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Query: UMLS:C0231807 (exertional dyspnea)
 3,402 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The development of neuromotor patterns in relation to birth weight was studied in the rabbit, a perinatal brain developer. In order to induce intrauterine growth retardation and to increase the number of low birth weight rabbits, experimental ischemia to half the fetuses in each doe was achieved by total ligation of approximately 30% of spiral vessels to the placenta, during the last trimester of gestation. Following natural delivery, the rabbit pups were periodically observed for the appearance of eye-opening and righting reflex, and for the cessations of falling, circling and dragging of hind limbs. An index of neuromotor development was assigned to each rabbit by summing up the age (in days) of appearance of each of the neuromotor milestones. An association was found between low birth weight and delayed neuromotor development at 2 weeks of age. The most significant correlation was found between low birth weight and delayed disappearance of falling. The latter may represent incoordination as an expression of cerebellar dysfunction.
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PMID:Neuromotor development in relation to birth weight in rabbits. 56 25

The development of biochemical parameters (cellular DNA and protein) in relation to birth weight was studied in the rabbit, a perinatal brain developer. To induce intrauterine growth retardation and to increase the number of low-birth-weight rabbits, experimental ischemia, in half the fetuses of each doe, was achieved by total ligation of approximately 30% of uteroplacental vessels during the last third of gestation. Following natural delivery, the rabbit pups were raised until 60 days of age, at which time the brains were removed and dissected into cerebral hemispheres, cerebellum and brain stem. The amount of DNA (representing cell number) and protein (suggesting cell size) was estimated in each brain region. A significant correlation was found between low birth weight and reduced DNA in the cerebellum and reduced protein in the cerebral hemispheres. These persistent deficiencies could be related to some lasting handicaps, especially motor incoordination, as an expression of cerebellar dysfunction.
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PMID:Vascular-induced intrauterine growth retardation: relations between birth weight and the development of biochemical parameters in young rabbits. 407 72

The introduction of thrombolysis has reduced the mortality of acute myocardial infarction (MI) by 25%. Large-scale studies have revealed that especially patients over 65 benefit from this therapy. Nevertheless, many centers apply an age limit for thrombolytic therapy due to the higher risk of stroke or bleeding in elderly patients. In 1993 181 patients suffering from acute MI were admitted to the intensive care unit of the University Clinic of Internal Medicine, Graz, and 54 (29.4%) of them were treated with fibrinolytic drugs. In this paper we report on the successful thrombolytic management of acute MI in two male patients (87 and 88 years old) who were treated with 100 mg recombinant tissue-type plasminogen activator complex. As a sign of successful reperfusion a rapid increase in plasma creatinine kinase levels and fast amelioration of the ischemia-related ECG changes were observed. In the follow-up examination after four months the first patients showed only minimal exertional dyspnea and was otherwise well. The second patient died one month after MI following a laparotomy for ileus. We draw the conclusion that patients of advanced age also benefit from thrombolytic treatment of acute myocardial infarction, but the indications and contraindications have to be carefully observed.
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PMID:[Thrombolytic therapy of acute myocardial infarct in advanced age (based on 2 case reports)]. 773 94

Dynamic mitral regurgitation (MR) is typically associated with either severe systolic left ventricular dysfunction or episodes of acute myocardial ischemia. We report three patients with mild combined mitral stenosis and regurgitation and normal global left ventricular systolic function who presented with severe exertional dyspnea. Upright bicycle exercise echocardiography revealed development of severe dynamic MR in all three cases with Doppler evidence of severe pulmonary hypertension. There was no echocardiographic or electrocardiographic evidence of ischemia. Exercise echocardiography is an established tool for assessing dynamic changes in transvalvar pressure gradients. These results suggest that exercise echocardiography may also be useful for evaluating changes in severity of MR and for the assessment of dynamic changes in pulmonary artery systolic pressures.
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PMID:Exercise echocardiography in combined mild mitral valve stenosis and regurgitation. 1014 21

