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

Unknown is the significance of the abnormalities of repolarization observed at rest in patients with coronary artery disease (CAD) demonstrated by coronary angiography, except for ischemic episodes, myocardial infarction, left ventricular hypertrophy, electrolyte changes or pharmacological interactions. The chronic T wave inversion and ST segment depression are usually considered as an alteration due to ischemia ("chronic myocardial ischemia"); this definition is, in our opinion, erroneous, because myocardial ischemia is an acute episode caused by a sudden lack of balance between demand and availability of myocardial oxygen, corresponding to transient electrocardiographic alterations. Thus, the definition of "chronic myocardial ischemia" referred to stable abnormalities of repolarization is incorrect, because a "chronic" lack of balance between MVO2 and O2 availability would produce necessarily irreversible myocardial damage (necrosis). To contribute to the comprehension of the stable ECG changes at rest, we have selected a group of patients with CAD demonstrated by coronary angiography, presenting stable T wave alterations and ST depression at rest. We have studied the main and regional left ventricular function through radionuclide angiocardiography (ACS). Comparing the abnormalities of repolarization (ECG) on the one hand with angio, EFR and VER on the other, we have obtained different positive correlations, according to the functional parameters considered (EFR and VER). In our study, the lowest positive correlation has been noticed comparing ECG versus angio, VER and EFR (37.5%), while the highest correlation was obtained when ECG was considered versus angio and VER (56.25%). Evaluating ECG versus angio and EFR we have obtained a positive correlation equal to 43.75%. So we have deduced that VER is the functional parameter that better relates to angio and ECG.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A critical review of the stable changes in ventricular repolarization in ischemic cardiopathy. A correlation with the angiographic findings]. 148 33

An inventory has been made of the practice of angioplasty in 14 European countries from 1985 onwards. The numbers of procedures performed varied in 1985 from 3 to 186 per million inhabitants, in 1991 from 52 to 716. All countries showed a steady increase, but the highest performer. Belgium, achieved only 55% of the number of angioplasties performed in 1991 in the U.S.A. No relation was found between the number of angioplasties and death rate for ischaemic heart disease, national income, number of cardiologists or spending on health care. The number of catheterization laboratories was related to the number of procedures. Prices of angioplasty disposables varied widely between countries. In 1989 Italy and Spain had very high costs, averaging almost 2500 ECU and 2000 ECU for ACS and Schneider balloon catheters respectively, while Switzerland and the U.K. were cheap with costs between 700 ECU and 500 ECU for the same products. In 1991 average prices for balloon catheters fell by 25% in Spain, while in Switzerland average prices increased by 10%, bringing the almost four-fold price difference in 1989, down to a difference of 2.5 in 1991. If the U.S.A. is taken as a standard and set against the death rate from ischaemic heart disease in Western Europe in 1991 the number of 'missing' angioplasties was 215,500, the U.K. accounting for 42% of this deficit.
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PMID:Utilization of coronary angioplasty and cost of angioplasty disposables in 14 western European countries. European Angioplasty Survey Group. 829 46

Perfusion balloon catheters are designed to provide continuous transcatheter blood flow and thereby reduce myocardial ischemia during coronary angioplasty. To compare the transcatheter flow rates of active and passive (auto-) perfusion catheters, a well-controlled experimental study was performed in a circulation model that duplicates the phasic, predominantly diastolic flow pattern of the left coronary artery. Mean diastolic coronary driving pressure varied between 20 and 100 mm Hg. For the autoperfusion catheters, a strong relationship between transcatheter flow and diastolic coronary driving pressure was found. For example, a coronary driving pressure of 80 mm Hg provided a coronary flow of 30 ml/min (RX-Perfusion [RP], ACS), 28 ml/min (Speedflow [SF], Schneider), 20 ml/min (Lifestream [LS], ACS), and 19 ml/min (Flowtrack [FT], ACS). Reduction of driving pressure to 40 mm Hg decreased the absolute transcatheter flow, which was now 16 ml/min (RP), 13 ml/min (SF), and 10 ml/min (LS and FT). The relative catheter flow (the ratio of absolute flow to baseline coronary flow rate without a catheter in place), was independent of actual coronary driving pressure and ranged between 21% +/- 1% (RP) and 14% +/- 1% (FT and LS). For the active perfusion system (Coreflo, Leocor, a maximal transcatheter flow of 82 ml/min was found. Using this active perfusion system, the relative catheter flow increased with decreasing coronary driving pressure:80 --> 40 mm Hg: 56% --> 107%. For all catheters, the distal perfusion decreased between 30% (3.0 mm RP) and 50% (3.0 mm LS) by a 0.014-inch guidewire placed through the inner channel of the catheter. Because of the strong relationship between coronary driving pressure and transcatheter flow, the residual flow through all autoperfusion catheters becomes critical (<20 ml/min), when the coronary driving pressure drops below 50 mm Hg. By contrast, active perfusion systems are independent of the actual coronary driving pressure and are therefore advantageous for prolonged dilation in patients with low aortic pressure.
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PMID:Comparison of passive and active perfusion catheters: an in vitro study in a pulsatile coronary flow model. 885 58

