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)

Five term and two premature newborn infants were referred for respiratory distress and congestive heart failure, and were found to have electrocardiographic Q or ST-T abnormalities suggesting ischemia. Echocardiographic and/or hemodynamic assessment excluded anatomic heart disease in six infants. In three infants, moderate or severe hemodynamic impairment within 36 hours of age was suggested by these studies. Myocardial perfusion images in all patients showed very poor myocardial uptake of thallium 201, compatible with global myocardial ischemia. Infants of similar age with myocarditis, or with congenital heart disease and congestive failure, had normal myocardial uptake. Rapid clinical improvement occurred within three to seven days. Two to five months later, all infants were well. Two had persistent electrocardiographic abnormalities but repeat thallium 201 imaging in six demonstrated almost normal myocardial uptake. These data provide further evidence that perinatal respiratory distress may be associated with myocardial dysfunction and congestive heart failure in some infants without anatomic heart disease, and suggest that myocardial dysfunction in these infants is associated with global myocardial ischemia, most of which is transient. The timing and nature of the insult causing the ischemia are unclear.
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PMID:Transient myocardial ischemia of the newborn infant demonstrated by thallium myocardial imaging. 76 22

In vivo anaphylaxis is associated with respiratory distress and cardiovascular failure. The present investigation was designed to further characterize respiratory and cardiac anaphylactic events. In guinea pigs, sensitization was produced by subcutaneous application of ovalbumin together with Freund's adjuvant. Fourteen days after sensitization, the effects of an intravenous infusion of ovalbumin were tested in the anesthetized artificially ventilated guinea pigs. The renewed application of the antigen induced an initial increase of left ventricular pressure which was followed by a rapid decrease 5 min after antigenic challenge. Enddiastolic left ventricular pressure increased within 3 min, thus indicating left ventricular pump failure. In the same time range, ECG recordings uniformly showed signs of acute myocardial ischemia. In addition, heart rate steadily decreased. All animals died within 15 min. Simultaneously with cardiac anaphylactic malfunction, severe arterial hypoxia and carbon dioxide retention occurred, revealing respiratory distress. Histamine is known as a potent bronchoconstrictor via histamine H1-receptor stimulation. Administration of H1-receptor antagonists to improve respiration may therefore provide further information on the contribution of pulmonary malfunction to anaphylactic cardiovascular shock. Therefore, additional experiments were performed with sensitized guinea pigs pretreated with the histamine H1-receptor blocker mepyramine. In these experiments the antigenic challenge induced a dissociation of cardiac and respiratory manifestation of anaphylaxis. Despite inhibition of hypoxia and carbon dioxide retention, left ventricular pump failure and occurrence of myocardial ischemia were delayed but not suppressed. It is concluded that histamine is an important mediator of anaphylactic respiratory distress. However, vasoactive anaphylactic mediators other than histamine are primarily involved in anaphylactic cardiac malfunction occurring during the later phase of systemic anaphylaxis.
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PMID:Effects of histamine H1-receptor blockade on respiratory and cardiac manifestation of systemic anaphylaxis. 168 6

A prospective study in 76 newborn with perinatal asphyxia searching for myocardial ischemia was carried out. The disease was found in 51% of the patients. With electrocardiogram, myocardial enzymes, X ray and clinical manifestations the diagnosis was elaborated. No difference in the sex was present, the mean of gestational age was 35 weeks, and with mean birth weight 2,216 g, respiratory distress was present in all the people; only 20.5% developed heart failure and two had heart murmurs; 61.5% showed cardiomegaly. The creatine kinase MB isoenzyme at twelve hours after birth was raised in most of the patients. Respiratory distress syndrome was the principal diagnosis in 38%; hypoxic ischemic encephalopathy and peri-intraventricular hemorrhage was present in 50 and 33% of the patients, respectively. Mortality rate was 33%. Also a comparative study in the infants with and without myocardial ischemia was carried out appearing significative difference in: 1. Cardiomegaly, 2. Hypoxic-ischemic encephalopathy and 3. Creatine kinase MB isoenzyme.
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PMID:[Transient myocardial ischemia in newborn babies with perinatal asphyxia (hypoxic cardiomyopathy)]. 209 33

