose, schemes for reversal of anticoagulation, and management of surgical patients. Finally, risk factors for deep venous thrombosis and pulmonary embolism are detailed in this review, presenting current clinical recommendations for oral anticoagulation of these patients.
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PMID:Oral anticoagulant therapy. Fundamentals, clinical practice and recommendations. 1793 86

Death due to hemorrhage from ruptured peripheral varicose veins is an uncommon event. A review of the files of Forensic Science SA (FSSA) in Adelaide, South Australia, was undertaken over a 10-year period from January 1996 to December 2005 for such cases. A total of 8 cases were found out of a total of 10,686, representing <0.01% of autopsy cases. The male to female ratio was 1:3, with an age range of 58-84 years (mean = 78 years). The victims were all located at their home addresses, where they had been alone at the time of their deaths. Scene investigations revealed considerable blood loss, with pooling around the victims' bodies, and also in other parts of the house, particularly the bathroom/toilet areas. Four ulcers were of an acute perforative type and 2 were of a chronic ulcerative type. In 2 cases, bleeding followed trauma. Toxicologic evaluation was performed in only 3 of the cases, revealing blood alcohol levels of 0.06% and 0.14% in 2 cases, respectively. A further victim had been prescribed anticoagulant drugs for an unrelated condition. Additional findings of significance were ischemic heart disease in 3 cases and deep venous thrombosis of the calf veins on the side of the fatal hemorrhage in another case (with no evidence of pulmonary thromboembolism). One victim had acute gastric erosions, suggesting that hypothermia following collapse played a role in the terminal event. Autopsy evaluation of such cases should include careful layer dissection of the area of hemorrhage to confirm the presence of the ruptured varix and to enable directed histologic sampling.
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PMID:The incidence and characteristic features of fatal hemorrhage due to ruptured varicose veins: a 10-year autopsy study. 1804 15

Weight adapted low molecular weight heparin (LMWH) treatment is recommended as initial anticoagulant therapy of deep vein thrombosis, pulmonary embolism, in patients with myocardial ischemia or when oral anticoagulation (OAC) must be interrupted peri- operatively. Traditionally unfractioned heparin (UFH) was used as standard short acting anticoagulant, with the therapy monitored by frequent laboratory testing. Currently LMWH have broadly replaced UFH as first- choice anticoagulant due to more preferable pharmacokinetics and a better safety profile. Therapeutic anticoagulation with LMWH can be achieved by subcutaneous weight adapted application and measurement of anti-factor Xa- activity (anti-Xa) has been established as gold standard for LMWH- monitoring. However, since almost all LMWH dosing regimens have been developed empirically without laboratory monitoring, there is still a debate ongoing about the usefulness and impact of anti-Xa-testing. Data are lacking that prove a clear correlation between obtained levels of anti-Xa and the patients' clinical outcome. Newer methods have been developed aiming to determine a broader spectrum of LMWH depending anticoagulant activity. Even though there are some promising preliminary results, these alternative methods are not ready for routine clinical use yet. Nevertheless, current guidelines advise determination of anti-Xa in special patient populations with markedly altered LMWH metabolism or to exclude residual LMWH- activity before surgery at very high risk of bleeding. The aim of this article is to review critically the usefulness of anti- Xa guidance of LMWH- therapy and to give new perspectives on upcoming methods of LMWH- monitoring.
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PMID:Monitoring therapeutic anticoagulation with low molecular weight heparins: is it useful or misleading? 1885 41

Evaluation of: Bellamy L, Casas JP, Hingorani AD, Williams DJ: Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. Br. Med. J. 335(7627), 974 (2007). Evidence has emerged over the years suggesting that women who develop hypertensive pregnancy disorders, most notably pre-eclampsia, are at an increased risk for cardiovascular disease later in life. In this study, a systematic review and meta-analysis were performed, assessing the future risks of cardiovascular disease, cancer and all-cause mortality in women with a history of pre-eclampsia and eclampsia. Women with a history of pre-eclampsia or eclampsia, compared with women without such a history, had an increased risk for cardiovascular disease, including a fourfold increased risk for hypertension, a twofold increased risk for ischemic heart disease, stroke and deep venous thrombosis, and a 1.5-times higher all-cause mortality. The study suggests that affected women may be eligible for preventive therapies at an earlier age, especially if future studies establish the role of pre-eclampsia as an independent cardiovascular risk factor.
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PMID:Pre-eclamptic pregnancies: an opportunity to identify women at risk for future cardiovascular disease. 1907 14

