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)

The treatment of chronic ventricular arrhythmias depends on the severity and tolerance of the arrhythmia. Extrasystoles, even repetitive, in the healthy heart, are usually respected when asymptomatic or treated with betablockers in first intention when symptomatic. These drugs should also be proposed for patients with ischemic heart disease and non-sustained ventricular tachycardia, a situation in which Class I antiarrhythmics should be avoided. The prevention of sustained ventricular tachycardial may be empirical, with betablockers and/or amiodarone, or guided by the results of pharmacological tests during endocavitary electrophysiological studies.
Arch Mal Coeur Vaiss 1992 Dec
PMID:[Drug treatment of chronic ventricular arrhythmia]. 128 83

The prevention of lipid-related coronary risk by lipid lowering drugs or diet has been the object of several therapeutic trials. This meta-analysis comprises the 6 available primary prevention trials (representing 30,695 subjects). There was an overall reduction of non-lethal infarcts (-26%) and coronary events (-18%) in the treatment groups. There was a tendency to less coronary deaths (-10%), though not statistically significant, and no difference in mortality due to all causes was observed. Some questions remain unanswered about the fact that the reduced incidence of ischaemic heart disease did not affect global mortality. This fact could be explained by an inadequate duration of treatment or follow-up, to an effect limited to chronic infarction or to eventual unidentified adverse effects (the meta-analysis does not show any significant differences in mortality due to cancer or accidental death).
Arch Mal Coeur Vaiss 1992 Sep
PMID:[Meta-analysis of therapeutic trials of primary prevention in ischemic cardiopathies by hypocholesteremic treatment]. 128 86

The protection of Mediterranean populations against ischaemic heart disease has been recognised ever since the "Seven Countries" Study by Keys. It is probably related to the life style and, in particular, to the dietary habits of these populations. The Mediterranean diet is characterised by a certain frugality, a low intake of saturated animal fats contrasting with a high but reasonable intake of mono or polyunsaturated fatty acids, slow carbohydrates, fresh vegetables rich in antioxidating vitamins, fish and wine. These dietary habits have been shown to improve the lipid profile (not only lowering LDL-cholesterol but also raising the HDL-cholesterol), platelet activity and to reduce the phenomena of lipoperoxidation. The roles played by garlic and onions are controversial. Nevertheless, at pharmacological dosages, they have cholesterol lowering, fibrinolytic and antiaggregant effects. These dietary habits, which have been proved to be beneficial, should therefore be preserved in our country.
Arch Mal Coeur Vaiss 1992 Sep
PMID:[Mediterranean nutrition: a model for the world?]. 128 93

The reduction in cardiovascular mortality and morbidity observed over the last decade may be considered to be largely the result of the prevention of lipid disorders. The beneficial effects of diet and increased consumption of unsaturated fatty acids on ischaemic heart disease is a generally accepted concept. The low death rate from coronary artery disease amongst Greenland eskimos who eat a lot of fish has been confirmed by epidemiological studies of other large fish eating populations like the Japanese. The results reported by Bang and Dyerberg have been confirmed by the Zutphen study undertaken by Kromhout in the Netherlands. Fish oil act by the intermediary of the omega-3 fatty acids. Fish oil is rich in high unsaturated omega-3 fatty acids, the most important one being eicosapentaenoic (EPA) and docosahexaenoic acids (DHA). On the basis of epidemiological studies and clinical and experimental observations, it would appear that the consumption of marine polyunsaturated fatty acids has at least a preventive effect on phenomena of atherosclerosis and thrombosis. Their efficacy on the regression or stabilisation of the atheromatous plaque has not been demonstrated. The sites of action are multiple: decreased platelet aggregation; inhibition of thromboxane A2 production; reduction of triglyceride and VLDL concentration; improved blood rheology; action on the endothelium and proliferation of the intimal cells, vascular tone and vasomotricity. The importance of cardiovascular mortality and the hopes raised by clinical and epidemiological trials justify the pursuit of complementary studies on the efficacy and modes of action of marine polyunsaturated omega-3 fatty acids.
Arch Mal Coeur Vaiss 1992 Sep
PMID:[Atheroma and fish oils]. 128

