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

It seems likely that a number of medical and surgical treatments have had an impact on the overall mortality from ischaemic heart disease in recent years although there is comparatively little data upon which to base conclusions. The two forms of treatment which have been shown, in controlled trials, to reduce mortality are beta blockade after infarction and coronary artery bypass surgery in chronic ischaemic heart disease. It is of interest that these treatments seem to be most often applied in countries that have had the greatest fall in mortality, although it is not suggested that they have played more than a small role. It is likely that other influences on mortality have included the use of pacemakers and the avoidance of previously undesirable medical practices. Much more careful documentation of the use of treatments in different countries is highly desirable.
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PMID:Treatment for chronic CHD. 257 69

The choice of therapy in chronic ischemic heart disease depends on identifying the underlying mechanism. Ambulatory monitoring provides a means of identifying those patients in whom increased myocardial oxygen demand is the most important mechanism and who will respond to a beta blocker. In contrast, those patients with coronary spasm are best treated with a calcium antagonist. The history of angina pectoris and the time of onset may, in itself, be misleading. Detailed ambulatory monitoring studies show that nocturnal angina is frequently due to increased myocardial oxygen demand and in such circumstances should be treated by careful control of the heart rate using a beta blocker without intrinsic sympathomimetic activity. Other factors that will influence the choice of medical therapy must be considered. Smoking is particularly important because it not only acts detrimentally in terms of increased myocardial oxygen demand, but may also interfere with the metabolism of those antianginal agents that are metabolized in the liver. The importance of silent myocardial ischemia has been emphasized recently, and studies using ambulatory pulmonary artery monitoring have shown that silent ischemic episodes have the same significance in terms of hemodynamic effects as painful ischemic episodes. The therapeutic and prognostic implications of these findings need to be explored.
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PMID:Choice of therapy in chronic ischemic heart disease. 288 99

This report describes the nuclear cardiology procedures available for use as diagnostic techniques in patients with definite or suspected cardiovascular disease. The usefulness of myocardial imaging, radionuclide angiocardiography and other radionuclide cardiovascular imaging techniques is classified within specific disease states. The clinical utility of each technique is graded from I to IV, depending on the clinical importance of the technique (I = most important; IV = not indicated). A grade of V is given for methods now considered to be in their research phase. The usefulness of these methods is discussed in patients with acute ischemic heart disease, chronic ischemic heart disease, valvular heart disease, pulmonary vascular disease and hypertensive heart disease. Selected references are provided.
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PMID:Guidelines for Clinical Use of Cardiac Radionuclide Imaging, December 1986. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures (Subcommittee on Nuclear Imaging). 294 47

The effect of fructose-1,6-diphosphate (FDP) on left ventricular function was assessed in seven patients with chronic ischemic heart disease and eight patients with idiopathic dilated cardiomyopathy. In a crossover study design each patient received 10 gm of FDP or saline placebo intravenously for three days. An M-mode echocardiographic assessment of left ventricular (LV) function was made before and after each treatment period. After FDP treatment, LV end-diastolic and systolic dimensions showed a 6% reduction (P less than 0.01), while peak lengthening rate of LV dimension in diastole and peak shortening rate of LV dimension in systole increased 17% and 10%, respectively (P less than 0.05). There was evidence that FDP was more effective in the patients with ischemic heart disease than in the patients with cardiomyopathy.
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PMID:Improved left ventricular function after short-term treatment with fructose-1,6-diphosphate: echocardiographic study in chronic ischemic heart disease and idiopathic dilated cardiomyopathy. 297 75

Continuous ECG monitoring is a useful method to evaluate the efficacy of antiarrhythmic drugs. The aim of our study was to evaluate the effects of amiodarone (400 mg day-1 for seven days and then 200 mg day-1, five days a week, for 60 days) in 20 patients with chronic ischaemic heart disease ascertained by stress test, thallium-201 myocardial scintigraphy and coronary angiography and with qualitatively and quantitatively similar cardiac arrhythmias in two continuous ECG monitoring sessions performed before starting treatment. All patients were previously on treatment with isosorbide 5-mononitrate (Is-5-Mn). Patients underwent two ECG monitoring sessions for 48 h, with an ICR instrument with two leads, first during pharmacological treatment with Is-5-Mn plus placebo and then after 60 days on treatment with Is-5-Mn and amiodarone. Heart rate decreased significantly with amiodarone (from 76.9 to 69.5 beats min-1) as did premature ventricular complexes (from 4686 to 329 day-1), ventricular couplets (from 154.3 to 5.0 day-1), ventricular tachycardia runs (from 91.7 to 0). ST segment depression more than 1.5 mm was present for 93.8 min day-1 on Is-5-Mn plus placebo, and was significantly less frequently observed (for 13.8 min day-1) on Is-5-Mn plus amiodarone. Finally, transient episodes of ischaemia, both symptomatic and asymptomatic, diminished on amiodarone from 22 to 9 day-1 in a significant way. In conclusion, amiodarone is a useful drug to obtain a reduction of ventricular arrhythmias and symptomatic and asymptomatic episodes of ischaemia in patients with ischaemic heart disease.
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PMID:Effects of low doses of amiodarone on cardiac arrhythmias in patients with chronic ischaemic heart disease. 324 49

