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)

Postmortem coronary angiography was undertaken in 230 hospital deaths from all causes. X-rays before and after decalcification of the intact coronary arterial tree were assessed with regard to the degree and morphology of arterial lesions and extent of calcification. These angiographic appearances were correlated with histological sections following routine paraffin embedding and serial sectioning where appropriate. Stable but patent lesions, characterized histologically by an intact plaque cap and no intraluminal thrombus formation, angiographically revealed a smooth interface between the barium and vessel wall with no filling defect and often an hour-glass configuration. In contrast, patent unstable lesions, characterized histologically by plaque fissuring and intra-intimal or intraluminal thrombus formation, showed an irregular interface angiographically, often with irregular filling defects. Similarly, distinction between an old stable occlusion and a recent thrombotic occlusion could be made angiographically on the basis of smooth or irregular interfaces between barium and vessel wall. Various angiographic appearances are interpreted in the light of the histological morphology encountered and it is concluded that postmortem coronary angiography is an accurate, rapid and invaluable technique in the autopsy investigation of ischemic heart disease and sudden death.
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PMID:The postmortem detection of coronary artery lesions using coronary arteriography. 157 68

R 56865 is an experimental compound that has been shown to ameliorate the effects of cardiac glycoside toxicity and myocardial ischemia. We evaluated the direct electrophysiological effects of R 56865 and its effects on the electrophysiological sequelae of ouabain toxicity in vivo and in vitro. In normal anesthetized dogs, R 56865 alone at doses of 0.04 to 0.16 mg/kg i.v. had no effect on atrial, AV nodal, or ventricular conduction times and refractoriness, but at doses of 0.64 to 2.5 mg/kg it tended to increase these parameters. In ouabain-pretreated dogs, R 56865 (0.08 to 0.32 mg/kg i.v.) dose-relatedly reduced ouabain-induced ventricular arrhythmias. In normal isolated canine Purkinje fibers, R 56865 (1-10 microM) reduced Vmax at short pacing cycle lengths and decreased the action potential duration at concentrations of 0.1 to 10 microM. R 56865 at concentrations through 10 microM had no significant effect on normal action potentials of canine ventricular muscle and slow response action potentials in guinea pig papillary muscles. In Purkinje fibers exposed to toxic concentrations of ouabain, R 56865 (1 microM) reduced the delayed after depolarization (DAD) amplitude and inhibited triggered activity. R 56865 had no effect on normal automaticity in canine Purkinje fibers at 1 microM, but 10 microM significantly slowed it. R 56865 at 10 microM did not affect isoproterenol-enhanced automaticity and only slightly reduced barium-induced abnormal automaticity that occurred at reduced membrane potentials. These results demonstrate that R 56865 reverses cardiac glycoside-induced arrhythmias in anesthetized dogs at doses that do not significantly affect conduction or refractoriness. Suppression of ouabain-induced DAD and triggered activity in isolated Purkinje fibers, at concentrations not affecting normal or abnormal automaticity, may be the mechanism of R 56865's antiarrhythmic actions in vivo. Suppression of DAD does not appear to be associated with blockade of voltage-dependent calcium channels, but R 56865 may prevent intracellular sodium overload by limiting excessive sodium entry during ouabain intoxication.
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PMID:Investigation of electrophysiologic mechanisms for the antiarrhythmic actions of R 56865 in cardiac glycoside toxicity. 172 Aug 42

