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)

60 patients with ischemic heart disease and angina pectoris, aged 42 to 74 years (mean 59), were included in this randomized study. All suffered from coronary disease demonstrated by ECG changes and/or positive exercise test results. Twenty percent of the patients had coronary angiograms revealing significant CAD. All patients had had typical angina pectoris episodes for a period of 22 +/- 10 months at a frequency of 4 +/- 2 attacks a week. A positive response to sublingual nitroglycerin was observed in all patients. The patients were randomly assigned to four groups (1 mg, 2.5 mg, or 5.0 mg buccal nitroglycerin and a control group with 0.8 mg sublingual nitroglycerin). Exercise testing was done by bicycle ergometer in the recumbent position at maximal work loads in 3-min periods; hemodynamic measurements were performed using a pulmonary artery catheter (Grandjean). Pulmonary artery pressure, heart rate, systemic blood pressure, and ST-segment changes in the ECG were recorded before administration of the drug as well as 5, 15, 30, 60, 120, and 180 s after administration. Exercise tests were performed 3, 30, and 180 min after administration. The study demonstrates that buccal Synchron nitroglycerin has immediate hemodynamic and clinical effects, documented by the reduction in pulmonary artery pressure values at rest and exercise and the increase in exercise tolerance and cardiac output. The best antianginal effects were achieved with the dosage of 2.5 mg buccal nitroglycerin. We conclude that buccally administered nitroglycerin has early effects similar to those of nitroglycerin administered sublingually; the hemodynamic and clinical effects, however, persist over a minimum of 180 min.
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PMID:Effect of buccal nitroglycerin on pulmonary artery pressure at rest and during exercise: a comparison with sublingual nitroglycerin in patients with coronary artery disease. 642 Oct 10

To evaluate coronary hemodynamics more precisely in ischemic heart disease, great cardiac vein flow ( GCVF ) and coronary sinus flow (CSF) were simultaneously measured before and during atrial pacing by a continuous thermodilution technique with the multithermistor catheter in 10 patients with significant coronary stenosis (narrowing of the left anterior descending artery of 75% or more) (Group 1: CAD) and 12 cases with the normal coronary artery (narrowing of 25% or less) (Group 2: NonCAD ). GCVF reflects the anterior regional flow of the left ventricle and CSF reflects total left ventricular flow. Between the two groups, no significant differences were noticed in either resting GCVF or resting CSF. However, atrial pacing induced a reduction of coronary resistance (CR) and increasing regional myocardial blood flow in both groups in the same way, and the maximal pacing provoked anginal episode in CAD group in which both the percent decrease of coronary resistance (CR) (% delta CRant 25.3% and % delta CRt 23.3%) and the percent increase of regional myocardial blood flow (% delta GCVF 49.6% and % delta CSF 40.6%) were lower than those in NonCAD group (% delta CRant 42.3%, % delta CRt 37.6%, % delta GCVF 80.6%, and % delta CSF 68.3%, respectively). These data imply that resting coronary blood flow may be maintained as normal in patients with angiographically significant coronary stenosis, though coronary reserve probably decreased in these patients. In this respect, the continuous thermodilution technique using the multithermistor catheter may be useful for the clinical estimation of coronary hemodynamics induced by various interventions. This technique can be performed repeatedly for a short time and permits simultaneous assessment of venous blood flow draining from the anterior wall and of total left ventricular flow.
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PMID:[Clinical estimation of the relation between coronary artery disease and regional myocardial blood flow by continuous thermodilution with the multithermistor catheter]. 667 78

