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)

The occurrence of sustained ventricular tachycardia with worsening hemodynamic performance in patients with ischemic heart disease can represent a critical event when the arrhythmia, refractory to antiarrhythmic drugs, recurs after D.C. shock. In this case temporary DDD pacing can be a reliable alternative treatment.
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PMID:[Usefulness of temporal bicameral stimulation in the interruption of refractory ventricular tachycardia]. 129 27

Our preliminary experience with dual-chamber DDD pacemakers is reported. Technological innovations of the device, atrio-ventricular electrode stability and sequential stimulation have contributed to improve the conditions of patients previously submitted to VVI pacemaker implantation. Primary indications for DDD pacemaker implantation in our series included 7 patients with complete atrio-ventricular (A-V) block, 3 with Mobitz type II second-degree A-V block and 2 with sick sinus syndrome. In six of the 12 patients (50%) additional indications included: ventricular tachycardia in 4 patients, atrial fibrillation in one and pacemaker syndrome in one. Other cardiac conditions were diagnosed: dilated cardiomyopathy in 3 patients, ischemic heart disease in 2 patients, valvular heart disease in 2 patients, congenital heart disease in 1 patient and hypertrophic cardiomyopathy in one patient. The implanted pacemakers were: 5 Genesis, 4 Ultra CPI and 3 Versatrax. J-shaped atrial electrodes were used in 8 patients and in 4 instances a screw-in electrode was employed. Improvement of hemodynamic function was achieved by frequent follow up and reprogramming of DDD pacemaker in every patient. While 4 patients died with progressive deterioration of cardiac function, eight patients survived with adequate sequential stimulation. We conclude that DDD pacemakers are reliable and afford symptomatic relief in a broad spectrum of patients.
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PMID:[DDD dual chamber pacemakers. Initial experience]. 134 19

As part of a multicentre WHO MONICA-Project the present drug consumption by Warsaw population was assessed (evaluated by DDD). In Warsaw population 2646 inhabitants aged 35-64 years were examined. Ischaemic heart disease was diagnosed in 30% screened persons. Only 39% of subjects were involved in taking cardiovascular drugs. In ischaemic heart disease the drugs used most frequently were pentaerythritol tetranitrate and dipyridamole. The influence of several psychosocial factors on the fact of undertaking of pharmacological therapy was analysed using multivariant logistic function method. Significant relationships were found for age, health self-care self-estimation of health status and fact of medical consultation. Persons with high values of MLF (fifth quintile) underwent drug treatment six time more often, then persons with low values of MLF (first quintile).
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PMID:[Drug consumption by the patients with ischemic heart disease (IHD) studied by the Pol-Monica Warsaw and the effect of selected factors on the treatment of IHD]. 152 53

The advent of dual chamber pacing systems that restore atrioventricular synchrony and allow rate variability in response to physiologic stress has provided a major advance in pacing therapy. Undesirable pacemaker-mediated tachycardias may arise when the atrial sensing amplifier of a VDD or DDD device detects a retrogradely conducted P-wave, ectopic atrial tachycardia, myopectoral contractions, or environmental electromagnetic interference. The rate of the resultant tachycardia is determined by the programmed upper tracking rate of the pacemaker. Although seldom life-threatening, troublesome myocardial ischemia may ensue in patients with coronary artery disease. In most instances, the incidence and rate of pacemaker-mediated tachycardias may be minimized by judicious programming.
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PMID:Pacemaker-mediated tachycardias: an unresolved problem. 620 49

