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

In 25 patients with ischaemic heart disease the effect of nitroglycerin [NTG] on segmental and global function of the left ventricle was assessed by means of left ventricular cineangiography. In 14 patients a segmental disturbance of contraction at rest was found; in six of them the function inproved after NTG. After NTG, the left ventricular diastolic volume, end-diastolic pressure, and systolic blood pressure decreased, the heart rate increased. The global left ventricular function did not significantly change. In patients with ischaemic heart disease NTG helps to differentiate reversible and irreversible disturbances of left ventricular contraction.
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PMID:Dynamic ventriculography in patients with ischaemic heart disease. I. Influence of nitroglycerin on left ventricular function. 9 85

Results with a new anti-angina molecule (nifedipine: Adalat) in the long-term management of 28 patients with ischaemic heart disease are presented. The effectiveness of the drug was judged outstanding on the strength of its reduction of angina outstanding on the strength of its reduction of angina crises and consumption of NTG beads. Non side-effects were noted.
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PMID:[Long-term clinical study of a new molecule (nifedipine) in ischemic cardiopathy]. 40 86

3 patients with different clinical and electrocardiographic manifestations of coronary artery spasm are discussed. All 3 patients had anginal attacks at rest. In addition, 2 of these patients, who did not have significant preexisting narrowing of their coronary arteries, also had anginal pain related to exercise. During pain, 1 patient showed ST-segment elevation, the other ST-segment depression, while the third showed ST-segment depression shortly followed by ST-elevation on the electrocardiogram. At coronary angiography, spontaneous or induced spasm of one of the major coronary arteries could be demonstrated in all 3 patients. In 2 cases, sublingual nitroglycerin failed to completely relieve the spasm. This raises the question whether a residual stenosis after NTG conclusively proves a fixed organic narrowing. It is concluded that the clinical spectrum of spasm of the coronary arteries is wider than was originally reported by Prinzmetal and coworkers. Clinical and electrocardiographic manifestations are probably dependent on the site and severity of the spasm, which may cause different degrees of myocardial ischemia.
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PMID:Variant forms of angina pectoris. 71 Apr 90

Peripheral perfusion abnormalities are considered a possible reason for myocardial ischemia in the absence of visible coronary artery stenoses. In 85 women (age: 41-58 years, mean age: 46 +/- 8) with pathological exercise ECG (precordial mapping: 50 leads), hemodynamic studies were performed without medication, after sublingual nitroglycerin (NTG, 0.8 mg), sublingual Nifedipin (N, 30 mg), and intravenous Dipyridamol (D, 0.5 mg/kg). Eighteen women showed normal coronary arteries and a normal myocardial perfusion (group I), 21 an impaired perfusion due to coronary stenoses (Group II), and 46 women a reduced perfusion without visible changes (Group III). Reference methods were measurement of pulmonary artery pressure, 201-TI-scintigraphy, and coronary angiography. In group II, enddiastolic and endsystolic left ventricular volume (EDV, ESV) as well as enddiastolic pulmonary artery pressure (pAd) were increased, the ejection fraction (EF) was reduced, and cardiac output (CO) was normal. In group III, ESV, EDV, EF, and CO were significantly reduced, while pAd increased. In group II, N led to a normalization of ESV, EDV, EF, and pAd. In group III, NTG led to a reduction of pAd and EDV, and concomitantly to a further reduction of the already low CO. In both groups the reduction of ST-segment depressions after NTG was significant. N led to a moderate reduction of pAd and ST-segment depression, but to an increase of CO in both groups. D exhibited a comparable effect in group III. In group II an increase of ST-segment changes and of pAd with unchanged CO was observed. With regard to longterm treatment of women in group III, N and D seemed to be more efficacious than nitrates due to a beneficial effect on cardiac output.
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PMID:[Differential therapy of myocardial ischemia in females]. 251 81