The effect of dobutamine on exercise performance was assessed in 20 patients with ischemic heart disease (CAD) and a positive stress test. These patients had a wide range of resting left ventricular ejection fraction (range 22% to 69%, mean 42%). Each patient entered a double-blind crossover study in which two identical exercise radionuclide ventriculograms were performed in patients on dobutamine, 5 micrograms/kg/min intravenously, or placebo. Dobutamine increased resting left ventricular ejection fraction. Although ejection fraction fell with dobutamine during submaximal exercise, it remained higher than with placebo. At peak exercise, ejection fraction fell to the same level on dobutamine as with placebo. Dobutamine diminished exercise time and time to ischemia while peak pressure-rate product was unchanged. Four of 20 patients developed complex ventricular premature beats, all while on dobutamine. Although useful when administered to resting patients with acute left ventricular failure, dobutamine's effects may be deleterious in exercising patients with chronic ischemic heart disease.
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PMID:The effect of dobutamine on exercise performance in patients with symptomatic ischemic heart disease. 669 Dec 44

We used the cold pressor test as provocative of myocardial ischemia in 23 subjects evaluated for chest pain on effort. Seven of them (group N) had normal coronary arteries, and 16 (group CAD) had critical stenoses along the main branches of the left coronary artery. In both groups exposure to cold induced increase in arterial pressure and double product. Left ventricular end-diastolic pressure increased +60% from baseline (P less than 0.001). Angiocardiographic parameters, unchanged in group N, showed an impairment of left ventricular function in group CAD. End-diastolic volume increased +11% (P less than 0.01), ejection fraction decreased -8% (P less than 0.0025), with a significant reduction in segmental wall motion in the area of the diseased artery (P less than 0.001). The mean Vcf was slightly and not significantly reduced, while early-systolic and end-diastolic stress and the constant of stiffness consistently increased in both groups. The appearance or extension of ventricular wall contraction abnormalities in group CAD, in the absence of demonstrable coronary spasm and in the presence of a remarkable increase in left ventricular end-diastolic pressure and stress, was interpreted as due to ischemia secondary to increased extravascular resistances to coronary flow. The cold pressor test is proposed as a useful tool for the diagnosis and evaluation of patients with ischemic heart disease.
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PMID:Effects of the cold pressor test on the left ventricular function of patients with coronary artery disease. 687 44

Hemodynamic and metabolic studies were performed in 15 patients without heart disease (controls, group A), in 21 patients with typical stress-induced anginal pain but normal coronary and left ventricular angiograms (angina pectoris with normal arteriogram, group B), and in 10 patients with angiographically proved coronary artery disease (CAD, group C). Coronary dilatory capacity, determined by measuring total myocardial blood flow at rest and during maximal coronary vasodilatation (dipyridamole, 0.5 mg/kg i.v.), was markedly reduced in group B and C patients. In group B patients, left ventricular catheter biopsy specimens revealed no evidence of small-vessel disease, but did show histologic alterations of mitochondria. During atrial pacing, the control subjects showed no changes in myocardial lactate uptake, whereas in group B patients, myocardial lactate production occurred. In contrast to controls, patients in group B showed a significant decline in ejection fraction and circumferential fiber shortening during isometric exercise. These findings suggest that myocardial ischemia is the cause of angina pectoris in patients who have angina but normal coronary arteriograms.
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PMID:Reduced coronary dilatory capacity and ultrastructural changes of the myocardium in patients with angina pectoris but normal coronary arteriograms. 747 37

