Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prospective 5-year follow-up was accomplished among males ranging in age between 50 and 59 and forming four random samples from the respective population of the Bauman region in Moscow subjected to primary cross-sectional epidemiologic survey. The results show that in primary survey general mortality and the mortality of ischemic heart disease were significantly higher among males with ischemic heart disease than among the rest of the individuals examined. The mortality of ischemic heart disease proved to be particularly high among individuals with a history of myocardial infarction (relative death risk 5.8) and among those with typical anginal pectoris (relative death risk 4.4). Ischemic heart disease mortality was lower (relative death risk 2.1) in the group of males who had suffered from silent myocardial infarction or had silent ischemic heart disease than among those who had had myocardial infarction or with angina pectoris, but higher among males who did not have these diseases. To study the prognostic value of atypical chest pain in angina pectoris, it is necessary that prospective follow-up be continued.
 ...
PMID:[Prognosis of life expectancy of patients with ischemic heart disease detected during mass screening]. 30 22

A radioimmunoassay for human myoglobin has been used to study the serum myoglobin level in 13 normal individuals and 68 patients admitted to a Coronary Care Unit because of chest pain. Values in normal individuals ranged from 3 to 75 and averaged 25 +/- 23 (SD) ng/ml. Thirty-two patients with myocardial infarction initially examined within 12 hours of the onset of chest pain all showed clear-cut elevations in serum myoglobin, peak values ranging from 200 to 5500 and averaging 1368 +/- 1357 ng/ml. Seventeen patients with clinically atypical chest pain and no subsequent evidence of myocardial necrosis had myoglobin levels in the normal range, as did 11 of 19 patients with chest pain thought clinically to represent myocardial ischemia but no subsequent evidence of myocardial necrosis by conventional criteria. The final eight patients in the latter group showed mild elevations of serum Mb, peak values ranging from 102 to 280 and averaging 162 +/- 52 ng/ml; the basis for these elevations remains to be clarified.
 ...
PMID:Radioimmunoassay for human myoglobin. Initial experience in patients with coronary heart disease. 56 27

Mitral leaflet prolapse syndrome has been associated with anginal chest pain, atypical chest pain, electrocardiographic abnormalities and positive stress electrocardiograms. These features overlap those of ischemic heart disease. Furthermore, coronary artery disease is frequently associated with mitral leaflet prolapse. This study evaluated the usefulness of stress myocardial scintigraphy in distinguishing these two disorders. Thirty-two patients with an angiographic diagnosis of mitral leaflet prolapse were studied. Of the 22 patients (8 men and 14 women, mean age 48 years) with a normal coronary arteriogram, 5 had "typical" angina pectoris, 6 had resting electrocardiographic abnormalities and 6 had a positive stress electrocardiogram; all 22 patients had a normal stress myocardial scintigram. Of the 10 patients (7 men and 3 women, mean age 55 years) with at least 70 percent stenosis of one coronary artery, 6 had "typical" angina pectoris, 1 had resting electrocardiographic abnormalities and 7 had a positive stress electrocardiogram. Nine of these 10 patients had one or more demonstrable perfusion defects on stress myocardial scintigrams. It is concluded that mitral leaflet prolapse syndrome is not associated with regional myocardial ischemia as demonstrated with stress scintigraphy, and that stress scintigraphy, a noninvasive technique, is useful in distinguishing the mitral prolapse syndrome from mitral prolapse associated with coronary artery disease.
 ...
PMID:Stress myocardial imaging in mitral leaflet prolapse syndrome. 70 87