Each year about 550,000 new patients are diagnosed as having congestive heart failure, which for acutely symptomatic patients is also referred to as acutely decompensated heart failure. The incidence of congestive heart failure is approximately 10 per 1000 for Americans over the age of 65 years. Men and women are affected in equal numbers, and 5-year mortality has been reported to be as high as 50%. Increased longevity increases the likelihood that heart failure will develop as a consequence of pathophysiologic processes that gradually weaken the myocardium and the vascular system. Patients who present to the emergency department with complaints of shortness of breath, dyspnea on exertion, increasing lower extremity edema, and/or worsening fatigue should have heart failure included in the differential diagnosis. Heart failure patients experiencing symptoms consistent with cardiac ischemia, hypoxia, potentially lethal arrhythmias, marked hypertension, or hypotension should be immediately triaged to a critical care area. The approval of nesiritide by the U.S. Food and Drug Administration in 2001 has stimulated the development of revisions in strategies for the emergency department treatment of acute decompensated heart failure patients. The early use of nesiritide, along with topical nitroglycerin and a loop diuretic, may lead to more rapid resolution of these patients' acute symptoms and hemodynamic dysfunction.
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PMID:Acutely decompensated heart failure: opportunities to improve care and outcomes in the emergency department. 1243 25

A 63 year-old female presented with dyspnea on exertion. Her chest X-ray showed cardiomegaly, and right ventricular overload and tricuspid regurgitation were detected. Her pulmonary ventilation and blood flow scintigraphy findings were suspicious of pulmonary vascular disease; the diagnosis was pulmonary hypertension and bilateral branch pulmonary artery stenosis. After the inflammation settled, the stenotic bilateral branch pulmonary artery was reconstructed with a prosthetic vessel and the pulmonary pressure normalized immediately. A resected specimen revealed that the stenotic changes were from Takayasu's disease. The patient's postoperative course was uneventful, and pulmonary ventilation and blood scintigraphy returned to an almost normal range. At follow-up 5 years and 6 months after the operation, there was no evidence of pulmonary artery disease (eg, stenosis and/or ischemia) or of any change in the central vessels of the retina, the so-called Takayasu's retinopathy.
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PMID:Reconstruction of bilateral branch pulmonary artery stenosis caused by Takayasu's aortitis. 1527 40

Congenital anomalous origins of the coronary arteries represents a rare but well-described cause of myocardial ischemia and sudden death. Left coronary artery (LCA) arising from the right sinus of Valsalva is a rare congenital coronary anomaly that seems to be commonly associated with sudden death in young trained athletes. The possibility of a coronary artery anomaly should always be considered in young individuals with a history of chest pain or syncope, particularly if the episodes are triggered by exercise. We describe a case of congenital LCA anomaly in an asymptomatic 10-year-old girl with no family history of sudden death; no previous unexplained syncopal episodes or exercise-induced symptoms were reported. She experienced a cardiac arrest while she was resting at school and was not recoverable despite early emergency department admission and intensive prolonged cardiopulmonary resuscitation attempts. Post-mortem pathological findings revealed a single origin from the right sinus of Valsalva for both right and left coronary arteries. The LCA was compressed between the aorta and the pulmonary trunk. Histologic features suggested recent ischemia. Although sudden death can be the first manifestation of this condition, it is important to be particularly aware of prodromic symptoms: exertional dyspnea, chest pain, syncope or dizziness. Recognition during life of this coronary anomaly is mandatory to prevent the risk of sudden death and to plan surgical correction if clinically indicated.
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PMID:Exercise-unrelated sudden death as the first event of anomalous origin of the left coronary artery from the right aortic sinus. 1624 3