Twenty adults underwent implantation of an automatic (DDD) pacemaker (Medtronic model 7000, Versatrax I) for treatment of symptomatic bradyarrhythmias. Only 9 patients had optimal DDD mode pacing during 78 paced months. In 3 patients, the DDD mode was changed to atrioventricular (AV) sequential (DVI) early because of risk imposed by sustained tachycardia upon underlying myocardial ischemia. The remaining 8 had had tachycardia due to pacemaker reentry, and 7 had neurologic and cardiovascular symptoms. DDD pacing was abandoned in 5 when reentry could not be interrupted by digitalis administration or reprogramming. Three continue to be paced in DDD mode despite intermittent reentrant tachycardias, with digitalis diminishing episodes of reentry in only 1. Mean ventriculoatrial conduction time was 229 +/- 34 ms. Reentrant pacemaker tachycardia developed in 7 of 12 with normal or nearly normal AV conduction, but in only 1 of 5 with complete heart block. Preimplantation electrophysiologic study did not reliably detect and initial postoperative Holter monitoring did not predict reentrant tachycardia. The risk of reentry caused by a short, fixed atrial refractory period combined with the high occurrence of slow retrograde AV conduction, particularly in patients with normal or nearly normal anterograde conduction, renders the Versatrax I and other similar pacemakers unsuitable for DDD mode pacing in many patients.
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PMID:Current physiologic pacemakers: a serious problem with a new device. 685 35

A patient with drug-resistant ventricular tachycardia due to ischemic heart disease with severe left ventricular failure was successfully treated by the implantation of a DDD pacemaker system pacing at a rate of 90 beats/min (overdrive suppression). Additional therapy with high doses of beta-blockers was necessary. The ECG demonstrated a delay of 100 ms between atrial spike and p-wave. The hemodynamic effects of this ineffective atrial contraction were assessed by jugular venous puls tracing, phonocardiography, echocardiography, and radionuclide-ventriculography. The desired positive effects of physiological pacing could only be achieved by further prolongation of the A-V interval by these 100 ms. This observation shows that, with DDD pacemakers, AV intervals of varying length may be necessary with VAT or VDD and DVI modes in individual cases.
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PMID:[Delayed atrial excitation following bifocal pacemaker stimulation]. 686 43

The aim of the study was to analyse the changes in pharmacotherapy of ischaemic heart disease (HD) and arterial hypertension (AH) between 1984 and 1988 using the results of screenings of two independent samples of Warsaw inhabitants. In this period the prevalence of IHD in Warsaw population aged 35-64 increased by 4.3% (from 30.3% to 31.6%) as well as the percentage of treated subjects by 19.5% (from 39.0% to 46.6%). Prevalence of arterial hypertension (AH) decreased in this period by 4.7% (from 35.8% to 34.1%) whereas the percentage of undertaking pharmacotherapy in these patients increased by 47.9% (from 33.8% to 50.0%) as well as the effectiveness of undertaken treatment (goal of treatment: < or = 160/95 mmHg) increased by 115.8% (from 22.8% to 49.2%). In subjects with IHD selected from general population the consumption of nitrates, beta blockers and calcium channel blockers increased and these drugs were the most frequently taken in IHD. In treatment of AH diuretics, the most frequently used in 1984, were replaced, to some extent, in 1988 by beta blockers and calcium channel blockers. Consumption of drugs by general population, expressed in DDD/1000 i/day, changed too--the consumption of beta blockers increased in 1988 twice, of calcium channel blockers 3-fold and of nitrates 1.5 fold, whereas that of dipyridamole decreased by 60%, while comparing of these consumption in 1984.
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PMID:[Direction of pharmacotherapeutic changes used in cardiovascular diseases assessed by examination of two population samples from Warsaw]. 771 52

Hypertrophic cardiomyopathy is a clinical and anatomofunctional entity that determines a series of hemodynamic consequences closely related to sintomatology. Left ventricular hypertrophic, subaortic stenosis, diastolic dysfunction and myocardial ischemia are the different pathophysiology mechanisms that generate similar clinical manifestations. Sintomatology defines two groups of patients with different profiles and clinical management. Ventricular arrhythmias are not uncommon and the forms that imply a darkest prognosis are supported symptomatic ventricular tachycardia and the induced ventricular tachycardia in patients that have suffered a cardiac arrest or have had syncopes. Basic explorations in all patients, in addition to physical examination, chest radiography and rest electrocardiogram, are Doppler echocardiography and Holter. Other explorations, such as Tallium-201 stress test, tilt test, electrophysiological and hemodynamic studies, are rationalized according to risk profile, sintomatology and responses to indicated treatment. In general, prognosis in asymptomatic patients is good and complex explorations are not justified nor are preventive character treatments. Symptomatic patients who have a higher risk must be studied more closely, and frequently require complex and invasive explorations. They also need pharmacological treatment and often more invasive therapeutical options, DDD pacemakers or surgery, if those fail.
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PMID:[Cardiomyopathy (X). Clinical approach to the patient with hypertrophic cardiomyopathy]. 875 12