An anaphylactic reaction in the isolated perfused heart is characterized by a drastic coronary constriction, arrhythmias, and an impairment of contractility. In vivo anaphylaxis is associated with respiratory distress and cardiovascular failure. The present investigation was designed to ascertain the electrocardiographic and cardiovascular changes during systemic hypersensitivity reactions. In addition, an attempt was made to differentiate cardiac from respiratory events. In guinea pigs, sensitization was produced by s.c. administration of ovalbumin together with Freund's adjuvant solution. Fourteen days after sensitization, the effects of an i.v. infusion of ovalbumin were tested in the anesthetized guinea pigs, which were ventilated with room air or 100% oxygen. A second administration of the antigen induced the development of cardiovascular collapse, leading to death within 12 min. Within 3 min, cardiac output decreased by 90% and end-diastolic left ventricular pressure increased significantly, indicating left ventricular pump failure. In the same time range, ECG recordings uniformly showed signs of acute myocardial ischemia. In addition, arrhythmias occurred in the form of atrioventricular block. Left ventricular contractility declined continuously within the first 4 min. Finally, after 4 min, blood pressure steadily decreased. During ventilation with room air, severe hypoxia developed, with arterial PO2 decreasing from 94 mmHg to 14 mmHg after 3 min. However, under ventilation with 100% oxygen, a dissociation between cardiac damage and respiratory distress occurred. Myocardial ischemia and signs of cardiac failure preceded the development of hypoxia by a significant time interval. It is to be concluded that cardiac damage is a primary event in anaphylactic shock. Furthermore, the electrocardiographic signs of ischemia are interpreted as a result of coronary artery spasm.
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PMID:Systemic anaphylaxis--separation of cardiac reactions from respiratory and peripheral vascular events. 221 74

Antiarrhythmic-induced hypoglycemia is an ill-defined phenomenon. Sporadic cases have been reported with disopyramide, a class IA antiarrhythmic agent. We report a case of cibenzoline-induced hypoglycemia in an elderly male with a history of ischemic heart disease, congestive heart failure, ventricular arrhythmias, and chronic obstructive pulmonary disease. Cibenzoline is a class I antiarrhythmic agent currently undergoing clinical investigation in the U.S. The initial hypoglycemic episode occurred after two years of successful treatment with cibenzoline. Blood glucose during the first hypoglycemic episode was 40 mg/dL. The hypoglycemia was associated with central nervous system depression, hyperkalemia, electrocardiographic abnormalities, and respiratory distress. Rechallenge with cibenzoline resulted in recurrence of symptoms and a blood glucose level of 21 mg/dL. A second rechallenge resulted in symptoms suggestive of hypoglycemia, but cibenzoline was discontinued before frank hypoglycemia and hyperkalemia recurred. Hypoglycemia occurred during periods of fasting, which most likely ruled out reactive-type hypoglycemia. Insulinoma was ruled out by the presence of normal fasting blood glucose and plasma insulin levels. It was concluded that this patient's hypoglycemia was secondary to cibenzoline. Hypoglycemia is a rare and sporadic adverse effect associated with antiarrhythmic therapy. However, the severity of these reactions warrants increased awareness of their occurrence in patients presenting with symptoms of hypoglycemia who are receiving disopyramide or cibenzoline.
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PMID:Cibenzoline-induced hypoglycemia. 354 36

At the Laennec Hospital in Paris, between 1976 and 1980 twenty-two children with Truncus Arteriosus Communis (TAC) underwent primary total repair during the first twenty-four months of life, according to the technique described by McGoon in 1968. All infants operated before the age of three months (group A: 7 patients) were in severe cardiac insufficiency with respiratory distress. Eleven patients (group B) were electively operated between four and nine months of age. Only four patients (group C) underwent surgical treatment after twelve months and before twenty-four months of age. The hospital mortality was very high in group A, because of the severity of the preoperative conditions. In three patients who underwent total repair at eight and eighteen months of age respectively, irreversible pulmonary hypertension (stage IV according to Edwards classification) was the cause of death. In our experience, severe postoperative myocardial ischemia was often associated with complete atrio-ventricular block (BAV): the possible causes are discussed. Furthermore, all patients, to a variable extent, had some manifestations of left ventricular (LV) insufficiency, which was always reversible after medical treatment. For several days, almost systematically, mechanical ventilation is necessary after a total repair of TAC. The result in the nine surviving patients is excellent: they had a strictly normal life, without any therapy. In conclusion, we believe that elective surgery for TAC can be performed more safely between six and nine months of age: if medical treatment cannot control heart failure, surgery must be performed urgently in order to avoid severe ventilatory disturbances. After twelve months of age, total repair is performed only if a pulmonary biopsy confirms the possibility of regression of the pulmonary vascular lesions.
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PMID:[Surgery of truncus arteriosus in the first 2 years of life. Analysis of a consecutive series of 22 patients]. 718 11