Thrombin stimulates phosphoinositide hydrolysis and increases cytosolic calcium in several types of cells. To determine whether thrombin exerts similar stimulatory actions in the heart and whether this mechanism is linked to changes in cardiac electrical activity, the effects of thrombin on several biochemical and electrophysiological parameters were examined. In neonatal rat ventricular myocyte cultures freed of fibroblast contamination by irradiation, thrombin rapidly induced the breakdown of phosphoinositides. Formation of inositol trisphosphate was detectable within 5 seconds and was followed by the sequential accumulation of inositol bisphosphate and inositol monophosphate. The effect of thrombin to stimulate phosphoinositide hydrolysis was inhibited by hirudin, but not by propranolol, prazosin, or pretreatment with pertussis toxin. The inositol phospholipid response was unassociated with changes in intracellular cAMP levels. To determine the electrophysiological effects of thrombin, we used microelectrode techniques to study canine Purkinje fibers. Thrombin increased the beating rate of fibers depolarized using barium, but not those at normal maximal diastolic potential. In addition, thrombin prolonged the action potential duration in fibers driven at a constant cycle length. This response was inhibited by hirudin and nisoldipine, but not by propranolol, prazosin, or pretreatment with pertussis toxin. Thrombin also augmented cesium-induced early afterdepolarizations. Using the fluorescent calcium indicator fura-2, we demonstrated that thrombin increased the beating rate, diastolic calcium, and peak systolic calcium of spontaneously contracting cultured ventricular myocytes. Cytosolic calcium also increased in both rat ventricular myocytes and canine Purkinje myocytes that were electrically driven at a constant basic cycle length, indicating that thrombin modulates cellular calcium metabolism independent of its actions to enhance automaticity. Taken together, these findings demonstrate several novel biological actions of thrombin in the mammalian heart that may be functionally related. The actions of thrombin to enhance automaticity and prolong repolarization may contribute to the electrical abnormalities observed in the setting of myocardial ischemia and infarction.
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PMID:Thrombin modulates phosphoinositide metabolism, cytosolic calcium, and impulse initiation in the heart. 185 Mar 29

The ability of the rhesus monkey to form coronary collaterals was tested in ten animals. Ameroid constrictors were implanted on the left circumflex coronary artery and allowed to remain for 12 weeks. One animal died of an acute myocardial infarction nine days after surgery; the remaining animals survived without clinical signs referable to myocardial ischemia. The hearts were excised at 12 weeks postsurgery for perfusion fixation and coronary vascular injection with barium-gelatin. All hearts exhibited infarction scars in the circumflex-perfused regions, with infarcts varying from a transmural scar to cases with a thin margin of surviving myocardium at the epicardial surface. Coronary collaterals were infrequent and small in size, and particularly evident in the atria. We conclude that the rhesus monkey is unable to develop sufficient coronary collateral blood flow to prevent myocardial infarction after gradual, total coronary occlusion with ameroid constrictors.
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PMID:Coronary collateral development in the rhesus monkey (Macaca mulatta). 665 40

Angina-like chest pain frequently arises from the esophagus. However, when a patient has chest pain, the gravity of possible myocardial ischemia indicates that a cardiac workup must be done. Those individuals with typical anginal pain who have normal multistage exercise tests or normal coronary arteriograms and any person with atypical chest pain should be thoroughly evaluated for esophageal disease. This evaluation should include a barium swallow, a Bernstein test, esophageal manometry, and, if indicated, esophagoscopy. Reproduction of the chest pain with the Bernstein test incriminates gastroesophageal reflux disease. Esophageal manometry is required to make the diagnoses of achalasis, DES, and hypertensive LES or esophageal body (Table 1).
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PMID:Chest pain: differentiating esophageal disease from angina pectoris. 716 Jan 64

