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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Employing a new catheter and technique complete retrograde left heart catheterization was accomplished in 96 of 100 consecutive patients. These 96 patients included 37 with ischemic heart disease, 13 of 17 with isolated aortic valve deformities, 11 with isolated rheumatic mitral valve deformities, 10 with combined rheumatic aortic and mitral valve deformities, and 25 with other problems. The only failures were in 4(of 27) patients with aortic valve deformities. No untoward complications occurred. The retrograde catheterization fluoroscopy time was usually less than 2 minutes. The shortest time was 44 seconds, the longest, 6 minutes and 2 seconds. These data indicate that this new catheterization method achieves safe, reliable (when the aortic valve is not deformed), simple, and rapid complete left heart catheterization. They further indicate it may be useful in assessing patients with mitral stenosis, pulmonary hypertension, hypertrophic obstructive cardiomyopathy, and left-to-right shunt problems.
Cathet Cardiovasc Diagn 1978
PMID:New performed catheter and method for retrograde left atrial or complete left heart catheterization. 73 34

To clarify the influence of propranolol-and particularly its heart-rate effects-on myocardial ischemia, coronary hemodynamics and metabolism were studied in 15 patients utilizing a protocol to control heart rate. Ten patients had significant coronary narrowing (CAD) and 5 were normal. Systemic pressure, coronary sinus blood flow (CSBF), left ventricular oxygen utilization (LVVO2), ST Segment depression, and myocardial lactate extraction were measured before and after propranolol (10 mg IV), at rest, during pacing-induced tachycardia stress. Propranolol-related reduction in CSBF and LVVO2 at rest was reversed when heart rate was controlled in both patient groups. Propranolol failed to alter heart-rate threshold, tension-time index (TTI), CSBF, or LVVO2 at angina in the CAD patients. Likewise, ischemic-type ST depression, decreases in lactate extraction, and coronary resistance were unchanged compared to values observed during tachycardia stress before propranolol. In normal coronary patients, propranolol also produced no significant change in LVVO2 or coronary resistance when its heart rate effects were controlled. These data imply that a major coronary and metabolic influence of propranolol relates to changes occurring secondary to its influence on heart rate. Furthermore, this agent's anti-ischemic effect is not prominent during tachycardia stress suggesting that this stress test may be clinically useful in patients taking propranolol.
Cathet Cardiovasc Diagn 1977
PMID:Effects of propranolol on coronary hemodynamic and metabolic responses to tachycardia stress in patients with and without coronary disease. 83 33

The effects of isoproterenol and dopamine on regional myocardial blood flow were studied in 10 open-chest dogs after acute stenosis of the proximal circumflex coronary artery. Blood flow was determined by the radioactive microsphere technique. Isoproterenol led to a homogenous increase in blood flow in the normal myocardium. In the myocardium with compromised coronary blood flow, isoproterenol led to a relative subendocardial ischemia. This occurred despite increased aortic flow and peak left ventricular dp/dt. Dopamine also increased aortic flow and peak left ventricular dp/dt, but it did not cause regional myocardial ischemia. The findings suggest that dopamine is the preferable inotropic agent in managing low cardiac output in patients with significant coronary artery disease.
J Thorac Cardiovasc Surg 1977 Mar
PMID:The effects of isoproterenol and dopamine on regional myocardial blood flow after stenosis of circumflex coronary artery. 83 34

In summary, therefore, to effectively apply invasive methods and beneficially use data derived from these procedures, it is essential that physicians have an understanding of the pathophysiology of ischemic heart disease and power failure, and of other situations in cardiology including the management of the complex problems of the critically ill from a variety of causes. There should be an experience and proficiency in the techniques from the optimal application and use of invasive methods including direct arterial puncture and recording of arterial blood pressure, and the use of the Swan-Ganz catheter systems. This must be reinforced by continuous educational experiences and updating with the newer techiniques as they become available. All personnel concerned must have a knowledge of and respect for the complications inherent in any invasive procedure, particularly involving the vascular system. In addition, they must have the ability to translate the relative hemodynamic measurements into meaningful diagnostic and therapeutic decisions. Under these circumstances, invasive methods have a major and valuable role to play in the management of all forms of critical illness.
Cardiovasc Clin 1977
PMID:What is the role of invasive monitoring procedures in the management of the critically ill? 84 84

The tissue uptake of 3H-methylprednisolone (3H-MP) was studied in anesthetized cats during acute myocardial ischemia 1 and 2 hours after injection of 3H-MP. There was a rapid uptake of 3H-MP by many tissues. Liver, kidney, and pancreas exhibited tissue/perfusion ratios of 3 to 7, heart, lungs, and intestine about 2, spleen, adrenal, and aorta 1 to 2, and skeletal muscle and omentum less than 1. Very similar tissue uptakes occurred in cats subjected to myocardial ischemia and sham myocardial ischemia at 1 and 2 hours. Plasma clearances of 3H-MP was not significantly altered either 1 or 2 hours after the onset of myocardial ischemia. Although ischemic myocardial tissue took up less than nonischemic myocardial tissue, this region accumulated significant amounts of 3H-MP. Myocardial tissue metabolized only about 15 to 20 per cent of the 3H-MP taken up after 2 hours. These data indicate that in acute myocardial ischemia, myocardial tissue takes up large amounts of exogenously administered glucocorticoid, most of which remains in the native form during the early phase of acute myocardial infarction.
J Thorac Cardiovasc Surg 1977 Jul
PMID:Tissue uptake of 3H-methylprednisolone in acute myocardial ischemia. 87 40