This case study presents evidence that angioplasty and dual chamber pacing can be used as a therapeutic alternative to coronary artery bypass grafting and myectomy. The following case report describes this treatment option in a patient with hypertrophic cardiomyopathy and ischemic heart disease who refused surgery. A severe coronary lesion was successfully treated with percutaneous transluminal coronary angioplasty (PTCA). Subsequent deterioration of the patient's clinical status occurred, yet a repeat heart catheterization revealed no angiographic changes from the PTCA. The left ventricular outflow gradient was 97 mmHg despite optimizing medical therapy. Temporary pacing leads were inserted and the patient was DDD paced at 70 ppm while measuring the LV gradient at varying AV intervals. Significant reduction of the outflow tract gradient occurred at all AV intervals tested. Although the pressure gradient decreased during VVI pacing, atrial contribution was necessary to achieve the desired hemodynamic benefit. A permanent DDDR pacemaker was implanted with satisfactory clinical results.
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PMID:Clinical benefit of dual chamber pacing in hypertrophic cardiomyopathy: a case report. 884 68

Biventricular (BV) pacing acutely improves the hemodynamic status of patients with chronic heart failure (CHF) and wide QRS complex. Long-term data are few. This study examined the relationship between hemodynamic and clinical status of BV-paced CHF patients over an intermediate duration of follow-up. Forty-seven patients (mean age 64 +/- 11 years, 19% women, LVEF 0.23 +/- 0.07) with QRS > or = 140 ms received a DDD-BVP device for management of CHF due to ischemic disease in 21 (45%) patients. Clinical, electrocardiographic, exercise testing, and hemodynamic measurements were followed over an 8-month period. Seven patients died during the study, four patients suddenly. A significant decrease in NYHA class, from 3.3 +/- 0.6 before implantation, to 2.5 +/- 0.57 months after device implantation (P < 0.01) was measured, although 23% of patients reported no symptomatic improvement. Paced QRS narrowing by BVP was unchanged throughout follow-up (166 +/- 28 vs 159 +/- 23 ms, P = NS). Maximal VO2 values did not change (15.7 +/- 5 vs 16 +/- 8 mL/kg per min, P = NS). Echocardiographic parameters showed that the degree of mitral regurgitation was significantly decreased during BV pacing compared with no pacing (1.8 +/- 1.0 before implantation vs 1.3 +/- 0.7, P < 0.01). The radionuclide LVEF was not statistically different during no pacing, versus BV pacing at 3 months or 8 months after pacemaker implantation (24 +/- 9 vs 26 +/- 11 vs 25 +/- 10%, respectively, P = NS). Of nine patients whose QRS duration was prolonged by BV pacing, two were not hemodynamically and clinically improved at the end of follow-up. Patients not improved by BV pacing had the same degree of QRS shortening (203 +/- 39 vs 167 +/- 26 ms, P < 0.01) as patients who were clinically improved during follow-up (193 +/- 40 to 171 +/- 24 ms, P < 0.01). In multivariate analysis, ischemic heart disease (P = 0.025), absence of mitral regurgitation regression (P = 0.01), and older age (P = 0.04) predicted the absence of improvement by BV pacing. By standard noninvasive measures, intermediate-term BV pacing was associated with no objective hemodynamic improvement, though more than three fourths of the patients reported being clinically improved. A global improvement in left ventricular function by BV pacing may become apparent only over longer periods of observations. Patients with CHF unimproved by BV pacing are more likely to suffer from ischemic heart disease and less likely to have BV pacing induced regression of mitral regurgitation, regardless of changes in QRS duration.
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PMID:Intermediate-term results of biventricular pacing in heart failure: correlation between clinical and hemodynamic data. 1113 7


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