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)

Coronary artery anomaly has been reported at a rate of 0.6% to 1.3% in routine angiographic series. Moreover, single coronary artery is one of the rarest anomalies among coronary anomalies. Eventhough patients with coronary anomalies are usually asymptomatic, they may also be associated with myocardial ischemia, ventricular fibrillation, syncope, congestive heart failure, and sudden death. In this article, we report a case of single coronary artery anomaly with the left anterior descending (LAD) and left circumflex (LCx) coronary artery arising separately from the proximal right coronary artery. Since the presented case was associated with ischemic heart disease, coronary artery bypass grafting was carried out. He is currently well.
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PMID:Anomalous LAD and CX artery arising separately from the proximal right coronary artery--a case report of single coronary artery with coronary artery disease. 1668 72

The main manifestations of cardiac diseases are dyspnea, chest pain, palpitations, giddiness and syncope. A careful evaluation of subjective symptoms during history taking allows a rapid identification of an ischaemic heart disease, heart failure or cardiac arrhythmias. The additional clinical findings during bedside examination by inspection of the jugular veins, palpation of cardiac impulses and auscultation of heart sounds and murmurs are often sufficient to diagnose most of the frequent underlying disorders, such as valvular diseases, heart failure or pulmonary hypertension. The clinical assessment remains essential to select the most appropriate additional tests, such as echocardiography, scintigraphy, computer tomography or coronarography. Systematic teaching of the clinical skills should remain a central element in the formation of medical students and clinical fellows.
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PMID:[The clinical examination in cardiology]. 1690 Jul 24

Long QT syndrome (LQTS) can be asymptomatic-identifiable as an incidental finding on electrocardiogram-or it can present with palpitation, syncope, seizures, or sudden cardiac death. LQTS is characterized by a prolonged QT interval, which can be associated with a specific form of polymorphic ventricular tachycardia known as torsade de pointes. Other electrocardiogram changes in LQTS include T-wave abnormalities, particularly bifid T waves, U waves, and T-wave alternans. The precipitating factors of LQTS include electrolyte abnormalities, bradyarrhythmias, medications (such as antiarrhythmic drugs, antibiotics, antipsychotics, and antihistamines), and myocardial ischemia. The authors report a case of LQTS in a 47-year-old woman with no other significant cardiac history.
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PMID:Congenital long QT syndrome. 1709 73

Exercise stress testing is an important diagnostic tool for the evaluation of suspected or known cardiac disease. In 2002, the American College of Cardiology (ACC) and the American Heart Association (AHA) revised their guidelines for exercise testing. Ten categories from the ACC/ AHA 1997 guidelines were modified: ST heart rate adjustment, unstable angina, older patients, acute coronary syndromes, chest pain centers, acute myocardial infarction, asymptomatic patients, valvular heart disease, rhythm disturbances, and hypertension. Adjustment of the ST heart rate can identify myocardial ischemia in asymptomatic patients with elevated cardiac risk. Intermediate- and low-risk patients with unstable angina, acute coronary syndromes, or chest pain should undergo exercise stress testing when clinically stable. Provided they are stable, patients who have had acute myocardial infarction can undergo a submaximal exercise test before discharge or a symptom-limited exercise stress test any time after two to three weeks have elapsed. In asymptomatic patients with cardiac risk factors, the exercise stress test may provide valuable prognostic information. Aortic regurgitation is the only valvular heart disorder in which there is significant evidence that exercise stress testing is useful in management decisions. The stress test also can be used in older patients to identify the presence of coronary artery disease. However, because of other comorbidities, a pharmacologic stress test may be necessary. Exercise stress testing can help physicians successfully evaluate arrhythmia in patients with syncope. The exercise stress test also can help identify patients at risk of developing hypertension if they show an abnormal hypertensive response to exercise.
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PMID:Update on exercise stress testing. 1713 6

Syncope is defined as transient loss of consciousness as a result of inadequate cerebral perfusion. The causes of syncope fall into five broad categories: neurally mediated, orthostatic (the most frequent causes), cardiac arrhythmias, structural cardiovascular (relatively uncommon cause), and cerebrovascular (very rare). The initial evaluation of the syncope patient includes a detailed medical history and physical exam, and usually an ECG and echocardiogram. Thereafter, selected additional testing (e.g. ambulatory ECG recording, autonomic function testing, electrophysiologic study) may be needed on a case-by-case basis. Neurally mediated and orthostatic syncope should first be treated by conservative therapies including hydration/volume expanders and physical counter-maneuvers. Various drugs may play a role as second-line of treatment. However, apart from midodrine, randomized studies of drug therapy are largely lacking, and most agents have not proved to be predictably effective. For syncope due to cardiac arrhythmias, treatment options (depending on the specific circumstance) include ablation of the arrhythmia origin, antiarrhythmic drugs, and/or implantable devices (pacemakers and defibrillators). In the case of syncope due to structural cardiovascular defects (e.g. acute myocardial ischemia, pulmonary hypertension, obstructive cardiomyopathy), treatment is aimed at ameliorating the underlying structural defect. In brief, establishing a specific cause(s) for syncope is crucial. Only then can a potentially effective treatment strategy be contemplated.
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PMID:Current management of syncope : focus on drug therapy. 1807 7