The introduction of selective coronary arteriography and aorto-to-coronary saphenous vein bypass surgery (a.-c bypass) has fundamentally altered our understanding of ischemic heart disease (IHD). The indications for the effective diagnostic procedure and the results of the new and increasingly important surgical technique are summarized. Selective coronary arteriography should be performed (a) in patients with known IHD in order to furnish the anatomical and functional information necessary to assess the indication for surgery, i.e. in patients below 60 years with intractable stable or unstable (impending infarction) angina. It is rarely indicated in patients with an old myocardial infarction who are free from symptoms. It is debatable in patients during the acute stage of infarction; (b) in patients with questionable IHD, with the aim of ruling out or confirming the condition, i.e. mainly in patients with atypical chest pain or with equivocal ecg findings. The risks of the procedure, if carried out by experienced personnel, are small. Selective arteriography will always be supplemented by a selective left ventricular angiography yielding important information concerning the functional behaviour of the myocardium. In judging the therapeutic value of a.-c. bypass surgery it should be noted that postoperatively 60 to 70 percent of the patients present without symptoms and 80 to 95 percent feel markedly better, and that physical performance is enhanced in about the same proportions. An improvement in left ventricular function under exercise conditions seems to be rare. Hospital mortality of a.-c. bypass operation is small and below 5 percent if patients with stable angina and without myocardial failure, previous infarctions or mitral regurgitation are considered. In the presence of an ischemic cardiomyopathy, on the other hand, the mere surgical risk soon reaches prohibitive limits. The incidence of early complicating myocardial infarctions ranges around 10 percent. Bypass occlusion occurs in some 5 to 15 percent during the early postoperative phase, while in the following months and years the patency rate diminishes but little. If the survival rates of operated and non-operated patients with IHD are compared it becomes evident that a prolongation of life is possible whenever surgery aims at a correction of two- and three-vessel disease (including the prognostically unfavourable isolated stenosis of the left anterior descending branch and stenosis of left main artery) whereas the natural course of isolated lesions of the right coronary artery and the left circumflex branch seems to balance the effect of corresponding surgical interventions. It should be borne in mind, however, that the follow-up periods on which these statements are based do not exceed 3-4 years.
 ...
PMID:[Problems of aortocoronary bypass. Indications for coronary angiography and ventriculography; results of direct bypassing coronary surgery]. 107 91

The operating characteristics of thallium stress testing for detection of significant epicardial coronary artery disease (CAD) in hypertensive subjects with chest pain or electrocardiographic (ECG) ischemia have not been previously defined. This becomes important because of the high prevalence of both hypertensive heart disease and CAD. Ninety-two hypertensives with a history of typical or atypical chest pain or ECG myocardial ischemia underwent coronary arteriography, 2D-guided echocardiography, and thallium-201 stress testing, combined with intravenous dipyridamole if the rate-pressure product was less than 20,000. Patients with myocardial infarction, prior revascularization procedure, valvular heart disease, and chronic ethanol abuse were excluded. The mean age was 54.8 +/- 9.9 years with 55% blacks and 46% women. Eighteen patients (19.6%) had significant (greater than or equal to 50% luminal diameter narrowing) epicardial CAD at catheterization, of whom 17 had positive thallium scans. Overall, there were 17 true positives, 47 true negatives, 27 false positives, and one false negative resulting in 94.4 +/- 5.4% sensitivity (95% confidence limits [95% CL] 71 to 100%), 63.5 +/- 5.6% specificity (95% CL 51 to 74%), 38.6 +/- 7.3% positive predictive value (95% CL 25 to 54%), 97.9 +/- 2.1% negative predictive value (95% CL 88 to 100%), and 69.6 +/- 4.8% overall accuracy (95% CL 59 to 79%). For hypertensive patients with chest pain or ECG myocardial ischemia, the high sensitivity and negative predictive value and low false negative rate support the role of thallium stress testing +/- dipyridamole as an exclusion test for significant CAD.
 ...
PMID:A negative thallium (+/- dipyridamole) stress test excludes significant obstructive epicardial coronary artery disease in hypertensive patients. 153 15

Stress radionuclide studies were performed in a patient with angiographically proven multiple coronary-pulmonary fistulas, in the presence of atypical chest pain. MIBI scintigraphy showed no myocardial perfusion defects. Multigated ventriculography showed an ejection fraction of 68% and 80% at rest and following exercise, respectively. Three separate fistulas were present between each coronary artery and the pulmonary trunk. The Qp:Qs ratio was 1.3. In the presence of atypical chest pain, stress MIBI scintigraphy and multigated ventriculography both failed to reveal myocardial ischemia in a 49-year-old patient with multiple coronary-pulmonary fistulas. She is using no medication, but advice concerning endocarditis prophylaxis was given.
 ...
PMID:Stress MIBI scintigraphy in multiple coronary-pulmonary fistula: failure to demonstrate "steal" phenomenon. 157 49