The authors evaluated the occurrence of risk factors, mode of therapy and in-patient mortality in 726 patients admitted to 38 Czech and Moravian hospitals for unstable angina pectoris with ECG finding of ischaemia without ST segment elevation, who were indicated to application of anticoagulant treatment with low molecular weight heparin. The duration of the before-hospital phase represented a significant risk factor for the progression of disease up to Q myocardial infarction. The relapse of stenocardia occurred in 19.8% of patients during the hospitalization and myocardical infarction Q occurred in 7.5% patients, while 2.89% patients died during hospitalization. These results were compared with those performed in the registries of GRACE, ENACT and Euro Heart Survey Acute Coronary Syndrome-EHS-ACS. The results of therapy in the Czech Republic may be further improved by a more advanced health education within the framework of secondary prevention of IHD, a risk stratification of patients, more modern drug therapy and a better collaboration of hospitals lacking invasive catchment area workplaces of intervention cardiology.
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PMID:[Patients with unstable angina pectoris--what were the real facts in Czech and Moravian hospitals in the year 2000?]. 1451 77

Over the next decade, more early and aggressive treatments will become available for acute stroke. As EPs have been forced to push their skills and knowledge significantly further with the advent of time-sensitive interventions for myocardial ischemia, a similar sophistication will undoubtedly emerge in the management of acute stroke. Certain components of the neurological examination will likely assume a new significance and, as with the renewed focus on the nature of ST segment change on the ECG in ACS, there will be new attention to early imaging findings in stroke. Although it is unclear whether the balance of future advances in treatment will come from the world of neurosurgery, neurology, or interventional radiology, the EP is relatively assured to play a central role in their implementation.
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PMID:The acute cerebrovascular event: surgical and other interventional therapies. 1470 11

CVD are on the first place among death causes in the world. The half of all death at middle age persons is CVD causality, the most often because of ischaemic heart diseases, and there are a few clinic forms: acute coronary syndrome, stabile pectoral angina, variant pectoral angina, syndrome x, and silent myocardial ischemia. Toward definition ACS include clinical manifestation causality of myocardial ischemia due of atherosclerotic plague rupture. ACS include: non-stable pectoral angina non-Q infarction, Q myocardial infarction and sudden cardiac death. Consequence of plague rupture is occlusive thrombus which produces typical ST elevation on ECG after that appearance Q-in ECG with blood markers elevation (Troponin I, T, CK and CK-MB). There are sometimes non-typical ST elevation on ECG with blood markers elevation and chest pain. On that way becomes non-Q infarction. Smaller thrombus make non stable pectoral angina and appearance of ST depression on ECG without blood markers elevation. Sometimes sudden cardiac death is the first sign of coronary disease in the diagnostic management coronary disease due of: clinical symptom of chest pain, ECG (with or without ST elevation) and appearance appsence biochemical blood markers (at myocardial necrosis troponins are present in blood during 14 days, CK-MB is present 3 days). Sometimes echocardiography examination is helpful in estimate of regional kinetic disorders. European society of cardiologists made guidelines for management od ACS without ST elevation and guidelines management of acute myocardial infarction with ST elevation.
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PMID:[New approach in the diagnosis of acute coronary syndrome]. 1520 7