Coronary artery spasm can cause both brady- and tachyarrhythmia, through induction of AV block (usually linked to coronary spasm of the right coronary artery) or ventricular tachycardia/fibrillation linked to extensive myocardial ischemia. The electrocardiographic aspect of coronary artery spasm is an ST segment elevation. We describe the case of patient implanted with an implantable cardioverter defibrillator (ICD) for unexplained syncope which, during coronary artery spasm, received an inappropriate device firing due to ST segment elevation, leading to a double count of the QRS by the ICD.
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PMID:Coronary artery spasm as a cause of ST elevation and inappropriate implantable cardioverter defibrillator intervention. 1816 21

Syncope is a very common problem during childhood presenting to emergency departments. It generates a great deal of anxiety among children and their parents because of the fear that syncope are at risk for sudden death. Neurocardiogenic (vaso-vagal) syncope are the most common, while cardiac type are rare. The vaso-vagal syncope are secondary to irregularities in an autonomic reflex resulting in an abnormal relaxation of the blood vessels. This is non-life threatening form of syncope in differ cardiac type that can be very dangerous. In cardiac syncope causes can be secondary to obstruction to blood flow (Tetralogy of Fallot, cardiomyopathies, aortic stenosis), heart rhythm abnormalities (WPW, L-QTS, A-V block) as well as ischemic heart disease secondary to an anomalous coronary artery. The cardiac syncope are rare (6%) but the most inconvenient because they can be life-threatening.
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PMID:[Syncope in children]. 1843 22

We investigated the prognostic value of normal adenosine stress cardiac magnetic resonance (CMR) in suspected coronary artery disease (CAD). Prospectively enrolled in the study were 218 patients with suspected CAD, no stress hypoperfusion, and no delayed enhancement in CMR, and consecutively deferred coronary angiography. The primary end point was a 12-month rate of major adverse cardiac events (MACE; cardiovascular mortality, myocardial infarction, revascularization, hospitalization due to cardiovascular event). CMR indication was symptomatic angina (Canadian Cardiovascular Society II in 42% and III in 7%) or evaluation of myocardial ischemia in patients with arrhythmia, syncope, and/or equivocal stress tests and cardiovascular risk factors (51%). As the main result, the 12-month MACE rate was 2/218 (1 stent implantation, 1 bypass surgery) and CMR negative predictive value 99.1%. There was no cardiac death or myocardial infarction. In conclusion, normal adenosine stress CMR predicts a very low MACE rate and an excellent 1-year prognosis in patients with suspected CAD. Our results provide clinical reassurance that patients at risk for CAD-associated MACE were not missed by CMR. Hence, CMR may serve as a reliable noninvasive gatekeeper to reduce the number of redundant coronary angiographies.
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PMID:Prognostic value of normal adenosine-stress cardiac magnetic resonance imaging. 1847 50

Syncope and pre-syncope represent common symptoms in patients with hypertrophic cardiomyopathy. The clinical scenario of recurrent and frequent syncopal episodes is one of the most challenging in the management of patients with hypertrophic cardiomyopathy. Syncope in hypertrophic cardiomyopathy patients usually recognizes two underlying mechanisms: arrhythmias or primary hemodynamic mechanism. The concomitant presence of myocardial ischemia is one of the potential triggers in the context of syncope due to hemodynamic mechanism. Myocardial ischemia is not generally related to epicardial coronary artery atherosclerotic disease but rather to the presence of partially obliterated intramural coronary arteries or narrowed vessels. We report the rare case of a patient with hypertrophic cardiomyopathy presenting with recurrent syncopal episodes due to myocardial ischemia secondary to severe stenosis of the left anterior descending coronary artery.
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PMID:[An unusual cause of syncope in hypertrophic cardiomyopathy]. 1854 97

Atrial fibrillation (AF) is associated with a higher incidence of mortality, stroke, and coronary events than is sinus rhythm. AF with a rapid ventricular rate may cause a tachycardia-related cardiomyopathy. Immediate direct-current cardioversion should be performed in patients with AF and acute myocardial infarction, chest pain due to myocardial ischemia, hypotension, severe heart failure, or syncope. Intravenous beta blockers, verapamil, or diltiazem may be given to immediately slow a very rapid ventricular rate in AF. An oral beta blocker, verapamil, or diltiazem should be used in persons with AF if a fast ventricular rate occurs at rest or during exercise despite digoxin. Amiodarone may be used in selected patients with symptomatic life-threatening AF refractory to other drugs. Digoxin should not be used to treat patients with paroxysmal AF. Nonpharmacologic therapies should be used in patients with symptomatic AF in whom a rapid ventricular rate cannot be slowed by drugs. This is part 1 of a 2-part review of the etiology, pathophysiology, and treatment of atrial fibrillation. The second part will be published in the subsequent issue of Cardiology in Review.
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PMID:Etiology, pathophysiology, and treatment of atrial fibrillation: part 1. 1856 8


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