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 effectivity of subendocardial perfusion was investigated in 266 probands aged 40-68 years (112 patients with ischaemic heart disease, 116 patients with essential hypertension, and 38 practically healthy persons) by a noninvasive technique - the myocardial vitality index (MVI) or the quotient of the diastolic and systolic tension-time indexes (DTTI/STTI). The close and statistically significant correlation was found between the MVI, findings of selective coronarography, and total physical performance (exercise tolerance threshold) in per cent of the maximal oxygen consumption (MOC) adequate to the given subject's age, sex, and body mass. Attention is drawn to the diagnostic potential of the novel mode of a rapid assessment of the expected exercise tolerance threshold in per cent of the admissible MOC, determined by the magnitude of the coronary reserved of energy output (in kcal/min or kJ/min), and to the possibilities of predicting the maximal admissible heart rate during exercise on the basis of the myocardial oxygen supply/consumption quotient during a state of relative muscular rest, reflecting the MVI.
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PMID:The diagnostic significance of the correlation between the effectiveness of subendocardial perfusion and the energy output compatible with the coronary reserve. 706 62

The purpose of thee present work is to compare th value of two non invasive techniques: cycloergometer and dynamic ECG (Holter) in the diagnosis of ischaemic heart disease in subjects without basal ECG abnormalities and without clearcut clinical signs of coronary insufficiency. Twenty patients underwent both tests while in hospital. The ECG was continuously monitored for 24 hours according to the Holter method. In fifteen out of the twenty cases examined for results obtained with the two different techniques were in agreement; in three cases ischaemic ECG changes were seen only with the ergometer, in one only with the Holter and in one they were clearly present with the Holter, but were doubtful with the ergometric test. In our experience the Holter method should represent the first approach to studying patients suspected to be suffering from angina pectoris in view of its good sensitivity and of the absence of risk and contraindications. Maximal exercise test should be reserved to the patients in whom the Holter method has given negative results. The latter not only has a diagnostic value, but also "quantifies" the degree of ischaemia by recording symptomatic and asymptomatic ST depressions.
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PMID:[Value of cycloergometer and dynamic ECG (Holter ) in the diagnosis of coronary insufficiency (author's transl)]. 746 35

In most patients with stable angina pectoris, severe eccentric atherosclerotic narrowing of coronary arteries is responsible for chest pain and myocardial ischemia. If myocardial infarction or death occurs, it is usually the consequence of a ruptured plaque. About 10% to 20% of patients with stable angina have normal coronary arteries, and their long-term prognosis is excellent. In patients with angina secondary to atherosclerotic lesions, the annual mortality rate is 1.6% to 3.2%; prognosis is determined by systolic left ventricular function and the extent of coronary artery disease. Patients can be stratified into low- and high-risk groups by medical history, left ventricular function at rest, and results of physical examination and stress testing. Coronary angiography should be reserved for high-risk patients. Risk-factor modification and appropriate use of antianginal drugs are successful in most patients, but those who fail to respond should be considered for angioplasty or coronary bypass surgery; patients with left main coronary artery disease or three-vessel disease and poor left ventricular function should be considered for coronary artery bypass surgery.
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PMID:Chronic stable angina pectoris. Strategies for effective drug therapy. 750 78

The use of antihypertensive agents in patients with renal insufficiency necessitates careful consideration of dosages, titration, and monitoring. Renal function must be estimated to appropriately make dosage adjustments for antihypertensives that exhibit extensive renal elimination. Thiazide diuretics are useful in mild degrees of renal insufficiency but loop diuretics become necessary as renal function deteriorates further. With either class, low dosages should be used to prevent hypovolemia, hyponatremia, and hypokalemia which may worsen renal blood flow. Angiotensin-converting enzyme (ACE) inhibitors have become popular because they may have unique renal protective properties. All ACE inhibitors except fosinopril require reduced dosages and/or less frequent administration in patients with renal insufficiency. It is often necessary to use a diuretic with an ACE inhibitor and special dosing considerations are important. Due to demographic and physiologic characteristics of patients with renal insufficiency, beta blockers are often reserved for patients with other indications for beta blockers such as ischemic heart disease. Several beta blockers are eliminated primarily by the kidney and dosage reductions are necessary for these agents. Calcium antagonists may also have renal protective effects. Because calcium antagonists are metabolized extensively, significant dosage adjustments are not necessary. Data suggest that antihypertensives may slow the decline in renal insufficiency. The pharmacokinetics of several antihypertensives change with renal impairment because of reduced elimination. Therefore, dosage adjustments, slower titration, and less frequent administration are often necessary.
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PMID:Dosing of antihypertensive medications in patients with renal insufficiency. 775 16

