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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Renal anemia is a well-recognized complication of chronic kidney disease (CKD). The primary cause is the deficiency of erythropoietin (EPO). There is an evident association between low hemoglobin with adverse outcomes of CKD patients. Many morbidity conditions observed in CKD patients are cardiovascular complications including left ventricular hypertrophy, ischemic heart disease, chronic heart failure, generalized atherosclerosis, and stroke. It is suggested that renal anemia, chronic renal failure, and chronic heart failure all interact to cause or worsen each other (anemia-renalcardio syndrome). Treatment of renal anemia may be successfully achieved with the use of erythropoesis-stumulating agents (ESAs), but the therapeutic benefits of ESA could be far beyond the correction of anemia. ESA can protect organs via hematopoiesis-dependent and -indemendent manner. A pleiotropic affect of EPO has been shown in the kidney, the central nervous system, and the cardiovacular system. Alarge number of CKD patients will benefit from early recognition and appropriate correction of renal anemia with ESA. Research during the past years has clearly demostrated that the administration of ESA reduced brain injury associated with stroke, blunt trauma, cytotoksicity, and prevented spinal cord injury. The correcting of anemia with ESA in patients suffering from congestive heart failure caused an improvement in cardiac function. The renal function may be improved, at least, in selected subjects, by the ESA treatment of anemia.
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PMID:[Erythropoesis-stimulating agents: past, present and future]. 2023 51

To date, there is much evidence confirming that impaired arterial elastic properties have a direct impact on prognosis in patients with chronic renal failure, arterial hypertension, or diabetes mellitus in the general population and in the elderly. At the same time, in most cohort studies the manifestations of coronary heart disease (CHD) constitute about two thirds of developed cardiovascular events (CVE); the value of arterial stiffness after CHD manifestations has not been conclusively ascertained. There are various opinions on the mechanism and pattern of this association. Rigidity of large vessels may be a marker of cardiac artery lesion, on the one hand, and promote deterioration of myocardial ischemia in the presence of coronary atherosclerosis, on the other. This review of literature discusses the pathogenetic and clinical aspects of the impact of stiffness of the great vessels on the development of CVE.
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PMID:[Arterial stiffness as a predictor of cardiovascular events in coronary heart disease]. 2036 7

In patients with chronic renal failure undergoing dialysis the mortality rate from cardiovascular conditions is 10 to 100 fold than in general population. The higher mortality rate is due not only to the influence of traditional risk factors, such as hypertension, diabetes, obesity, dyslipidemia and cigarette smoking, but also to specific factors of uremic patients. Acute complications commonly take place during routine hemodialysis treatments (HD) due to unsteadiness in the cardiovascular system balance. We will review most important cardiovascular complications during HD from hypotension to ventricular hypertrophy, from arrhythmias to sudden death, and finally myocardial ischemia. A large number of structural and functional peripheral vascular and cardiac abnormalities including electrolyte imbalance, hemodynamic instability and neuro-humoral stress exert an overwork on myocardium and lead to occurring of a single cardiovascular complication but are always strictly correlated events.
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PMID:Acute cardiovascular complications of hemodialysis. 2042 75

The quality indicators program in the community has existed in Clalit Health Services for over a decade. As a part of this program, approximately 70 evidence-based quality indicators have been defined, in 11 different domains. The indicators relate to preventive medicine (immunizations, early detection of diseases, e.g. colorectal cancer, breast cancer, hypertension, chronic renal failure), chronic disease management (diabetes, hyperlipidemia, ischemic heart disease, asthma, congestive heart failure), care of the elderly (prevention of repeated hospitalizations) and child care (obesity detection, anemia detection and treatment). The indicators program is founded on one of the worldwide leading information systems, based on a common data warehouse with data regarding sociodemographic factors, purchase of medications, health services utilization, laboratory and imaging data, as well as a unique, validated registry of chronic diseases. The program has led to progress in several domains, including control of diabetes and hyperlipidemia, pneumococcal vaccination and early detection of colorectal cancer. The program narrowed the gaps and reduced inequalities between the Arab and Jewish populations, and between socioeconomic levels. The improvement in quality indicators is based on teamwork of physicians, nurses, other health professionals and administrative staff. The day-to-day work and the major effort invested in Clalit's enrollees are reflected in the continuing improvement in clinical quality.
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PMID:[The quality indigators program in Clalit Health Services: the first decade]. 2081 90

A case of fluvastatin-induced rhabdomyolysis after coadministration of colchicine is reported. A 77 year old man with ischemic heart disease, chronic pericardial effusion, diabetes mellitus, dyslipidemia, arterial hypertension, chronic renal failure (stage 2 of classification of chronic kidney disease of National Kidney Foundation) and chronic gout presented with a generalized muscle pain. The patient had been taking 80 mg/day of fluvastatin for 4 years, and, for four weeks before presentation, he had also been taking a dose of colchicine (1.0 mg daily) for an exacerbation of gout. Investigations confirmed the diagnosis of rhabdomyolysis. Discontinuation of fluvastatin and colchicine therapy and adequate fluid administration resulted in the resolution of clinical and biochemical features of rhabdomyolysis. Although neuromuscular adverse effects of fluvastatin and colchicine are well recognized, rhabdomyolysis is rare, making this is only the second case reported of fluvastatin and colchicine co-administration induced rhabdomyolysis in literature.
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PMID:Rhabdomyolysis induced by co-administration of fluvastatin and colchicine. 2111 May 12