An 81-year-old man with a history of chronic pulmonary disease due to heavy smoking and ischemic heart disease had been suffering for the past few years from chronic constipation and urinary incontinence and was receiving medication for cardiopulmonary symptoms and urinary incontinence. He was admitted for repeated falling for a few months prior to admission. When put in the supine position, his blood pressure fell. He had bilateral pulmonary rales, consistent with lung disease, eccentricity of the left pupil (after cataract surgery), constriction of the right pupil, and absence of the pupillary light reflex. There was generalized hyperreflexia and a bilateral Babinski sign. He had normocytic, normochromic anemia; B12, folic acid and ferritin were within normal ranges, ESR was rapid, there was hyperglobulinemia (IgA and IgG), urea nitrogen and creatinine were increased but returned to normal after rehydration. ECG and chest X-ray were consistent with his cardiopulmonary status. Bone-marrow biopsy showed hypocellularity. IVP and barium enema were normal. Echocardiography revealed a possible old posterior wall myocardial infarction. CT-scan showed moderate cerebral and cerebellar atrophy, calcifications in the carotid and vertebral arteries, and small infarcts in both hemispheres. At this point, after an extensive survey of the literature, the diagnosis of Shy-Drager syndrome was proposed and proved by monitoring ECG and serum levels of noradrenaline during postural changes. He was treated with Fluorinef and there were no more episodes of postural hypotension. Several weeks after discharge he reported that he was feeling well and had not fallen since discharge.
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PMID:[Shy-Drager syndrome]. 775 2

Using the patch clamp technique, normal and abnormal functions of cardiac ion channels were studied. The transient outward K+ current contributes to the early repolarization phase of the action potential as well as to the plateau height and total duration. The latter role is observed in at premature excitations due to slow recovery from inactivation of this current compared to that of the Ca2+ current. Early and delayed afterdepolarizations are produced by multiple components of ionic currents, especially in the former case. Transient inward current is mainly involved in the formation of delayed afterdepolarizations, but the activities can be produced by a different ionic mechanism in rare occasions. Barium-induced automaticity can be brought about by blocking and unblocking of the inward rectifier K+ channels. The ATP-sensitive K+ channels are assumed to play important roles in myocardial ischemia and related conditions. The channels are a target of the K+ channel openers and their functions are modulated by various intracellular factors. While the channel activity is strongly inhibited by intracellular ATP, ATP is necessary for the channel in an operative state. The former effect by ATP is produced by its ligand action, but the latter may be brought about by hydrolysis of MgATP, which may be regulated by the assembly and disassembly of the actin cytoskeleton.
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PMID:Functions of cardiac ion channels under normal and pathological conditions. 897 82

A 68-year-old man with ischemic heart disease, abdominal aortic aneurysm, and rectal cancer was referred. Coronary angiography indicated triple-vessel disease with jeopardized collaterals, and dipyridamole myocardial scintigraphy disclosed no viability in the inferior, posterior, and lateral walls. Abdominal computed tomography scanning revealed an infrarenal abdominal aortic aneurysm, 65 mm in diameter, with an expanding rate of 8 mm/year. Barium enema revealed stenosis 4 cm in length 5 cm inward from the anal verge, and an endoscopic finding was ulcerated type tumor with a clear margin and circumferential stenosis. Histological examination of a biopsy specimen revealed adenocarcinoma, and the clinical stage in the Japanese classification of colorectal carcinoma was II according to other examinations. Simultaneous operations were scheduled because of the jeopardized collaterals of the coronary arteries, rapid expansion of the aneurysm, and subileus due to the cancer. The patient underwent simultaneous off-pump coronary artery bypass grafting to the left anterior descending artery with the in situ internal thoracic artery through a median sternotomy, abdominal aortic aneurysm repair with a tube graft through a median laparotomy, and the Miles' operation with total mesorectal excision. Although infection of the perineal wound was postoperatively recognized, it remained local and was healed with irrigation only. The patient is doing well 12 months after the operation, without myocardial ischemic symptoms or recurrence of the cancer.
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PMID:Simultaneous operation of ischemic heart disease, abdominal aortic aneurysm, and rectal cancer. 1602 67

