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)

To clarify the central effects of physical training on patients with coronary heart disease, 81 subjects were selected for the present study. Evaluations of the oxygen transport system function were performed according to the definition proposed by Bruce and others in terms of FAI (functional aerobic impairment), LVI (left ventricular impairment) or MRI (myocardial reserve impairment), CRI (chronotropic reserve impairment) and PCI (peripheral circulatory impairment). Remarkable improvement in left ventricular impairment was found in those patients with single vessel disease or those who experienced disappearance of chest pain after the completion of the program. In another series of study on myocardial perfusion performed on 11 patients with coronary heart disease, improvement in ischemia was also demonstrated in 7 of 8 patients who revealed redistribution pattern in 201TL exercise stress images specifying myocardial ischemia. In conclusion, exercise training could induce improvements not only the left ventricular functions characterized by increased maximal pressure rate product and maximal heart rate, but also in myocardial ischemia. Further studies are needed to specify its effects, since natural progression or regression of the disease process itself may influence the results.
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PMID:Physical training of the patients with coronary heart disease: noninvasive strategies for the evaluation of its effects on the oxygentransport system and myocardial ischemia. 228 45

Neoangiogenesis, congestive heart failure and prevention of reoclusion after PCI represent the main targets of gene therapy (GT) in cardiology. Therapeutic angiogenesis can be used in advanced myocardial ischemia and in angina pectoris not suitable for the revascularization by cardiosurgery or by catheterization techniques. Heart failure is another indication of GT in cardiology. Modulation of calcium homeostasis, beta-adrenergic receptors and resistance of myocytes against apoptosis belongs to main forms of GT in this indication. Prevention of restenosis after PCI (with or without stent implantation) represents the third possible indication of GT. Conversion of ventricular myocytes into pacemaker cells using the gene potassium channel was described. Some benefit of GT can be expected in systemic and pulmonary hypertension. An optimal vector should be defined, as well as the optimal access (probably transmyocardial supplemented with intravenous application) and doses. GT seems to be safe and well tolerated by patients. Randomized, placebo control studies should be initiated for the final clinical assessment of this method.
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PMID:[Gene therapy in cardiovascular diseases]. 1460 40

Cardiovascular complications are important causes of morbidity with major non cardiac procedures. Preoperative risk stratification relies on the identification of the cardiac problem, its stability, its severity and previous treatment. The approach to risk stratifying preoperative patients should be performed by accepted guidelines used for patients with suspected coronary artery disease (CAD) or known CAD and not as an "obligatory test" prior to operation. Risk stratification is based on clinical predictors, stress testing, including cardiac imaging if necessary, and the kind of operation. Most of the tests are noninvasive and some invasive tests conducted are intended to identify myocardial ischemia and critical lesions of the coronary arteries. Most of the patients are able to undergo elective procedures without any problem with the perioperative cardiac event rate of up to 2% considered as an accepted goal. The use of invasive diagnostic and therapeutic methods, such as cardiac catheterization, PCI, CABG, has to be restricted only to patients who are at very high risk. The partial reduction of the cardiac event rate in the short term and monitoring for 24 hours after operation is most important, as well as the administration of beta blockers, starting prior to surgery. Furthermore, long term follow-up for cardiac events in these patients in essential, as the clinical predictors and cardiac tests performed for preoperative risk stratification are also used for long term prognosis.
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PMID:[Preoperative cardiac risk evaluation in non cardiac surgery]. 1463 9

Ischemic heart diseases continue to be leading causes of death throughout the world. Blood platelets play a pivotal role not only in haemostasis but also in the pathogenesis of thrombosis and atherosclerosis, platelet aggregation being an essential step in the formation of either an effective haemostatic plug or an intravascular thrombus. The benefits of various antiplatelet therapies ranging from aspirin, ticlopidine, Clopidogrel, and intravenous platelet GPIIb/IIIa antagonists in various thromboembolic disorders are well documented. The studies of CAPRIE, CURE, PCI-CURE and MATCH have shown that the clopidogrel has a highly advantageous preventive effect in the ischaemic vascular diseases, that is why clopidogrel be highly recommended in the stroke prevention.
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PMID:[Clopidogrel in the prevention of stroke]. 1571 89

