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)

In a number of cardiac conditions (acute myocardial infarction, chronic left ventricular aneurysm, dilated cardiomyopathy, infective endocarditis and atrial fibrillation in the absence of valvular disease), the risk of embolism gives cause for concern. Although anticoagulation with warfarin (Coumadin)-derivatives has been shown to be effective in some of these situations, there is no evidence regarding the role of antiplatelet agents. The common factor in the thromboembolic potential of acute myocardial infarction, chronic left ventricular aneurysm and dilated cardiomyopathy is mural thrombus. This can be detected by two-dimensional echocardiography and indium-111 platelet scintigraphy. Although of value in elucidating the natural history of mural thrombus, in most cases, management is not substantially aided by these investigations. In patients with extensive myocardial infarction, particularly anterior infarction, moderate intensity anticoagulation started soon after hospital admission reduces the rate of embolism. After 8 to 12 weeks, embolic risk is low so that anticoagulants can usually be discontinued. Patients with chronic left ventricular aneurysm have a low incidence of embolism; anticoagulation is, therefore, inappropriate. Dilated cardiomyopathy is associated with a high risk of embolism; moderate intensity anticoagulation may be advisable in many such cases. Little information is available regarding the incidence of thromboembolism or the role of antithrombotic therapy in the patient with a diffusely dilated left ventricle due to ischemic heart disease. In native valve infective endocarditis, the risk of hemorrhage is high, and the efficacy of conventional anticoagulants unclear; thus, anticoagulation should not be instituted for the cardiac condition as such. However, in prosthetic valve endocarditis, the risk of embolism seems to be very high, and anticoagulant therapy should be continued, but with great care because there is a substantial risk of cerebral hemorrhage. Atrial fibrillation in patients with valvular heart disease is dealt with in a previous review. Patients with nonvalvular atrial fibrillation are at varying risk of embolism, depending on the etiology of the arrhythmia; trials of antithrombotic therapy are needed for the various subsets of patients. In most elderly patients, the etiology is not known, and their stroke risk is high. The risk of embolism in younger patients with idiopathic atrial fibrillation is so low as to make any antithrombotic therapy unnecessary.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Thrombosis and embolism from cardiac chambers and infected valves. 353 72

The choice of conduit is the most important factor influencing long-term patency of coronary artery bypass grafts (CABGs); arterial grafts are far superior to saphenous vein bypass grafts (SVGs) in this regard. Aspirin therapy should be started early in the perioperative period and continued indefinitely. Warfarin (Coumadin; Dupont, Wilmington, DE) and other platelet inhibitors offer no added value to aspirin, but may be used with benefit in aspirin-intolerant patients. Every effort should be made to reduce low-density lipoprotein cholesterol (LDL-C) to a value well below 100 mg/dL. In most instances, this will require the use of an 3-hydroxy-3-methyglutaryl coenzyme A (HMG CoA) reductase inhibitor. Avoidance of cigarette smoking is imperative. Achieving a normal blood pressure, ideal body weight, and a regular exercise program are helpful. Those patients who have important obstruction in a SVG or arterial graft and who are symptomatic, or who have important myocardial ischemia with orjwithout symptoms should be treated with a procedure to improve perfusion to the myocardium supplied by the occluded bypass graft. Successful percutaneous transluminal coronary angioplasty (PTCA) and stenting of the obstructed graft usually will lead to improved myocardial perfusion, although in other clinical circumstances repeat CABG surgery will be required. On occasion, reperfusion of the myocardium can be achieved by PTCA of the native coronary artery with or without stenting while the degenerated graft is abandoned. When planning therapy for myocardial ischemia, the higher rate of PTCA related restenosis and the increased risks from repeat CABG must be carefully considered.
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PMID:Coronary Artery Bypass Graft Degenerative Disease. 1113 89