Three cases are reported to demonstrate the range of possible lesions and wide variation in lethal mechanisms that may be found in cases of unexpected death subsequently shown to be due to bacterial endocarditis. Case 1: A 36-year-old man was found dead on his bedroom floor surrounded by drug paraphernalia. At autopsy, acute myocardial ischemia was present caused by coronary artery ostial occlusion complicating acute bacterial endocarditis of the aortic valve. Case 2: A 54-year-old man with chronic renal failure was found dead in bed at home. At autopsy, a left middle cerebral artery territory cerebral infarct was present due to septic embolization from bacterial endocarditis involving the aortic valve. Case 3: A 23-year-old man was found collapsed in a pool of blood. At autopsy, upper airway hemorrhage from an arteriobronchial fistula was present caused by septic pulmonary infarction from previous endocarditis of a congenital ventricular septal defect. This report demonstrates that bacterial endocarditis may still be a cause of sudden and unexpected death presenting to forensic mortuaries and that the underlying mechanisms may involve complex sequences of pathological changes that compromise vascular function.
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PMID:Sudden death as a complication of bacterial endocarditis. 2151 91

We herein present the case of a 66-year-old man with both gastric cancer and an infrarenal abdominal aneurysm. The patient's medical history included bladder cancer, chronic renal failure, and ischemic heart disease. We performed a simultaneous endovascular aneurysm repair (EVAR) and total gastrectomy. Following the procedure, the patient remained in the intensive care unit for 3 days. Oral feeding was resumed on postoperative day 7, and the patient was discharged from the hospital on postoperative day 13 with no complications. Despite the patient's medical problems and higher operative risk, he tolerated simultaneous EVAR and total gastrectomy, and had a good outcome after undergoing these simultaneous procedures.
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PMID:Simultaneous total gastrectomy and endovascular repair of an abdominal aortic aneurysm: report of a case. 2153 50

The observation that renal failure leads to 'uraemia' through retention of solutes that would otherwise be excreted by healthy kidneys, has been formulated as early as the first half of 19th century. The discovery of osmosis and a colloid membrane facilitated the first testing ofdialysis, originally in animals and in the first quarter of 20th century also in humans. In the mid 1940s, dialysis became the method of choice for the treatment of acute renal failure. At the beginning of 1960s, the development of long-term venous access made programmes of chronic haemodialysis possible in many countries. These achievements, together with kidney transplantation, saved or significantly extended life of millions of patients with chronic renal failure. The last 50 years saw a dramatic increase in the number of chronically dialyzed patients; the safety and efficacy of haemodialysis methods improved and effective treatments have been introduced of a number of complications associated with chronic renal failure (e.g. hypertension, anaemia or bone disease). Despite this, mortality of, particularly older chronically dialyzed patients, is very high and their quality of life sometimes low. High cardiovascular mortality, frequently due to chronic heart failure and sudden death (unlike ischemic heart disease in healthy population), is a dominating problem. However, it is difficult to reduce the high cardiovascular morbidity and mortality of haemodialyzed patients. Patient prognosis might probably be improved by more frequent use of convective methods of blood purification and frequent haemodialysis as well as effective management ofdyslipidemia. Nevertheless, early diagnosis of patients with chronic renal insufficiency and early management of all general as well as renal failure-specific risk factors in patients with mild to moderate chronic renal insufficiency is essential if the prognosis ofhaemodialyzed patients is to be improved. Future developments of renal replacement therapies are difficult to predict. The treatment should be individualized; early transplantation, peritoneal or home (frequent) haemodialysis should be performed in younger patients and conservative treatment, in addition to chronic haemodialysis, should be used in older patients. Miniaturization as one of the potential future trends could facilitate the use of portable artificial kidney. Artificial membranes coated with proximal tubule cells and ex vivo kidney cultivation represent another interesting perspective.
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PMID:[The past, the present and the future of renal replacement therapy]. 2187 92

Omega-3 polyunsaturated fatty acids (PUFA) may modulate autonomic control of the heart because omega-3 PUFA is abundant in the brain and other nervous tissue as well as in cardiac tissue. This might partly explain why omega-3 PUFA offer some protection against sudden cardiac death (SCD). The autonomic nervous system is involved in the pathogenesis of SCD. Heart rate variability (HRV) can be used as a non-invasive marker of cardiac autonomic control and a low HRV is a predictor for SCD and arrhythmic events. Studies on HRV and omega-3 PUFA have been performed in several populations such as patients with ischemic heart disease, patients with diabetes mellitus, patients with chronic renal failure, and in healthy subjects as well as in children. The studies have demonstrated a positive association between cellular content of omega-3 PUFA and HRV and supplementation with omega-3 PUFA seems to increase HRV which could be a possible explanation for decreased risk of arrhythmic events and SCD sometimes observed after omega-3 PUFA supplementation. However, the results are not consistent and further research is needed.
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PMID:Omega-3 polyunsaturated Fatty acids and heart rate variability. 2211 Apr 43

A 67-year-old morbidly obese female with a background of stage 4 chronic renal failure, ischaemic heart disease, congestive cardiac failure, atrial fibrillation and type 2 diabetes mellitus presented with sepsis and necrotic lesions of the proximal lower limbs. Initial histological findings were consistent with the clinical diagnosis of calciphylaxis and supportive treatment was commenced with addition of a phosphate binder and dietary restriction. Due to high anaesthetic risk, her wounds were managed with larva therapy in the first instance, however, ultimately surgical debridement was the required. Repeat histology from a further biopsy revealed necrosis secondary to numerous thrombi in the cutaneous vessels and a new diagnosis of purpura fulminans was made, likely secondary to her sepsis. Unfortunately, despite aggressive medical and surgical treatment measures, this patient died of multiple organ dysfunction following a prolonged admission.
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PMID:Atypical presentation of purpura fulminans following sepsis in an adult. 2267 87


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