Coronary revascularization with PTCA or by means of CABG surgery is frequently used in the care of patients with ischemic heart disease. Before revascularization is performed, stress myocardial perfusion imaging may assist in management decisions by demonstrating the presence of myocardial ischemia and viability, and delineating the severity and extent of coronary artery disease. The presence of myocardial ischemia may provide an indication for revascularization, even in asymptomatic persons. The significance of equivocal lesions may be determined and the culprit vessel may be successfully defined by this radionuclide technique. Recently, the quantitative estimation of myocardial flow reserve with N-13 ammonia PET and the precise detection of myocardial viability with F-18 FDG PET have been introduced to support the limitations of conventional SPECT imaging. After revascularization, these radionuclide techniques are useful to demonstrate improvement of myocardial perfusion or flow reserve, and are also very important to determine restenosis after PCI and graft disease after CABG surgery.
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PMID:[Value of cardiac nuclear imaging in clinical care of patients with ischemic heart disease]. 1572 93

Pharmacological therapy for acute coronary syndrome (ACS) is divided into the treatment for myocardial ischemia and that for coronary thrombosis. Immediate nitrates(sublingual tablets and sprays) are used to alleviate attacks and patients not responding them are treated by intravenously in 24 hours. The initial treatment for non-ST-segment elevation myocardial infarction(NSTEMI) with the administration of nitrates and beta blocker is judged as Class I (evidence level B) by ACC/AHA classification. Administering beta blocker in patients with ACS has reduced the progression to myocardial infarction by 13%. Ca antagonist is administered in patients for whom nitrates and/or beta blocker are contraindicated or in whom myocardial ischemia persists or frequently relapses in spite of the treatment with an adequate dose of the drugs. Since recent studies have suggested that ACS may not result from a local vascular stenosis, but from coronary inflammation, treating the local vascular lesion alone with PCI is not enough. Rather, pharmacological therapy is important to reduce overall patient risk, thereby suppressing the progress of atherosclerosis.
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PMID:[Anti-anginal medication in management of acute coronary syndrome]. 1661 94

Spontaneous coronary artery dissection (SCAD) is a rare condition that usually occurs in relatively young patients who are predominantly female. Seldom it could be a cause of acute myocardial ischemia leading to a sudden cardiac death. SCAD consists of intramural hematoma formation or, rarely, intimal tears that initiate and propagate the dissection in the vessel wall. In rare cases, the SCAD occurs in male patients. We report the case of a 56-year-old man with acute myocardial infarction who was successfully treated via systemic thrombolysis in a peripheral hospital. Associated conditions were thrombosis of right femoral artery in the past and high platelet count (800,000/mm3). After 1 month, elective coronary angiography revealed a very diffuse spiral dissection of the left anterior descending artery; hence, our choice of medical treatment consisted of double oral antiplatelet therapy (clopidogrel 75 mg plus aspirin 325 mg once daily). After a 2-year follow-up, there was absence of both angina and myocardial ischemia and there was a decrease in platelet count. Many strategies could be considered in patients with SCAD, such as PCI, bypass surgery, or conservative medical management. In general, the long-term prognosis of patients with SCAD is considered favorable if they survive the acute phase.
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PMID:Case report: a very large dissection in the left anterior descending coronary artery of a 56-year-old man. 1717 72