The experimental demonstration of a causal relationship between serum cholesterol and coronary artery disease has been confirmed by primary prevention trials. Four trials have fulfilled the methodological criteria of this type of research. Three of them have involved lipid lowering drugs (clofibrate, cholestyramine and gemfibrozil) and the fourth a diet low in saturated fats. They were undertaken in middle aged hypercholesterolemic men and offered 9 out of 10 chances of demonstrating a significant reduction in the prevalence in ischaemic heart disease if it existed. The serum cholesterol of the treatment groups was on average 8 to 13% lower to that of the control groups. In the 4 trials, the prevalence of severe coronary events, infarction and sudden death, was significantly reduced (relative reduction of 19 to 47%). The reduction in individual risk was proportional to the reduction in serum cholesterol. In 2 trials, this reduction was related to variations in the opposite directions of the LDL and HDL cholesterol: a reduction of 1% in LDL-cholesterol reduced the risk by 2% and an increase of 1% of HDL-cholesterol reduced it by 2 to 4%. None of the trials were designed to evaluate the effect of intervention on mortality. In one of them (clofibrate), all cases of mortality were temporarily increased during the trial.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1992 Sep
PMID:[Trials of primary prevention by diet or hypolipidemic treatment]. 128 3

The aim of this study, based on the data of the MONICA register in the Haute-Garonne, was to compare the prognosis and treatment of myocardial infarction between 1986 (253 cases) and 1989 (248 cases). The clinical features of these infarcts were comparable except for the previous history of ischaemic heart disease which was less common in 1989 (34.7% in 1986, 25.9% in 1989; p < 0.05). The 28th day mortality decreased from 8.4% in 1986 to 3.6% in 1989 without attaining statistical significance. The pre-hospital management was the same during the two periods of the study, with 67.6% of patients admitted to hospital before the 6th hour. Hospital care in 1986 and 1989 consisted of 5 days in the intensive care unit and lasted 14 days. Treatment changed considerably from 1986 to 1989. There was a higher incidence of platelet antiaggregant prescriptions (47.4% in 1986 and 80% in 1989; p < 0.001), of betablocker prescriptions (30.8% in 1986 and 47% in 1989; p < 0.05) and fibrinolytics (27.8% in 1986 and 52% in 1989; p < 0.01). Invasive procedures such as coronary angiography (83.5% in 1986 and 94% in 1989; p < 0.05), coronary angioplasty (20.3% in 1986 and 53.5% in 1989; p < 0.01) were undertaken in the majority of cases. The MONICA-Toulouse project shows a reduction in mortality and an increase in the use of therapeutic methods known to be effective in the reduction of mortality in myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1992 Oct
PMID:[Comparison of prognosis and treatment of myocardial infarction in Haute-Garonne between 1986 and 1989. MONICA project, Toulouse]. 129 96

Cardiac repolarisation depends mainly on the cellular extrusion of positive electrical charge related to the potassium ion through different channels. There are many potassium channels which are responsible for repolarisation in different cardiac tissues. Prolongation or shortening of the repolarisation period may be both antiarrhythmic and proarrhythmic depending on the given experimental conditions. Different potassium channels may be opened or blocked by clinically prescribed drugs. Activators of the iK(ATP) channels may exert antiarrhythmic effects by inhibiting activity induced by prolonged repolarisation. Experimentally, they may exert a proarrhythmic effect by predisposing to arrhythmias during myocardial ischemia. However, these effects have not been clearly demonstrated clinically. Potassium channel blockers may have an antiarrhythmic effect by reducing the variability of repolarisation, by prolonging the atrial and ventricular refractory periods and by their antifibrillatory actions. Nevertheless, they may have proarrhythmic effects resulting in triggered activation under particular conditions of bradycardia and/or ischemia. Examples of these effects have been reported in man. The understanding of the relationship between potassium channels and arrhythmias is particularly complex because of the multiple factors regulating the duration of repolarisation and the effects of drugs on this duration. These factors include the activity of the autonomic nervous system, the heart rate, ischemia and acidosis and the differences in response to endocardial and epicardial tissues.
Arch Mal Coeur Vaiss 1992 Dec
PMID:[Potassium channels and arrhythmia]. 130 98