Little data exist to identify pediatric patients who have developed transplant coronary artery vasculopathy (CAV). Transplant patients do not exhibit the usual signs of coronary disease, making diagnosis more difficult. The aim of this study is to assess the use of myocardial perfusion imaging to identify CAV in transplant patients and to derive an incidence of occurrence. We studied pediatric cardiac transplant recipients who have undergone myocardial perfusion imaging on a routine basis. All patients from September 1999 through November 2004 with nuclear perfusion scans were included. Twenty patients age 7-24 years (mean: 12.7), 11 male and 9 female, were studied by SPECT technetium 99M tetrofosmin imaging. Sixteen of the 20 patients were studied based on a newly instituted protocol for surveillance. Transplant was 1-14 years (mean: 7.9) earlier. Patients were also studied by stress echocardiography. Six of 20 patients (30%) had a positive perfusion scan. Ages ranged from 8 to 18 years (mean: 12). Time from transplant to positive scans ranged from 1 to 9 years (mean: 5.6). One patient showed the same perfusion defect as 2 years earlier. Five patients with positive nuclear perfusion scans showed the abnormality on the initial study; one had a previous negative study 6 months earlier. Four patients who demonstrated ischemia with exercise showed resolution at rest; the other two had no resting study. Five of these six patients with abnormal perfusion scans had negative stress echocardiograms. Only one patient identified with coronary involvement reported symptoms (exertional dyspnea). Hypertension and rejection episodes were similar in all patients and in those with positive nuclear scans. Of the six patients with positive nuclear perfusion scans, two demonstrated coronary disease at cardiac catheterization. Two patients with coronary disease at catheterization had normal nuclear perfusion scans; one of two had a normal stress echo. When three imaging modalities were used, the incidence of CAV was 30%. Symptoms in pediatric patients with CAV are seldom reported. Unfortunately, coronary arteriopathy occurs frequently and might be found as early as 1 year posttransplant. Six of 20 patients had abnormal perfusion; only 1 had any other noninvasive marker. Importantly, not all patients with CAV were identified by perfusion imaging, stress echocardiography, or coronary injection alone. Therefore, transplant patients need continued evaluation by multiple modalities for detection of developing coronary lesions.
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PMID:Identification of coronary artery disease in the pediatric cardiac transplant patient. 1789 35

Cardiopulmonary exercise testing (CPET) is a well-accepted physiologic evaluation technique in patients diagnosed with heart failure and in patients presenting with unexplained dyspnea on exertion. Several variables obtained during CPET, including oxygen consumption relative to heart rate and work rate provide consistent, quantitative patterns of abnormal physiologic responses to graded exercise when left ventricular dysfunction is caused by myocardial ischemia. This concept report describes both the methodology and clinical application of CPET associated with myocardial ischemia. Initial evidence indicates left ventricular dysfunction induced by myocardial ischemia may be accurately detected by an abnormal CPET response. CPET testing may complement current noninvasive testing modalities that elicit inducible ischemia. It provides a physiologic quantification of the work rate, heart rate, and O(2) uptake at which myocardial ischemia develops. In conclusion, adding CPET with gas exchange measurements is likely to be of value in diagnosing and quantifying both overt and occult myocardial ischemia and its reversibility with treatment.
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PMID:Exercise-induced myocardial ischemia detected by cardiopulmonary exercise testing. 1923 22

Coronary arteries originating from the opposite coronary cusp and crossing the path between the aorta and the pulmonary artery are associated with ischemia and sudden cardiac death. An increased prevalence of these cases may be attributed to diagnostic advances in computed tomographic angiography (CTA). We report a retrospective review of ten patients referred for surgical intervention from March 2008 to present. Nine patients were diagnosed with right coronary arteries arising from the left coronary cusp and one patient with a left coronary artery arising from the right coronary cusp. Seven patients were male and the median age was 40 years (range, 21 to 51). Symptoms included atypical chest pain, tachy-arrythmias, diaphoresis, and dyspnea on exertion. CTA demonstrated anomalous coronary arteries arising from the opposite coronary cusp and traveling between the aorta and the pulmonary artery. Surgical intervention was performed on all ten patients with no mortality and only one re-operation requiring bypass grafting. The sixth patient in the series had concomitant atherosclerotic disease, requiring left internal mammary artery grafting to the left anterior descending coronary artery. Cardiopulmonary bypass (CPB) was utilized with moderate hypothermia in all ten patients, with retrograde and/or coronary ostial cardioplegia administration. At routine surgical follow-up, all patients were without original presenting symptoms. Patients with anomalous coronary arteries arising from the opposite coronary cusp are at risk of acute myocardial infarction and sudden cardiac death. Surgical unroofing is a viable option for this patient population and avoids coronary artery bypass grafting. Since March 2008, we have operated on ten patients presenting with this anomaly and have had excellent short-term results. Further long-term follow-up is necessary.
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PMID:Surgical intervention utilizing cardiopulmonary bypass for coronary unroofing of anomalous coronary artery. 2051 83


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