In conclusion, sevoflurane appears to be similar to isoflurane and desflurane with a few exceptions. Sevoflurane was not associated with increases in heart rate in adult patients and volunteers, whereas higher MACs of isoflurane and desflurane and rapid increases in the inspired concentrations of these two anesthetics have been associated with tachycardia. Increasing concentrations of sevoflurane progressively decrease blood pressure in a manner similar to the other volatile anesthetics, and in unstimulated volunteers this decrease may be slightly less than with isoflurane at a higher MAC. Sevoflurane appears similar to isoflurane in its effect on regional blood flows, including the hepatic, renal, and cerebral circulation. In animals, sevoflurane appears to be a slightly less potent coronary vasodilator than isoflurane, and in a dog model, sevoflurane has not been associated with coronary flow redistribution ("steal"). Sevoflurane decreases myocardial contractility in a manner similar to equianesthetic concentrations of isoflurane and desflurane, and does not potentiate epinephrine-induced cardiac arrhythmias. Sevoflurane reduces baroreflex function in a manner similar to other volatile anesthetics. In several multicenter studies where patients with CAD or patients at high risk for CAD were randomized to receive either sevoflurane or isoflurane for cardiac or noncardiac surgery, the incidence of myocardial ischemia, infarction, and cardiac outcomes did not differ between treatment groups. Thus, sevoflurane has not been associated with untoward cardiovascular changes in volunteers and patients undergoing elective surgery compared with other volatile anesthetics, and it appears to offer a more stable heart rate profile than either isoflurane or desflurane.
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PMID:Cardiovascular responses to sevoflurane: a review. 748 43

We aimed to assess the relationship between frequent and complex ventricular ectopy by continuous electrocardigraphic 24-hours Holter monitoring in patients with coronary artery disease and inducible ischemia during exercise procedures. We investigated 609 consecutive patients. They were referred for chest pain (28% with a previous myocardial infarction, older than 6 months). In all population patients radionuclide ventriculography showed a global normal or mildly reduced left ventricular function (ejection fraction > 45%). All patients showed exercise-induced myocardial ischemia (ST depression) and exercise thallium-201 reversible defects. During Holter monitoring, in study population, divided according to incidence of premature ventricular complexes (PVC), we found a higher prevalence of complex ventricular arrhythmias (CVA) (bigeminy, couplets, ventricular tachycardia, multiformity) in patients with high incidence of PVC. The relationship between frequent and complex ventricular ectopy has been observed also during ischemic ST shifts occuring during 24-hours monitoring. In contrast, the R on T phenomenon was not related to incidence of PVC. Therefore, in patients with exercise-induced myocardial ischemia and global normal or mildly reduced left ventricular function there is a relationship between frequent and complex ventricular ectopy, as previously suggested in CAD patients with depressed left ventricular function.
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PMID:Incidence and complexity of ventricular ectopy during Holter monitoring in patients with exercise-induced myocardial ischemia and normal or mildly reduced left ventricular function. 756 35

CAD is present in most patients with peripheral arterial disease and is the leading cause of morbidity and mortality after vascular operations. Clinical risk assessment attempts to identify those patients at low, intermediate, or high cardiac risk for adverse cardiac outcomes. Additional tests add little information to the estimates obtained by clinical scoring in patients at low risk. Patients with high cardiac risk scores are clearly at increased risk of experiencing postoperative complications, but further investigations are needed only if knowledge of the functional severity or degree of myocardial ischemia will alter subsequent management. In general, high-risk patients should proceed to coronary angiography, intensive perioperative monitoring, alteration in the planned operation, or avoidance of surgery altogether if indications are less than compelling. Those patients identified as intermediate risk by clinical scoring benefit most from additional tests. In these patients special studies or even coronary arteriography may be useful if the vascular surgery can be delayed until myocardial revascularization is completed. Practically, preoperative cardiac work-up must also consider the indication for surgery. Patients who have threatened limbs or ruptured aneurysms or are severely symptomatic cannot afford the time involved for obtaining additional tests. Moreover, the question of what to do with the information provided by special studies is problematic in these patients. For example, if significant symptomatic or asymptomatic CAD is present in a patient with a gangrenous foot, what is gained by the delay in lower extremity revascularization required when prophylactic CABG is performed? Reports supporting prophylactic CAD intervention are nonrandomized and uncontrolled. CABG and PTCA should be performed only on the merits of the patient's cardiac symptoms and coronary artery anatomy, not to enhance safety of the proposed vascular procedure, because advances in surgical and anesthetic techniques and intraoperative and postoperative monitoring have resulted in lower morbidity and mortality of elective vascular surgery.
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PMID:Preoperative cardiac risk management. 763 11