Increases in extracellular potassium (K+) concentration (up to 20 mM) cause dilation in some blood vessels. This may be particularly important in myocardial ischemia because in this condition K+ is released from ischemic cells. In this study, we investigated mechanisms of effect of increased K+ concentration on the tone of isolated bovine coronary artery. Bovine coronary arteries were isolated and mounted in organ baths for isometric tension recording. After an equilibration period, arteries were contracted with serotonin (1 microM). When serotonin contraction reached a steady-state, K+ concentration of organ baths was increased from physiological levels to 10 mM, 14 mM, 18 mM or 22 mM in four groups of the arteries. After a washout period, this procedure was repeated in presence of ouabain, a blocker of Na+ /K+ ATPase or a K+ channel blocker (tetraethylammonium, 4-aminopyridine, glibenclamide or barium). Increasing K+ concentration of the organ baths to 10 mM, 14 mM and 18 mM caused dilation in the arteries. Ouabain abolished the dilation and barium (a blocker of inward rectifier K + channels) inhibited the dilation significantly.According to our results there is K+ -induced dilation in bovine coronary artery and it involves activation of both Na+ /K+ ATPase and inward rectifier K+ channels.
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PMID:Potassium induced dilation in bovine coronary artery involves both inward rectifier potassium channels and Na+ /K+ ATPase. 1994 49