NSTE-ACS is a complex clinical event characterized by a variable degree of myocardial ischemia and triggered, in most patients, by a rupture of a vulnerable plaque that leads to acute intraluminal nonocclusive thrombosis. Traditionally, acute management strategies for NSTE-ACS have been aimed at identification of vascular areas with discrete atheroma and revascularization of the affected myocardium. Studies that have evaluated invasive strategies in NSTE-ACS suggest that the rates of hard clinical events are similar for both intensive medical treatment and early invasive management strategies. As shown recently in the Cooperative Cardiovascular Project study, intensive therapy with beta-blockers appears to be a viable management option that has comparable outcomes in most patients with NSTE-ACS. Although several different treatment strategies have been advocated in the management of NSTE-ACS, the available evidence-based information does not fully support some of these traditional approaches. Future prospective, well-controlled trials are needed to fully ascertain the role of invasive and other medical management strategies in patients with NSTE-ACS. Long-term aggressive management of established risk factors for CAD is unquestionably the most prudent and cost-effective therapeutic approach in the long-term management in patients recovering from NSTE-ACS.
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PMID:Treating non-ST-segment elevation ACS. Pros and cons of current strategies. 1620 5

Recent evidence has suggested an association between Chlamydia pneumoniae infection and coronary atherosclerosis. A significant association has also been detected between heat shock protein (HSP) 60 antibody and the severity of coronary atherosclerosis. The aim of this study was to define the relationship between instability of ischemic heart disease (IHD) and serum levels of HSP60 and C. pneumoniae antibodies. Blood samples for the measurement of serum antibody titers were obtained from 1131 patients with ischemic heart disease (65+/-9 years; male/female, 828/303) and 127 non-IHD controls with normal coronary arteries (64+/-9 years; male/female, 60/67) on the day of cardiac catheterization. The serum levels of anti-human HSP60 IgG antibody and anti-chlamydial IgM, but not IgG or IgA, antibody were significantly higher in ACS patients than in stable IHD patients or controls. These results suggest that acute C. pneumoniae infection with HSP60-related immunological responses may contribute to the pathophysiology of acute coronary syndromes.
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PMID:Acute Chlamydia pneumoniae infection with heat-shock-protein-60-related response in patients with acute coronary syndrome. 1621 93

Systemic factors and blood flow velocity related to atherosclerosis have been examined mainly separately or by in vitro studies. The aim of our study was to investigate the association between local coronary blood flow (corrected TIMI frame count, CTFC) and systemic atherosclerosis-related inflammatory parameters such as soluble intercellular adhesion molecule-1 (sICAM-1), interleukin-6 (Il-6), high sensitivity C-reactive protein (hsCRP) and von Willebrand factor (vWF) in humans. We enrolled the following groups of ischemic heart disease (IHD) patients: patients with coronary stenosis and stable (CAD, n = 96) or unstable angina (ACS, n = 27), patients with documented myocardial ischemia and normal coronary angiogram (NEG, n = 68). Patient groups showed only marginal differences in CTFC or sICAM-1 levels. In contrast, when IHD patients were studied individually, general positive correlation was found between CTFC and sICAM-1 level (r = 0.33; in NEG r = 0.25; in CAD r = 0.37; in ACS r = 0.61), being the strongest in ACS. The relation was independent from age, gender, BMI, smoking, hypertension, diabetes, previous myocardial infarction, family history of IHD, medication, hsCRP, IL-6 and vWF levels. (odds ratio, OR = 6.4; CI 95%: 2.43-16.84; p < 0.05). Nevertheless, correlation between CTFC and IL-6, hsCRP, vWF levels was not found. These results indicate inverse correlation between coronary blood flow and adhesion molecule production independently from conventional cardiovascular risk factors and inflammatory markers.
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PMID:Inverse correlation between coronary blood flow velocity and sICAM-1 level observed in ischemic heart disease patients. 1629 92