Fluorocarbons and other highly fluorinated materials offer considerable potential in diagnosis and therapeutics due to their unique physical properties, chemical inertness, capacity to transport oxygen and drugs, and ability to function as contrast agents. Applications such as hemodilution and organ preservation, cancer diagnosis and chemotherapy, x-ray imaging of the lymph nodes and magnetic resonance imaging of the GI tract, cardioplegia and reperfusion, the treatment of myocardial ischemia and respiratory distress syndrome, as well as drug delivery, all obviously require different product characteristics, calling for an array of products which may range from different neat fluorocarbons to diversely formulated emulsions, or fluorinated vesicles. Substantial progress has been made in terms of emulsion efficacy and stability. Stable, ready-to-use, concentrated, though fluid, injectable emulsions have now been developed. Small doses of such emulsions were demonstrated to be highly efficient in tissue oxygenation. Commercial-scale manufacturing including heat sterilization of these emulsions have been achieved. Some of the side-effects, which generally relate to the normal response of the organism to injected particles, have been reduced, and their mechanism determined. Further efforts will undoubtedly be devoted to understanding and adjusting emulsion properties for optimal efficacy in each identified application and to maximizing benefit vs side-effect ratio. Our ability to modulate in vivo recognition, intravascular persistence and subsequent biodistribution of fluorocarbon droplets, vesicles and other particulate matter in the organism is still in its infancy. Proper control of these characteristics would further extend the potential of such products for medical uses. It is essential that no effort be spared to increase our general understanding of their physicochemical properties and in vivo "physiology".
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PMID:The design and development of improved fluorocarbon-based products for use in medicine and biology. 808 44

Over a 41-month period, 1,233 "Code Blues" were retrospectively reviewed. Twenty-five codes on infants and children < 16 years of age were eliminated from the study group. The adult survivors of 1,208 codes numbered 243 (20.1%). Clinical chart review revealed that 49 (4.0%) did not involve cardiopulmonary resuscitation (CPR) or intubation and were "non-codes." Of the remaining 1,159 codes, there were 194 (16.7%) survivors. Of these survivors, 102 (52.5%) were patients with respiratory distress or failure and required intubation only. No CPR was needed. Thus, only the remaining 92 survivors of the 1,057 codes were cardiac cases for which CPR was appropriate (8.7% survival). Ventricular tachycardia and fibrillation, promptly defibrillated, was the most important rhythm factor for survival. Underlying ischemic heart disease (acute myocardial infarction and chronic ischemic heart disease with arrhythmia) was the most common underlying disease entity among the survivors. CPR performed in the group of patients unlikely to survive was expensive.
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PMID:The misuse of cardiopulmonary resuscitation. 848 27

The aim of this study was to assess the contribution of bronchoalveolar lavage (BAL) in the diagnosis of fat embolism syndrome (FES). The presence of fat droplets in alveolar macrophages was addressed in 13 trauma patients with bone fractures and 10 non-trauma patients with acute respiratory distress syndrome (ARDS). The control group was composed of 5 anesthesized patients with ischemic heart disease, immediately prior to cardiac surgery. Two patients with suggestive clinical and laboratory signs of FES had 40% and 24% fat-containing alveolar cells, respectively. The trauma patients without signs of FES displayed a wide variation in the percentage of fat-containing macrophages (from 3% to 95%). Most of the patients with ARDS who were receiving lipid emulsion as part of their parenteral nutrition, had a high percentage (> 85%) of fat-containing macrophages. Patients with normal lungs had no fat-containing macrophages. Our findings suggest that BAL Oil Red O-positive macrophages are frequently observed in trauma patients irrespective of the presence of FES. Therefore, estimation of the percentage of fat-containing macrophages from BAL is an unreliable marker of FES.
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PMID:Alveolar macrophages fat stain in early diagnosis of fat embolism syndrome. 939 38

Leukotoxin (Lx), an epoxide derivative of linoleic acid, has been suggested to be a toxic mediator of multiple organ failure in burn patients and of acute respiratory distress syndrome. Lx production was recently shown during myocardial ischemia/reperfusion. However, a recent study suggested that to be toxic Lx must be metabolized to Lx-diol. In the present study, isolated adult rat ventricular myocytes were studied with the whole-cell patch-clamp technique to determine the effects of these compounds on cardiac electrical activity. Measurements of action potentials showed that neither linoleic acid nor Lx (100 microM) caused any significant changes in action potential properties. However, Lx-diol in the range of 10-100 microM produced a dose dependent increase in duration and a decrease in overshoot of the action potential. Subsequent voltage clamp experiments isolating Na current (INa) and transient outward K current (Ito) revealed that Lx-diol inhibited INa and Ito by about 80% at 100 microM, while linoleic acid and Lx had no effect on these currents at the same concentration. While Lx-diol produced the same inhibition of INa and Ito at 100 microM, its effects were more potent on Ito with significant inhibition at 10 microM. Lx-diol also hastened the activation kinetics of Ito but not INa. The action of Lx-diol was rapid (reaching steady state in 3-5 min) and was reversible in 5-10 min following washout. Thus, Lx-diol could favor arrhythmias or cardiac arrest in intact heart and may be responsible for the cardiac problems seen in systemic inflammatory response syndrome. These results further support the suggestion that Lx is not toxic in the heart but rather must be metabolized to Lx-diol to produce toxic effects on cardiac muscle.
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PMID:Effects of linoleic acid metabolites on electrical activity in adult rat ventricular myocytes. 1036 78


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