A residual platelet reactivity (RPR) on antiplatelet therapy in patients with ischemic heart disease (IHD) has been reported to be associated with adverse clinical events by some Authors. However, scarce data are present on the clinical parameters associated with this phenomenon. No study, at our knowledge, was designed with the specific aim to examine the relationship between clinical characteristics and RPR. We sought to evaluate the clinical and laboratory characteristics associated with RPR in patients with IHD undergoing coronary revascularization on dual (aspirin plus clopidogrel) antiplatelet therapy. We included in the study 868 patients undergoing a coronary angiography: 386 with acute coronary syndromes undergoing a primary coronary revascularization and 482 IHD patients scheduled to undergo an elective coronary angiography. We measured platelet function by both platelet aggregation with two agonists [0.5 mg/mL arachidonic acid (AA); 2 and 10 microM adenosine 5'-diphosphate (ADP)] and a point-of-care assay (PFA-100) on venous blood samples collected within 24 h from the end of the procedure. In patients with acute coronary syndromes and elective PCI diabetes is independently associated with RPR [group A: OR=2.9 (1.5-5.7) by 10 microM ADP, OR=5.3 (1.1-27.8) by PFA-100; group B: OR=4.0 (1.6-10.0) by 10 microM ADP]; reduced left ventricular systolic function [OR=3.7 (2.2-6.5) by AA-PA, OR=2.7 (1.6-4.6) by PFA-100], chronic use of aspirin [OR=0.2 (0.1-0.4) by AA-PA, OR=0.3 (0.2-0.5) by PFA-100] and loading dose of clopidogrel [OR=0.2 (0.06-0.5) by 10 microM ADP] were independent variables significantly associated with RPR in patients undergoing elective PCI. In addition, inflammatory status was found to be significantly associated with RPR in both groups of patients. These results provide indications for the selection of patients for whom the evaluation of platelet reactivity could be useful.
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PMID:Residual platelet reactivity is associated with clinical and laboratory characteristics in patients with ischemic heart disease undergoing PCI on dual antiplatelet therapy. 1755 59

Reperfusion arrhythmias are associated with epicardial reperfusion but may also be a sign of vascular reperfusion injury which can be seen as no-reflow phenomenon on coronary angiography and predicts in-hospital complications and recovery of left ventricular (LV) function. No-reflow phenomenon (thrombolysis in myocardial infarction [TIMI] <or=2 flow) is frequently observed in patients after mechanical or medical reperfusion procedures for acute myocardial infarction (AMI). The authors hypothesized that reperfusion arrhythmias (or peri-infarct arrhythmias) may be related to continuing myocardial ischemia. They documented all arrhythmia episodes in patients with AMI and compared arrhythmia rates in different therapy groups. They also compared arrhythmia rates according to TIMI flow achieved and those after MI. The highest arrhythmia rate was detected in patients to whom thrombolytic therapy was given for AMI (64%). The arrhythmia rate was lower in patients with primary PCI performed for AMI (46.2%) than in those receiving thrombolytic therapy. The arrhythmia rates according to therapy modalities for AMI were significantly different (p < 0.01). The achieved mean TIMI flow with primary PCI (2.46 +/-0.21 ) was higher than the mean flow achieved after thrombolytic therapy (2.12 +/-0.16). When compared to the arrhythmia rate according to TIMI flow, it was shown that the lowest arrhythmia rate was found in patients with TIMI 3 flow (17.2%) achieved with any procedure after AMI. The arrhythmia rate was 84% in patients with TIMI 2 flow and 33.3% with TIMI 0-1 flow (p <0.001). The arrhythmia rate was appreciably lower after 48 hours of MI. This finding suggests that the continuing myocardial ischemia represented by TIMI flow at the coronary angiography after acute myocardial infarction may have an important role in the pathogenesis of reperfusion arrhythmias.
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PMID:Reperfusion arrhythmias: are they only a marker of epicardial reperfusion or continuing myocardial ischemia after acute myocardial infarction? 1798 22

The association of statins with markers of inflammation, vasoconstriction, and coagulation was evaluated in 325 patients with abdominal aortic aneurysm with respect to statin treatment or not. Variables evaluated included routine laboratory markers, lipids, homocysteine, endothelin-1, matrix metalloproteinases (MMP)-2 and -9, and activated protein C-protein C inhibitor (APC-PCI) complex. Statin-treated patients were more often male (85% vs 75%; P = .024) and had ischemic heart disease (57% vs 19%; P < .0001). They showed lower levels of cholesterol (P < .0001), homocysteine (P = .027), MMP-9 (P = .038), and endothelin-1 (P = .005), and higher levels of APC-PCI complex (P = .042). Differences persisted in logistic regression for cholesterol (P < .0001), APC-PCI complex (P = .034), and homocysteine (P = .021). Statin-treated patients with abdominal aortic aneurysm show higher APC-PCI complex and lower homocysteine levels. Whether this translates into lower risk for aneurysm expansion or rupture will be evident from further follow-up.
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PMID:Associations between statin treatment and markers of inflammation, vasoconstriction, and coagulation in patients with abdominal aortic aneurysm. 1862 84


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