The incidence of coronary artery disease (CAD) has dramatically increased in India during the recent years. There are two facets of CAD: stable CAD and unstable CAD which includes patients with acute coronary syndrome (unstable angina, non-ST elevation myocardial infarction, ST elevation myocardial infarction). The treatment of stable CAD (stable angina) includes anti-anginal medication, medication to modify atherosclerosis and aggressive treatment of causative risk factors. Those patients with stable CAD who have symptoms refractory to medical treatment usually require coronary angiography to be followed by either percutaneous or surgical revascularization. Percutaneous coronary revascularization using drug eluting stents has been a major revolution during the last five years for symptomatic relief of angina in symptomatic CAD and can be applied to large subsets of patients. Off-pump surgical revascularization using arterial grafts is a major advance and bypass surgery continues to remain treatment of choice in diabetics with multi-vessel CAD, left main CAD and in patients with multivessel disease and impaired ventricles. Acute coronary syndromes are usually caused by plaque rupture with resultant thrombus and present as unstable angina, non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI). It is now increasingly realized that these patients (particularly the one with high risk) are best managed in advanced cardiac care centres with facilities for cardiac catheterization laboratory, percutaneous coronary interventions and coronary bypass surgery. In both, NSTEMI and STEMI aggressive medical management involving nitrates, ACE inhibitors, beta-blockers, dual anti-platelet agents, heparin and statins are recommended. High risk patients with NSTE-ACS require use of glycoprotein IIa / IIIb inhibitors along with early invasive approach involving coronary angiography, angioplasty using drug eluting stent and in some patients bypass surgery. Early reperfusion is key to management of patients presenting with STEMI. If facilities are available, primary percutaneous coronary intervention (angioplasty with stenting) is treatment of choice for patients with STEMI. In our country, thrombolysis still remains the most frequently utilized reperfusion therapy and all efforts should be devoted to provide this therapy at the earliest. All high risk patients with STEMI (including cardiogenic shock) are best treated in higher centres and these patients should be promptly transported to such centres. Early coronary angiography is recommended for majority of patients following thrombolysis for risk stratification and further treatment. In acute coronary syndromes there is drift towards early invasive treatment and this is reflected in marked increase in cardiac care (catheterization laboratories and cardiac surgery centers) facilities throughout India. All patients with CAD require life-long supervised treatment which includes medication, control of risk factors and lifestyle modification. Avoidance of smoking, heart healthy diet, proper exercise, ideal weight management are important for all the patients. Statins, ACE inhibitors, beta-blockers, antiplatelet agents have a great role to play in treatment and prevention and these drugs should be utilized under medical supervision. It is important that the medical profession play an important role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection and management of cardiac disorders. The American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), Society for Cardiovascular Angiography and Interventions (SCAI) and several other societies engage in production of guidelines in the area of cardiovascular diseases from time to time. These guidelines attempt to define practices that meet the needs of most patients in most circumstances. The aim of the guidelines is to improve the patient care. The ultimate judgement regarding the care of the particular patient is to be made by the clinician / healthcare provider keeping in mind all the circumstances. The incidence and prevalence of coronary artery disease (CAD) has increased tremendously in India during the last two decades and this change is largely attributable to lifestyle changes. There has also been a rapid progress in the treatment of CAD with proliferation of specialized cardiac care units, intensive care units, cardiac catheterization laboratories and facilities for bypass surgery. It is estimated that there are over 400 catheterization laboratories currently in India and nearly half of them are located in six major cities. The increase in disease and availability of facilities has resulted in a dramatic change and the focus is shifting from only medical treatment to invasive treatment. This document is an expert consensus document which has been prepared by going through the available guidelines and other relevant literature on the subject. The experts have performed a formal review of the literature and have weighed the strength of evidence for or against a particular therapy as it can be applied in Indian scenario. The consensus document deals with the management of ischemic heart disease (IHD) under following sections: 1) Stable Angina 2) Non ST Elevation Acute Coronary Syndrome (NSTE-ACS) 3) ST Elevation Acute Coronary Syndrome (STE-ACS) or Acute Myocardial Infarction (AMI).
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PMID:API expert consensus document on management of ischemic heart disease. 1721 32


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