Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Age is a recognized risk factor for coronary artery disease, but the relationship between age and silent ischemia is not well understood. We analyzed the data from 35 rest/stress radionuclide ventriculography examinations in patients with documented ischemic coronary artery disease who had experienced 1 mm ST segment depression accompanied by angina during exercise testing. An index of ischemic cardiac pain perception (PPI) was calculated by subtracting the time of onset of 1 mm ST segment depression from the time of onset of angina. The mean value of PPI was -97 +/- 311 seconds. PPI was significantly correlated with age (r = 0.37, p = 0.03). This suggests that as age increases, perception of pain during myocardial ischemic episodes becomes muted. This relationship remained significant when we controlled for the presence of medication and severity of disease (change in ejection fraction from rest to peak exercise). These findings suggest that age is an independent risk factor for a decreased perception of ischemic cardiac pain, and thus for silent myocardial ischemia.
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PMID:Aging and pain perception in ischemic heart disease. 236 May 10

The past 10 years has seen a revolution in noninvasive cardiac imaging. UFCT and MRI can demonstrate cardiac anatomy in exquisite detail and have become our most accurate methods of measuring ventricular function. PET and MRS are giving insights into myocardial metabolism that were previously impossible in vivo. UFCT and MRI have also made progress in imaging the coronary arteries and bypass grafts. Although neither technique is in a position to rival coronary arteriography, the first steps have been made. Accurate quantification of coronary calcium is possible with UFCT and promises to be our most valuable noninvasive tool in the diagnosis and management of patients with asymptomatic disease. Myocardial perfusion has been assessed with 201TL imaging for years, but new radiopharmaceutical agents and advances in UFCT and contrast-enhanced MRI are likely to bring great improvements. Table 2 lists the current modalities and outlines their main advantages and disadvantages. Despite all this progress, there has been little change in clinical practice. Invasive procedures, i.e., cardiac catheterization or transesophageal echocardiography, are still being performed even when equivalent information can be obtained noninvasively. While limited availability may explain the scant use of PET and UFCT for cardiac imaging, in those centers where it is available, interest is still muted. The need to foster multidisciplinary interaction is real. If the benefits of this revolution are to be passed on to patients, there needs to be a greater willingness among physicians from different specialties to collaborate and to be more tolerant than has occurred in many centers to date. This will not only improve patient care but it will also provide an appropriate evaluation of new technologies. All are critical if we are to solve the continuing problems of ischemic heart disease.
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PMID:Noninvasive imaging for the diagnosis and management of myocardial ischemia. 825 54

Angiogenesis is the proliferation of endothelial and smooth muscle cells to form new blood vessels. Largely muted after adolescence, angiogenesis may be reignited by cancerous cells. Neoangiogenesis plays a primary role in tumor growth and metastases. Antiangiogenic therapy to limit and even reverse the growth of tumors are under investigation and showing promise. A derivative of fumagillin, TNP 470, is the first angiogenesis inhibitor to be given to humans. Surprisingly, several potent inhibitors are derived from tumors themselves. Researchers nowc recognize that stimulation of angiogenesis may have a place in the treatment of cardiovascular disease. Reestablishing blood flow to ischemic tissue through angiogenesis may provide a biologic "bypass" for patients with ischemic heart disease. The same applies to the treatment of peripheral vascular disease.
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PMID:Regulating angiogenesis: a new therapeutic strategy. 980 69