On February 4, 2008, the world's largest low emission zone (LEZ) was established. At 2644 km2, the zone encompasses most of Greater London. It restricts the entry of the oldest and most polluting diesel vehicles, including heavy-goods vehicles (haulage trucks), buses and coaches, larger vans, and minibuses. It does not apply to cars or motorcycles. The LEZ scheme will introduce increasingly stringent Euro emissions standards over time. The creation of this zone presented a unique opportunity to estimate the effects of a stepwise reduction in vehicle emissions on air quality and health. Before undertaking such an investigation, robust baseline data were gathered on air quality and the oxidative activity and metal content of particulate matter (PM) from air pollution monitors located in Greater London. In addition, methods were developed for using databases of electronic primary-care records in order to evaluate the zone's health effects. Our study began in 2007, using information about the planned restrictions in an agreed-upon LEZ scenario and year-on-year changes in the vehicle fleet in models to predict air pollution concentrations in London for the years 2005, 2008, and 2010. Based on this detailed emissions and air pollution modeling, the areas in London were then identified that were expected to show the greatest changes in air pollution concentrations and population exposures after the implementation of the LEZ. Using these predictions, the best placement of a pollution monitoring network was determined and the feasibility of evaluating the health effects using electronic primary-care records was assessed. To measure baseline pollutant concentrations before the implementation of the LEZ, a comprehensive monitoring network was established close to major roadways and intersections. Output-difference plots from statistical modeling for 2010 indicated seven key areas likely to experience the greatest change in concentrations of nitrogen dioxide (NO2) (at least 3 microg/m3) and of PM with an aerodynamic diameter < or = 10 microm (PM10) (at least 0.75 microg/m3) as a result of the LEZ; these suggested that the clearest signals of change were most likely to be measured near roadsides. The seven key areas were also likely to be of importance in carrying out a study to assess the health outcomes of an air quality intervention like the LEZ. Of the seven key areas, two already had monitoring sites with a full complement of equipment, four had monitoring sites that required upgrades of existing equipment, and one required a completely new installation. With the upgrades and new installations in place, fully ratified (verified) pollutant data (for PM10, PM with an aerodynamic diameter < or = 2.5 microm [PM2.5], nitrogen oxides [NOx], and ozone [O3] at all sites as well as for particle number, black smoke [BS], carbon monoxide [CO], and sulfur dioxide [SO2] at selected sites) were then collected for analysis. In addition, the seven key monitoring sites were supported by other sites in the London Air Quality Network (LAQN). From these, a robust set of baseline air quality data was produced. Data from automatic and manual traffic counters as well as automatic license-plate recognition cameras were used to compile detailed vehicle profiles. This enabled us to establish more precise associations between ambient pollutant concentrations and vehicle emissions. An additional goal of the study was to collect baseline PM data in order to test the hypothesis that changes in traffic densities and vehicle mixes caused by the LEZ would affect the oxidative potential and metal content of ambient PM10 and PM2.5. The resulting baseline PM data set was the first to describe, in detail, the oxidative potential and metal content of the PM10 and PM2.5 of a major city's airshed. PM in London has considerable oxidative potential; clear differences in this measure were found from site to site, with evidence that the oxidative potential of both PM10 and PM2.5 at roadside monitoring sites was higher than at urban background locations. In the PM10 samples this increased oxidative activity appeared to be associated with increased concentrations of copper (Cu), barium (Ba), and bathophenanthroline disulfonate-mobilized iron (BPS Fe) in the roadside samples. In the PM2.5 samples, no simple association could be seen, suggesting that other unmeasured components were driving the increased oxidative potential in this fraction of the roadside samples. These data suggest that two components were contributing to the oxidative potential of roadside PM, namely Cu and BPS Fe in the coarse fraction of PM (PM with an aerodynamic diameter of 2.5 microm to 10 microm; PM(2.5-10)) and an unidentified redox catalyst in PM2.5. The data derived for this baseline study confirmed key observations from a more limited spatial mapping exercise published in our earlier HEI report on the introduction of the London's Congestion Charging Scheme (CCS) in 2003 (Kelly et al. 2011a,b). In addition, the data set in the current report provided robust baseline information on the oxidative potential and metal content of PM found in the London airshed in the period before implementation of the LEZ; the finding that a proportion of the oxidative potential appears in the PM coarse mode and is apparently related to brake wear raises important issues regarding the nature of traffic management schemes. The final goal of this baseline study was to establish the feasibility, in ethical and operational terms, of using the U.K.'s electronic primary-care records to evaluate the effects of the LEZ on human health outcomes. Data on consultations and prescriptions were compiled from a pilot group of general practices (13 distributed across London, with 100,000 patients; 29 situated in the inner London Borough of Lambeth, with 200,000 patients). Ethics approvals were obtained to link individual primary-care records to modeled NOx concentrations by means of post-codes. (To preserve anonymity, the postcodes were removed before delivery to the research team.) A wide range of NOx exposures was found across London as well as within and between the practices examined. Although we observed little association between NOx exposure and smoking status, a positive relationship was found between exposure and increased socioeconomic deprivation. The health outcomes we chose to study were asthma, chronic obstructive pulmonary disease, wheeze, hay fever, upper and lower respiratory tract infections, ischemic heart disease, heart failure, and atrial fibrillation. These outcomes were measured as prevalence or incidence. Their distributions by age, sex, socioeconomic deprivation, ethnicity, and smoking were found to accord with those reported in the epidemiology literature. No cross-sectional positive associations were found between exposure to NOx and any of the studied health outcomes; some associations were significantly negative. After the pilot study, a suitable primary-care database of London patients was identified, the General Practice Research Database responsible for giving us access to these data agreed to collaborate in the evaluation of the LEZ, and an acceptable method of ensuring privacy of the records was agreed upon. The database included about 350,000 patients who had remained at the same address over the four-year period of the study. Power calculations for a controlled longitudinal analysis were then performed, indicating that for outcomes such as consultations for respiratory illnesses or prescriptions for asthma there was sufficient power to identify a 5% to 10% reduction in consultations for patients most exposed to the intervention compared with patients presumed to not be exposed to it. In conclusion, the work undertaken in this study provides a good foundation for future LEZ evaluations. Our extensive monitoring network, measuring a comprehensive set of pollutants (and a range of particle metrics), will continue to provide a valuable tool both for assessing the impact of LEZ regulations on air quality in London and for furthering understanding of the link between PM's composition and toxicity. Finally, we believe that in combination with our modeling of the predicted population-based changes in pollution exposure in London, the use of primary-care databases forms a sound basis and has sufficient statistical power for the evaluation of the potential impact of the LEZ on human health.
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PMID:The London low emission zone baseline study. 2231 24


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