The diagnosis of silent ischaemic heart disease may be important in men as well as in women. However, diagnosing women by exercise ECG is limited due to the higher rate of false positive results. For improving diagnostic validity the following investigations were done. In 310 women, aged 41-63 years (mean age 47 years', revealing 'pathological' exercise ECG, further testing was performed using nitroglycerin (NTG 0.8 mg). As a reference method, pulmonary artery (PA) pressure measurement was used. As a result of NTG testing, two groups could be separated: (a) those in whom ST segment depression remained constant (N = 217, NTG negatives = 70%). Since the end-diastolic PA pressure was found normal, these results were interpreted to be false-positive. (b) NTG effected a reduction or normalization of exercise induced ST segment changes (N = 93, NTG positives = 30%). There was a correspondence with exercise inducible end-diastolic PA pressure decrease. Consequently, true positives were assumed. Analysis of angina pectoris history indicated typical chest pain in 2% of NTG negatives only, but in 16% of NTG positives. In agreement with this during exercise, angina was reported by NTG negatives in 3% of cases and by NTG positive in 17%. The rest of this group (83%) is considered having exercise induceable silent myocardial ischaemia. When checking-up after five years, exercised-induced angina could be found in 4% of NTG negatives again, but in 36% of NTG positives. It was concluded that exercise testing by additionally using nitroglycerin is a rather important approach for diagnosing myocardial ischaemia in women.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosis of silent myocardial ischemia in women. 314 36

To investigate still uncertain aspects of the diagnosis of ischemic heart disease (IHD) in women, between 1969 and 1984, repeated exercise studies were performed in 706 asymptomatic women (between the ages of 17 and 63 years). On observation of pathologic ST-segment depression of more than 0.1 mV, the exercise study was repeated after administration of 0.8 mg nitroglycerin. Pathologic ST-segment depression was seen in 310 women (44%). In 217 patients (31%), nitroglycerin had no effect (NTG negative); in 93 women (13%), there was normalization of the ST-segment changes (NTG positive). Additionally, in selected subgroups of patients, pulmonary artery pressure was measured at rest and during exercise and ECG mapping performed (n = 114); radionuclide ventriculograms (n = 64) and 201-thallium scintigrams (n = 99) were obtained and coronary angiography (n = 85) was performed. In the NTG-negative women, ejection fraction, myocardial perfusion and coronary arteries were normal. NTG-positive women had lower mean ejection fractions but still within normal limits and indications of impaired myocardial perfusion. High-grade coronary stenoses were found in 25%. No patient with pathologic ST-segment depression had mitral valve prolapse. NTG-positive women had significantly more risk factors than NTG-negative women. In the former group, pulmonary artery pressure measurements showed pathologic exercise hemodynamics, only in 25% of whom IHD with significant stenosis was found to be the cause. For this condition, differential diagnostic considerations include cardiomyopathy or small vessel disease.
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PMID:[New aspects in the diagnosis of ischemic heart disease in females]. 365 37

Haemodynamic investigations were performed in nine patients during aortic surgery for Leriche's syndrome. Most of these patients had ischaemic heart disease without cardiac failure. Fluid loading was carried out before and during aortic clamping. It was controlled according to the optimal wedge pulmonary pressure determined the day before surgery. Only six of the nine patients receive nitroglycerin (NTG : 0.2 micrograms X kg-1 X min-1) throughout the operation. Before clamping, cardiac index was improved in patients treated with NTG. During clamping, the patients not treated with NTG showed a drop in cardiac index, an increase in peripheral resistance and in left cardiac work. After declamping, there were no haemodynamic differences between the two groups. Two patients not treated with NTG developed azotaemia postoperatively; one patient developed cardiac failure requiring a dopamine perfusion during surgery. In this series, the association of optimal volume loading with a peroperative perfusion of 0.2 micrograms X kg-1 X min-1 NTG gave a good haemodynamic stability.
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PMID:[Combination of nitroglycerin and vascular loading in abdominal aorta surgery]. 641 48