Among the cardiovascular diseases and after ischemic heart disease and stroke, venous thromboembolism (VTE) is the third leading cause of death in the U.S. (3). Although VTE is seen across most ethnic groups in the U.S. as well as throughout the world, the rate varies. In the U.S., American Indians/Alaskan Natives as well as Asians have been reported to have a significantly lower rate of deep vein thrombosis (DVT) and pulmonary embolism (PE) as compared to blacks and whites. In sharp conrast blacks appear to have much higher rates than whites. Although these rate differences are thought in part by some to be attributable to disparities in diagnosis and care as well as genetics, it nevertheless is important to define as well as to understand the true incidence and impact so that both public health and clinical resources can be maximally utilized. The purpose of this commentary is to review the VTE burden in the U.S. with respect to ethnicity in terms of clinical demographics and genetics with particular emphasis on blacks.
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PMID:Venous thromboembolism in African-Americans: a literature-based commentary. 1957 96

Although the long-term results following traditional total joint arthroplasty are excellent, postoperative pain management has been suboptimal. Under-treatment of pain is a focus of growing concern to the orthopedic community. Poorly controlled postoperative pain leads to undesirable outcomes, including immobility, stiffness, myocardial ischemia, atelectasis, pneumonia, deep venous thrombosis, anxiety, depression, and chronic pain. Over the past decade, the attempt to minimize postoperative complications, combined with the move toward minimally invasive surgery and early postoperative mobilization, has made pain management a critical aspect of joint replacement surgery. Effective protocols are currently available; all include a multimodal approach. Debate continues regarding the ideal approach; however, reliance on narcotic analgesia alone is suboptimal.
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PMID:Postoperative pain management. 2083 19

Hyperhomocysteinemia is a known risk factor for the development of deep vein thrombosis (DVT). Various studies have been conducted in the western countries to know the prevalence of hyperhomocysteinemia in patients with DVT and in general population. There is no documented literature of the prevalence of hyperhomocysteinemia in Indian population. Thus the aim of this study was to determine the prevalence of hyperhomocysteinemia in cases of DVT in our population. To evaluate the prevalence of hyperhomocysteinemia, a prospective cross sectional study done on a total of 70 patients admitted in KLES Dr Prabhakar Kore hospital, Belgaum, India. DVT was confirmed by Doppler examination. Serum homocysteine was measured and the data analysed. Statistical significance was calculated using chi square test. A total of 70 patients were studied of which 53 were males and 17 were females. The prevalence of hyperhomocysteinemia among the cases of DVT was 31.428%.The prevalence among males was 35.85% and among females was 17.64%.There was statistically significant association between hyperhomocysteinemia and presence of ischaemic heart disease with a p value of 0.005 on chi square analysis. The prevalence of hyperhomocysteinemia in cases of deep vein thrombosis in our population was 31.428%. There was a statistically significant association between hyperhomocysteinemia and ischaemic heart disease.
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PMID:A cross-sectional study to detect the prevalence of hyperhomocysteinemia in cases of deep vein thrombosis. 2193 96

Since the late 1980s, low dose aspirin has been used to prevent stroke and ischemic heart disease. However, prophylactic effect of antiplatelets against venous thromboembolism (VTE), in patients who undergo hip fracture surgery (HFS) is controversial. Our purpose was to determine the incidence of symptomatic VTE after HFS and to evaluate whether antiplatelets reduce the development of symptomatic VTE following HFS. We retrospectively reviewed 858 HFS in 824 consecutive patients which were performed from May 2003 to April 2010 at an East Asian institute. We compared the incidence of symptomatic VTE in antiplatelet users and non-users using multivariate logistic regression analyses. Overall incidences of symptomatic pulmonary embolism including fatal pulmonary embolism, and symptomatic deep vein thrombosis in this study were 2.4% (21/858), and 3.5% (30/858), respectively. The incidence of symptomatic VTE was 4.8% (12/250) in antiplatelet users and 4.3% (26/608) in non-users (P = 0.718). It is suggested that antiplatelet agents are not effective in prevention of symptomatic VTE after HFS.
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PMID:Little impact of antiplatelet agents on venous thromboembolism after hip fracture surgery. 2214 1


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