Ninety five patients with a mean age of 39 +/- 19 years, 82 of whom were symptomatic, having an accessory atrioventricular bidirectional conduction pathway (WPW syndrome: 77; "concealed": 18) were followed up for an average of 7.3 +/- 2.6 years. The objectives were to analyse: the incidence and causes of death and the possible predictive factors of death due to the WPW syndrome--the influence of medical treatment and type of medication on survival and symptoms. Of the 8 cardiac deaths, 6 seemed to be related to the WPW syndrome, a prevalence of 7.8% and an annual incidence of 1.1/1000. The main risk factors which were identified were: age 62 +/- 8 years versus 37 +/- 15 years in survivors; p < 0.02--associated organic heart disease, especially ischaemic heart disease (5/6)--the description of severe symptoms, in particular recurrent syncope--documented malignant spontaneous or induced arrhythmias (5/6)--anterograde AV conduction with an effective refractory period < or = 230 msec in 4, though it was only 270 msec in the other 2 patients, indicating that this parameter is not specific--amiodarone (6/6) did not prevent the fatal outcome in this particular group of patients. In the "benign" forms, only betablocker drugs could significantly reduce the frequency and severity of symptoms, especially when compared with Class I or IC antiarrhythmics. These results suggest that the indications of radical treatment should be widened in high risk patients, especially when elderly and with associated coronary artery disease. They also suggest that the role of betablocker drugs should be reevaluated in the so-called "benign" symptomatic forms.
Arch Mal Coeur Vaiss 1992 Nov
PMID:[Long-term outcome of a hospital series of patients with atrio-ventricular accessory pathway]. 136 71

Patients with suspected coronary artery disease are sometimes unable to exercise adequately (85% of age calculated maximal heart rate) to validate their ergometric stress test. Some groups suggest performing dipyridamole scintigraphy from the outset but then the information provided by exercise stress testing is lost. The aim of this study was to compare scintigraphies performed after exercise alone and after exercise combined with dipyridamole using a method of quantification. Thirteen patients with ischaemic heart disease without necrosis (coronary lesions greater than 75% luminal narrowing in: 7 right coronary, 10 left anterior descending, 3 left circumflex arteries and 1 left main coronary artery with 50% luminal narrowing) underwent exercise stress testing followed by Thallium imaging. One week later, the same exercise stress test was performed followed by an intravenous injection of dipyridamole and Thallium scintigraphy. The circumference of the radioactivity was traced and the surface of each segment calculated in three different short axis views, subdivided into 4 segments (anterior, lateral, inferior and septal walls). Any segment vascularised by a stenosed coronary artery was considered to be underperfused (105 segments). The ratios of the surfaces of underperfused/normal segments were compared using the two study protocols. Segments of the same wall in the 3 short axis views were grouped in the same myocardial zone. Thirty five myocardial zones were thus obtained: 25 zones were more underperfused after combining exercise and dipyridamole than after simple exercise stress (p = 0.014). The average increase in underperfusion after the combined exercise-dipyridamole was 12.4% compared with 5.5% after exercise alone (p = 0.03). Secondary effects were minimal.(ABSTRACT TRUNCATED AT 250 WORDS)
Arch Mal Coeur Vaiss 1992 Feb
PMID:[Quantitative thallium myocardial tomoscintigraphy. Value of intravenous infusion of dipyridamole after negative submaximal exercise test]. 156 21

This prospective study had two aims, to study the Doppler parameters of left ventricular systolic function with respect to heart rate, and to determine the influence of ischaemic heart disease on these variations. The Doppler indices (velocity time integral, maximum velocity and average acceleration of systolic flow in the left ventricular outflow tract) were measured and averaged over 3 beats after digitization: the measurements were repeated in 30 patients under basal conditions and after 2 minutes transoesophageal atrial pacing at 150 beats/min. These 30 patients were divided into 3 groups: group 1 control subjects with normal coronary arteries, n = 13, EF = 71 +/- 8.9%; group 2 coronary patients without myocardial infarction (greater than 70% stenosis on coronary angiography), n = 9, EF = 64.3 +/- 10.3%; group 3, coronary patients with previous infarction, n = 8, EF = 51.8 +/- 10.9% (p less than 0.0006). Variance analysis for repeated measurements showed significant decreases in velocity time integrals and maximum velocities after pacing (11.8% +/- 2.2 and 0.86 +/- 0.1 versus 18.3 +/- 2.2 and 0.91 +/- 0.1, p less than 0.0001 and p less than 0.05 respectively). This decrease was identical in the three groups. The variations observed were therefore related to the increase in heart rate and not to coronary status or left ventricular function.
Arch Mal Coeur Vaiss 1992 Feb
PMID:[Doppler parameters of systolic function and heart rate]. 156 23


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