An intravenous magnesium-loading test with 30 mmol/L of magnesium was used to evaluate the magnesium status in 38 patients with ischemic heart disease (IHD) admitted to the coronary care unit with suspected acute myocardial infarction (AMI), in ten healthy volunteers (control group), and in nine patients with chronic IHD in a stable phase of their disease (chronic IHD group). Sixteen of the patients admitted with acute disease proved to have AMI (AMI group) and 22 did not (non-AMI group). Patients with IHD both with and without AMI retained significantly more magnesium (9.3 and 10.7 mmol/L [22.6 and 26 mg/dL], respectively) than did the control group (1.4 mmol/L [3.4 mg/dL]). This 34% magnesium retention points to a state of magnesium deficiency in patients with IHD. However, since the patients with and without AMI did not differ, the observations do not indicate that AMI is associated with a more severe magnesium deficiency than that found in other IHD patients without AMI. When the patients with IHD were subgrouped according to long-term diuretic treatment, the patients (n = 19) receiving long-term diuretic treatment had a 39% retention of magnesium (11.6 mmol/L [28.2 mg/dL]) compared with a 29% retention (8.7 mmol/L [21.1 mg/dL]) observed in 19 patients who were not receiving long-term diuretic treatment. This observation was not influenced by the presence or absence of AMI. An even higher level of magnesium retention (17.1 mmol/L [41.6 mg/dL] equals 57% retention) was found when investigating patients with chronic ischemic heart disease in a stable phase of their disease. This indicates that patients with IHD may be severely magnesium deficient; that long-term diuretic treatment contributes to this deficiency, but that diuretic treatment per se is not the only cause of this condition.
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PMID:Magnesium deficiency in patients with ischemic heart disease with and without acute myocardial infarction uncovered by an intravenous loading test. 334 37

The authors examined peculiarities of the central and cerebral hemodynamics before and after treatment in 108 patients with cerebral infarction and acute or chronic ischemic heart disease (IHD). When myocardial and cerebral infarctions were combined, as well as in most cases of cerebral ischemia in the post-infarction period, the heart worked in conditions of hypodynamia. Disorders of the cerebral circulation were expressed in hypo- and hyperperfusion of the cerebral vessels. Patients with acute versus chronic IHD displayed differences in changes of hemocirculatory parameters in the process of treatment.
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PMID:[Hemodynamic disorders and means of their pharmacological correction in cerebral infarction in patients with ischemic heart disease]. 343 66

Evaluation of regional function and blood flow are used for describing regional myocardial performance. This approach however yields little if any information on regional substrate metabolism. The latter links function to blood flow. Persistence of metabolism, even though abnormal, may be critical for cell survival in myocardial ischemia. Fatty acid oxidation characteristically declines in ischemia while glycolytic flux may increase or be maintained. These changes can be evaluated with C-11 palmitate and F-18 2-fluoro 2-deoxyglucose (FDG) and leave characteristic "fingerprints" on cross-sectional positron emission tomography (PET) images. Blood flow and C-11 palmitate uptake are segmentally reduced while FDG uptake may be increased relative to flow or when compared to normal myocardium. The latter, a discordance between segmental blood flow and FDG uptake, signifies tissue viability and predicts recovery of segmental function after surgical revascularization. The pattern is more sensitive for detection of viable tissue than conventional techniques. It is also frequently seen in acute myocardial infarction. Segments with this pattern may regain function or not. Those segments that fail to improve function spontaneously may require aggressive treatment which could be decided based upon PET findings. Noninvasive detection of such "fingerprints" of myocardial ischemia by PET aids in establishing the presence of viable tissue and may therefore affect patient management. Development of quantitative criteria will be needed to more accurately predict possible tissue outcome which in turn will more clearly establish the need for more aggressive therapeutic measures in acute and chronic ischemic heart disease.
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PMID:Evaluation of "metabolic fingerprints" of myocardial ischemia. 348 8

This report describes the nuclear cardiology procedures available for use as diagnostic techniques in patients with definite or suspected cardiovascular disease. The usefulness of myocardial imaging, radionuclide angiocardiography, and other radionuclide cardiovascular imaging techniques is classified within specific disease states. The clinical utility of each technique is graded from I to IV, depending on the clinical importance of the technique (I equals most important; IV equals not indicated). A grade of V is given for methods now considered to be in their research phase. The usefulness of these methods is discussed in patients with acute ischemic heart disease, chronic ischemic heart disease, valvular heart disease, pulmonary vascular disease, and hypertensive heart disease. Selected references are provided.
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PMID:Guidelines for clinical use of cardiac radionuclide imaging, December 1986. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Cardiovascular Procedures (Subcommittee on Nuclear Imaging). 349 Sep 32

The contractile apparatus of cardiomyocytes was examined at the ultrastructural level in 20 heart biopsy specimens obtained during operations for aortocoronary bypass in patients with chronic ischemic heart disease (IHD). Myofilaments were found to have sustained compensatory-adaptive and destructive changes as well as changes indicative of impaired intracellular regenerations under conditions of chronic hypoxia and energy deficiency experienced by the muscle cells, with the result that myocardial contractility was substantially reduced. Together, these processes led to progressive restructuring of both the contractile apparatus of the cardiomyocytes and the cytoarchitectonics in general. This combined with signs of increasing hyperfunction of the contractile myocardium, which made the energy deficit worse and thus interfered with plastic processes in, and diminished the structural and functional capabilities of, the myocardium. On the other hand, distinct changes were noted in the cardiomyocytes that reflected their adaptation to the adverse conditions created by progressing coronary atherosclerosis. It is concluded that therapy for patients with chronic IHD should include measures aimed at promoting such adaptive changes.
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PMID:[Characteristics of the restructuring of the cardiomyocyte contractile apparatus in chronic ischemic heart disease]. 366 47


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