CAD continues to be the principal cause of mortality in the United States, and the largest group of patients with CAD are those with stable angina. Among this group of patients, the most common manifestation of CAD is presence of transient episodes of myocardial ischemia. The presence of transient ischemia and not the severity of angina has been found to be associated with poor clinical outcome in patients with stable CAD. As part of a global treatment strategy for patients with stable CAD, changes in lifestyle and modification of coronary risk factors should be emphasized as an integral part of treatment. Conventional antianginal therapy is quite effective in controlling anginal attacks. Currently, several drugs and therapeutic strategies are available for the treatment of patients with angina (see Table 5). Nitrates are highly effective antianginal drugs with complex beneficial actions in patients with CAD, but their usefulness is limited by development of tolerance during long-term use. When clinically indicated, the use of nitrates should be supplemented with another longer-acting antianginal drug, such as a beta-blocker or a calcium channel blocker. Based on the available data, beta-blockers, when tolerated, seem to be the most effective antianginal drugs for most patients with stable CAD. Beta-blockers are also the most effective anti-ischemic drugs that reduce the magnitude of myocardial ischemia detected during routine daily activities. Calcium channel blockers are also effective vasodilators and good antianginal drugs. The clinician should become familiar with the different actions that this heterogeneous group of drugs has on the heart and vessels. This knowledge allows the clinician to choose the appropriate combination of different antianginal drugs for patients on an individualized basis. It is also critical to develop the treatment strategy by carefully taking into account other associated medical conditions that are frequently encountered in patients with CAD.
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PMID:Contemporary approaches in medical management of patients with stable coronary artery disease. 767 85

The effects of anaesthesia for major abdominal vascular surgery on coronary flow regulation and mechanisms of myocardial ischaemia were studied in 56 patients with CAD, using a randomized, partly double-blinded protocol. After induction with fentanyl (3 micrograms.kg-1) and thiopentone (2-4 mg.kg-1) and tracheal intubation, principal anaesthetics were nitrous oxide/oxygen (60/40) with isoflurane (n = 20), halothane (n = 19) or fentanyl (15-20 micrograms.kg-1) (n = 17). Conventional invasive techniques and coronary venous retrograde thermodilution were used to assess systemic and coronary haemodynamics. Coronary vascular resistance was estimated from myocardial oxygen extraction. Myocardial ischaemia was diagnosed by 12-lead ECG and/or anterior wall motion abnormalities by cardiokymography and/or myocardial lactate production. When adjustment of anaesthetic dose was insufficient for haemodynamic control, i.v. phenylephrine and nitroglycerine were administered to treat hypotension and hypertension or cardiac failure respectively. Measurements were performed at four specific intervals; awake, before surgery and 10 and 30 min after abdominal incision. Comparable changes of systemic haemodynamics and myocardial oxygen consumption were observed in the three groups. Coronary vasodilation was evidenced in isoflurane patients only and was linearly dose-dependent (P < 0.001). Partial Least Squares Projections to Latent Structures modelling with cross validation confirmed this dose-dependency and ruled out a clinically measurable influence by intervention drugs or simultaneous systemic haemodynamic abnormalities. The incidence of myocardial ischaemia during anaesthesia and surgery was comparable in the three groups (35, 37 and 24%, respectively) and there was an association with systemic haemodynamic aberrations in 19 of the 27 ischaemic episodes. In contrast to ischaemic halothane and fentanyl patients, isoflurane patients with ischaemia had significantly lower myocardial oxygen extraction (P = 0.008 and P = 0.001, respectively), indicating that the oxygen extraction reserve was not utilized in a normal way during ischaemia.
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PMID:Anaesthesia for abdominal vascular surgery in patients with coronary artery disease (CAD), Part I: Isoflurane produces dose-dependent coronary vasodilation. 788 99


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