A new MpH-measuring system was used to investigate the mechanism of action of intravenous NTG on pacing-induced myocardial ischemia during critical stenosis. In ten anesthetized open-chest dogs, two MpH electrodes were placed in a segment supplied by the CCA, one superficial and one deep. Atrial pacing at a rate 50 beats/min higher than baseline was instituted for a period of 10 min (Pacing I). Critical stenosis was then applied to the CCA. Three more similar periods of atrial pacing were instituted during critical stenosis. Pacing II was without any intervention, Pacing III was after the intravenous administration of a bolus of NTG, and Pacing IV was after the intravenous administration of NTG + A. NTG (metamarinol) during critical stenosis and atrial pacing did not alter preload and did not reduce afterload more than critical stenosis and atrial pacing alone. It did not significantly alter flow in the CCA measured by an electromagnetic flow meter. Consequently, the magnitude of fall in both endo- and epicardial MpH during critical stenosis and atrial pacing was no different with or without the administration of NTG. That under these conditions NTG failed to reduce the degree of myocardial ischemia suggests that the beneficial effects of NTG during fixed critical stenosis are determined primarily by its ability to reduce the determinants of myocardial oxygen demand, and not by a direct effect on the ischemic myocardium per se. The study also demonstrates for the first time a significant transmural gradient in MpH in the canine heart, even in the normal resting state.
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PMID:Lack of effect of nitroglycerin on the transmural variation of tissue pH during fixed coronary stenosis. 642 Oct 3

Twenty patients undergoing coronary artery bypass grafting under fentanyl-pancuronium anesthesia were studied. Continuous electrocardiographic (ECG) recording by a Holter Monitor was utilized to determine the incidence of ECG changes of myocardial ischemia during the precardiopulmonary bypass period and to determine the efficacy of an intravenous nitroglycerin (iv NTG) infusion for preventing ischemic ECG changes. Patients in Group 1 (n = 9) received a 0.5 microgram . kg-1 . min-1 iv NTG infusion 20 min prior to induction of anesthesia and throughout the study. Patients in Group 2 (n = 11) received placebo. A randomized double-blind protocol was employed. Anesthesia was induced with fentanyl 3 micrograms . kg-1 . min-1. After fentanyl 25 micrograms/kg and pancuronium 0.1 microgram/kg, the trachea was intubated. After fentanyl 50 micrograms/kg surgery commenced. Prior to induction of anesthesia, iv NTG caused significant decreases in mean arterial pressure and pulmonary capillary wedge pressure, whereas placebo had no effect. However, subsequent to induction of anesthesia, hemodynamics in the two groups were identical. Fifty per cent of patients developed ECG changes of myocardial ischemia during the period from induction of anesthesia to commencement of cardiopulmonary bypass. The incidence of ischemic ECG changes was virtually identical in Group 1 (5/9) and Group 2 (5/11). Ischemic ECG changes were associated with increases in heart rate, mean arterial pressure, and rate pressure product, and decreases in the endocardial viability ratio (DPTI/SPTI). Increases in pulmonary capillary wedge pressure were not associated with myocardial ischemia. Fentanyl-pancuronium anesthesia, as administered in this study, was associated with a high incidence of myocardial ischemia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Failure of intravenous nitroglycerin to prevent intraoperative myocardial ischemia during fentanyl-pancuronium anesthesia. 643 81

The peripheral venodilation, principal effect of NTG and nitrates may cause a significant reduction in pulmonary venous pressure and, therefore, improve the symptoms of pulmonary venous congestion. Hemodynamic effects o high doses of oral isosorbide dinitrate in patients with chronic heart failure (N - 13). (Formula: see text). The other mechanism by which nitrates can potentially improve cardiac performance in patients with heart failure due to obstructive coronary artery disease is by relieving myocardial ischemia which tends to improve global myocardial function. Nitroglycerin or nitrates improve systolic motion of the ischemic but viable myocardial segments improved segmental wall motion consequent on relief of regional myocardial ischemia is probably related to a decrease in the determinants in oxygen demand rather than an increase in regional myocardial blood flow. An increase in collateral blood flow, however, may be contributory. Effects of nitrates on coronary dynamics and myocardial metabolism. (Formula: see text). These findings suggest with nitrates cardiac performance improves with decreased metabolic cost.
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PMID:Hemodynamic effects of nitrates in chronic heart failure and myocardial infarction. 677 91


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