In this paper the authors have evaluated the incidence and the clinical implications of sick euthyroid syndrome (SES) in a group of 144 patients in a department of internal medicine. SES is an alteration of thyroid hormone values in the absence of a thyroid disease, which is seen in patients suffering from serious diseases. Having classified SES into 3 subgroups according to the different alterations seen in the values of T3, T4, FT3, FT4, TSH, rT3 and TBG, they show the hypotheses that explain the biochemical mechanisms which are at the basis of these hormonal alterations. Fourteen of the 144 patients under observation were excluded as they were suffering from ascertained or subclinical thyroid disease. Thirty (23% of cases) of the remaining 130 patients had alterations of the thyroid hormones in accordance with SES diagnosis. Of these 30 patients, 19 had hormone values found in SES type I (63%), 2 in SES type II (6.5%) and 9 in SES type III (30.5%). In SES type I the diseases seen, in order of frequency, were: obstructive chronic bronchopneumopathy with acute respiratory failure, diabetic ketoacidosis, neoplasms, ischemic heart disease, cardiac failure, chronic renal failure, liver diseases, acute cerebral vasculopathies, sepsis and collagenopathies. The disease seen in the 2 cases of SES type II was obstructive chronic bronchopneumopathy with acute respiratory failure. In SES type III the diseases seen were, in order of frequency: diabetic ketoacidosis, lung diseases, ischemic heart disease, cardiac failure, peripheral arteriopathies, acute cerebral vasculopathies, neoplasms, liver diseases, acute renal failure. The incidence of SES in 23% of the admitted to hospital patients was found to be slightly higher than in other studies; this could be explained by a stricter selection of inpatients: in fact self-sufficient patients or those not needing urgent admission, were sent to an efficient out patient clinic where necessary examinations were quickly carried out, hospitalization being reserved for patients with more serious illnesses. We would like to underline how the incidence of SES is much greater than that of what is known as thyroid disease (23% compared to 5%), thereby confirming that it is the most frequent cause of alterations of thyroid hormones. With regard to the pathogenetical hypotheses, it is confirmed that in SES, the reduction of T3 values is accompanied by an increase in the values of rT3 as for reduced activity of 5-desiodinasis enzyme. In SES type III the increase of T4 values is due to the increase of TBG resulting in an increase in the link for T4 and therefore a reduced peripheral hormone activity.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[The euthyroid sick syndrome. Its incidence and clinical significance in an internal medicine department]. 802 42

Ventricular tachycardia (VT) in children is different to that observed in the adult because ischemic heart disease is exceptionally rare in this age group. The arrhythmia sometimes presents with cardiac failure or loss of consciousness. VT complicates the outcome of operated Tetralogy of Fallot, arrhythmogenic right ventricular dysplasia and some cardiac tumours. Cardiomyopathies are also a cause of VT but it must be noted that ventricular dysfunction may be the result of a prolonged arrhythmia and will disappear after return to sinus rhythm. Many cases of childhood VT occur without any patent cardiac disease even after extensive investigations. Some are benign with a good prognosis, such as salvoes of VT or sustained attacks of so-called ventricular Bouveret. Others carry a more reserved prognosis and require active treatment. Incessant tachycardia of the newborn is difficult to stop may be cured without sequellae. Torsades de pointes is sometimes iatrogenic complicating congenitally long QT syndromes with or without deafness or familial nature, and which may be likened to adrenergic VT. Amiodarone and betablockers are the best antiarrhythmic agents. Investigations with a diagnostic or therapeutic objective are easier in older children but these techniques, whilst not being systematic, do not exclude the very young children. Ablation techniques progress and the limited indications of surgery and implantable defibrillators have to be considered case by case.
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PMID:[Ventricular tachycardia in children]. 826 8