Circulating blood volume, cardiac index, heart rate, and ejection rate were measured in patients with angina pectoris. The controls and the patients were divided in sub-groups of those under 45 and over 45 years of age. The investigation was carried out using the isotope method. A significant difference was observed in the value of intravascular blood volume at rest between the controls and patients with ischaemic heart disease unrelated to anginal attack. The blood volume was 5.6 litre in the control group and 6.4 litre in patients with ischaemic heart disease. Exercise tests produced further increases during attack in the blood volume of angina patients. A significant increase of blood volume after moderate exercise was also observed in patients under 45 with ischaemic heart disease but without angina. It is suggested that the increase of intravascular blood volume plays a part in the pathogenesis of angina pectoris.
Cardiovasc Res 1976 Mar
PMID:Increase of intravascular blood volume in Ischaemic heart disease. 93 84

A treadmill test with increasing "walk-work" load and continuous electrocardiographic monitoring has been used in 245 patients with intermittent claudication. It was found that many patients underestimated their walking capacity. No good correlation was obtained between the observed walking capacity and the systolic blood pressure in the toes. Pathological electrocardiograms were found at rest in 36 per cent of the patients. Additional pathological ecg-reactions indicative for ischaemic heart disease appeared during the tests in 34 percent of the patients. Around 10 per cent of the tests had to be interrupted because of threatening ecg changes.
J Cardiovasc Surg (Torino)
PMID:Continuous electrocardiography recording at examination of walking capacity in patients with intermittent claudication. 99 52

Survival in patients with ischemic heart disease is closely related to the extent of coronary artery obstruction as determined angiographically. One hundred forty-nine consecutive patients underwent coronary artery bypass surgery from November, 1971, to October, 1974. There were 2 late cardiac deaths, 1 late noncardiac death, and 1 hospital death, an operative mortality rate of 0.7 per cent and a total mortality rate of 2.7 per cent. Coronary angiograms were scored according to the method of Friesinger, Page, and Ross. Fifty-four per cent (80/149) had scores of 10 or greater. Cumulative survival was analyzed according to life-table techniques; in the 80 surgically managed patients with scores of 10 or greater, survival at 3 years was 98 per cent. Friesinger's 47 nonoperated patients with similar angiographic scores had a 3 year cumulative survival of 68 per cent. Although this study compares different groups, the surgical series was composed of older patients (mean age 52 as compared to 44 years), includes 22 patients operated on urgently for preinfarction angina pectoris, and includes 18 patients with abnormal ventricular function. These data suggest that coronary artery bypass surgery can favorably influence prognosis in patients with severe coronary artery disease.
J Thorac Cardiovasc Surg 1975 Sep
PMID:Improved survival after coronary artery surgery in patients with extensive coronary artery disease. 108 Aug 21

The ability of coronary collateral vessels to supply an adequate volume of blood to the subendocardium during the resting state and during periods of stress was studied. Regional myocardial blood flow was determined by the radioactive microsphere technique. Ameroid constricting devices were placed around the left circumflex coronary artery in 22 adult mongrel dogs. Three months later, regional myocardial blood flow was measured in a normal area of the left ventricle as well as in the area supplied entirely by coronary collateral vessels. Collateral blood flow was sufficient in the resting state to prevent myocardial ischemia distal to a gradually occluded coronary artery. However, in 10 animals (Group I) without aorta-coronary bypass grafts (ACBG), a selective underperfusion of the collateralized subendocardium occurred during periods of stress. In 12 animals (Group II), this selective underperfusion of the collateralized subendocardium with stress was abolished by placing ACBG's distal to the site of the coronary artery occlusion.
J Thorac Cardiovasc Surg 1976 Apr
PMID:Coronary collateral circulation during stress and the effects of aorta-coronary bypass grafts. 108 55

Selective coronary arteriography has become an unusually useful technique in evaluating patients with known or suspected ischemic heart disease. The contribution of F. Mason Sones in developing the technique and in emphasizing that properly performed studies in experienced hands can be done at an acceptable risk cannot be overemphasized. Although the study can give information only on the anatomical aspects of the disease, it has remarkably broadened ouo understanding of the whole spectrum of coronary arteriosclerosis and ischemic heart disease. This is related to the fact that the method has provided the opportunity to study an extraordinarily large number of patients representing virtually every clinical subset of the disease. The importance of nonanatomical factors, better prognostic information about the disease, and more complete understanding of the hemodynamic ocrrelates and mechanisms of drug action have resulted from investigative studies using coronary arteriographic methods. Because ischemic heart disease is such a complex and variable entity, it is important to stress that coronary arteriography and left ventricular angiography can provide only anatomical information, and that the method has significant but ordinarily recognizable limitations. Some of these limitations are technical and are not important considerations in experienced hands in well-run laboratories. Other problems are inherent in the anatomical complexity of the disease and the coronary circulation. Hence, appropriate emphasis on the details of the patient's history, including risk factors and age, as well as other selected clinical laboratory studiies, such as exercise electrocardiography, are important in assessing the patient's total problem. Because of these factors, the greatest value of coronary arteriography is realized when it is performed as part of a thoughtful, detailed--and highly individualized--evaluation of the patient.
Cardiovasc Clin 1975
PMID:Coronary arteriography: indications and pitfalls. 110 Feb 39


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