The coronary vasomotor responses to selective infusion of graded concentrations (10(-6) to 10(-4) M) of acetylcholine into the left anterior descending artery were assessed by quantitative coronary arteriography in 24 patients with normal coronary arteriograms (12 patients with atypical symptoms and 12 patients with typical anginal pain) and 36 patients with coronary artery disease with different degrees of atherosclerosis of the left anterior descending artery. In the patients with normal coronary arteries and atypical chest pain, acetylcholine induced predominantly a vasodilator response, which was maximal during a 10(-5) M acetylcholine infusion. In contrast, in patients with coronary artery disease, acetylcholine caused dose-dependent vasoconstriction, which was observed even if the left anterior descending artery itself was smooth. Marked vasoconstriction was also induced in the patients with typical anginal pain and angiographically normal coronary arteries. In nine of these patients, this constrictor response was associated with anginal pain and electrocardiographic evidence of myocardial ischemia. Intracoronary administration of isosorbide dinitrate (1 mg) relieved the anginal pain and dilated all vessels. These data suggest that 1) patients with normal coronary arteriograms and angina pectoris manifest impairment of endothelium-dependent vasodilation similar to that observed in patients with overt coronary atherosclerosis; and 2) abnormal coronary vasoconstrictor responses resulting from this impairment may contribute to the pathogenesis of myocardial ischemia and angina in these patients.
 ...
PMID:Impaired endothelium-dependent cholinergic coronary vasodilation in patients with angina and normal coronary arteriograms. 172 42

To diagnose myocardial ischemia and differentiate the chest pain syndrome in 20 females with coronary heart disease and effort angina pectoris, exercise test and ECG monitoring were performed. Their results were then compared. The informative value of 24-hour ECG monitoring was higher than that of bicycle ergometry in detecting the objective signs of ischemia in patients with effort angina. The indisputable advantage of long-term ECG recording is that one can identify silent ischemia in females with routine physical activity in the outpatient settings. The method of 24-hour ECG monitoring cannot be considered to be sufficiently effective in the differential diagnosis of the atypical chest pain syndrome.
 ...
PMID:[Comparison of exercise test and ECG monitoring results in women with ischemic heart disease]. 204 Dec 82

In patients with coronary artery disease, electrocardiographic signs of left atrial enlargement (LAE-negative P wave deflection greater than or equal to 1 mm2 in lead V1) are associated with increased left ventricular end diastolic pressure (LVEDP). We investigated the possibility that transient LAE could represent an additional criterion for diagnosing myocardial ischemia during exercise testing (EST). We studied 48 consecutive patients with chronic stable angina, positive EST and 201 Tl scintigraphy, and angiographically proven CAD; 200 other consecutive patients with atypical chest pain and normal stress/rest 201 Tl scintigraphy served as controls. During EST, transient LAE developed in 34/48 patients with CAD but in only 1/200 controls (p less than 0.001). When present, LAE preceded ST changes (6.1 +/- 1 min vs 8.2 +/- 2 min) and recovered earlier (4.7 +/- 4 min vs 5.8 +/- 3 min). The prevalence of 2-3 vessel CAD was significantly higher in patients with EST-induced LAE (54% vs 34%, p less than 0.05). In conclusion, transient ECG signs of LAE during EST represent a highly specific sign of reversible ischemia and are frequently associated with multivessel CAD. Although less sensitive than classical ST criteria, this sign may prove useful in patients exhibiting equivocal ST changes and in the presence of ventricular conduction disturbances.
 ...
PMID:[Left atrial enlargement during the exercise test: a new electrocardiographic sign of transitory ischemia]. 215 Mar 44

In recent years, radionuclide studies have gained an important place in the evaluation of ischemic heart disease, be it as diagnostic procedures, as predictors of prognosis or for evaluation of therapy. For diagnostic purposes, myocardial perfusion studies using thallium-201 or newer technetium-99m bound perfusion agents have been used as well as radionuclide angiocardiography both at rest and during exercise/stress. Used in a Bayesian approach, these methods yield the highest diagnostic accuracy in patients with a 30% to 70% pre-test likelihood of disease, i.e. in the clinically difficult patients with atypical chest pain and/or non-specific ECG changes. In addition, scintigraphic studies have proved valuable in the setting of silent ischemia and acute myocardial infarction. These methods provide not only a yes/no answer to our diagnostic questions but allow one to assess severity, extent and localization of coronary artery disease. Portable devices are now being constructed which allow continuous ambulatory monitoring of left ventricular function by scintigraphic techniques.
 ...
PMID:Radionuclide studies in the evaluation of ischemic heart disease. 218 64


1 2 3 4 5 6 Next >>