In the era of thrombolysis, exercise training for patients with ischemic heart disease should be reserved for enhancement of functional capacity and psychological well-being rather than improvement of prognosis. Low to moderate intensity exercise training enhances functional capacity to the same extent that group-based exercise training does and can be performed safely at home. The physical demands of occupational work have decreased to the point where patients with ischemic heart disease who manifest neither treadmill-induced myocardial ischemia nor left ventricular dysfunction can perform virtually any occupational task.
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PMID:Home-based and worksite-based exercise training for patients with coronary artery disease. 850 54

Of the treatments available for the management of established vertebral osteoporosis, hormone replacement therapy (HRT), intermittent cyclical etidronate therapy and salmon calcitonin have been shown in randomized, controlled trials to reduce the risk of further vertebral fractures. In order to compare the cost effectiveness of these different treatments we examined the cost and efficacy of each treatment using previously published data. HRT, cyclical etidronate and salmon calcitonin all decrease the incidence of further vertebral fracture by 50-60%. Estimation of the cost per vertebral fracture averted therefore reflects the underlying cost of medication, with HRT costing 138-680 pounds per fracture averted compared with 1880 pound for cyclical etidronate therapy and 9075-25 013 pounds for salmon calcitonin therapy. HRT is therefore the treatment of choice for post-menopausal women with osteoporosis, particularly as it may also decrease the risk of ischaemic heart disease. Although salmon calcitonin appears as effective as the other treatments, it is considerably more expensive, so should be reserved for situations where HRT and cyclical etidronate are inappropriate.
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PMID:A comparison of the effectiveness and cost of treatment for vertebral fractures in women. 860 60

The article analyzes an experience with the organization of autodonation of blood and its components in surgical treatment of 305 patients with congenital and acquired defects and ischemic heart disease. Methods of plasmacytapheresis and cryopreservation used at the terms from 3 days to 12 months before operation allowed storage of the autologous components of blood in 41.2% of the patients having indications for autodonation. In 29.1% of the observations the autotransfusion media were reserved under the outpatient clinic conditions which resulted in shorter terms of treatment at the hospital. The number of unfavorable reactions during the donation in patients did not exceed analogous parameters in regular donors. Autohemotransfusions 3-5 times reduced the volume of transfusions of the allogenic blood components and they were completely avoided in 20.1% of the patients.
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PMID:[The organization of the donation of autologous blood and its components in cardiac surgery]. 912 64

Calcium-channel blockers differ in their molecular structure, their sites and modes of action. Based on rapport's about short acting calcium-channel blockers, several recent publications have questioned the safety of agents in this class, particularly nifedypine. It has been well documented that nifedypine can cause a precipitation uncontrollable drop in arterial blood pressure, which can be dangerous in the presence of ischemic heart disease, hypertension and other hemodynamically unstable situation. The cardiovascular risk for patients prescribed short-acting calcium channel blockers was eight times than for those taking, long-acting ones. Sustained-release preparations are the preferred form of therapy, as they appear, to be safer than short-acting agents. Most calcium-channel blockers, including verapamil, diltiazem, amlodypine, felodipine, nitrendipine and nicardipine have been shown to be effective in reducing symptoms of myocardial ischemia, and all have been used successfully for lowering blood pressure in hypertensive patients. Data from trials of nondihydropyridines have not demonstrated increased mortality or myocardial infarction rates in patients with myocardial ischemia and good left ventricular function. In patients with coronary artery disease and in hypertensive patients with poor left ventricular function, amlodypine or felodipine may be relatively safe alternative. Particular attention should be paid to the benefits of werapamil in postinfarct patients. In patients with hypertension, calcium-channel blockers should be reserved for use when diuretics, beta-blockers or angiotensin-converting enzyme inhibitors have been used already or contraindicated or are not tolerated and when further blood pressure reduction is necessary.
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PMID:[Views on the use of calcium channel blockers in the treatment of heart ischemia and hypertension]. 1010 70


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