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At least 775 records · Page 43Linked to original sources
PubMed1982

Reduction of occlusive coronary artery thrombosis and myocardial ischemia by molsidomine in anesthetized dogs.

The antianginal drug molsidomine was evaluated for its in vivo antithrombotic effects in barbiturate-anesthetized open-chest dogs by inducing left circumflex (LCX) coronary artery thrombosis with low-amperage stimulation (150 microA for 6 h) of the intimal surface of the vessel. Intravenous bolus administration of 0.10 mg/kg molsidomine 10 min prior to onset of electrical stimulation partially prevented occlusive LCX thrombosis and prolonged time to complete vessel occlusion by 45 min (p less than 0.05). Intracoronary thrombus mass was reduced (14 +/- 0.8 vs. 32 +/- 4 mg in controls, p less than 0.05). Final 6-h infarcts after complete LCX coronary artery thrombosis were measured by triphenyltetrazolium chloride (TTC) staining and were smaller after molsidomine pretreatment when related to left ventricular mass (14 +/- 3 vs. 28 +/- 2%, p less than 0.02) or to the LCX vessel area at risk for infarction (18 +/- 3 vs. 58 +/- 4%, p less than 0.01). Molsidomine did not induce hemodynamic alterations during time to complete thrombotic LCX coronary artery occlusion. In saline controls, heart rate and end-diastolic pressure increased whereas blood pressure and contractility decreased significantly. The percentage of ventricular ectopic beats concomitant to thrombus formation and myocardial ischemia was significantly reduced in the drug-treated dogs. Molsidomine also partially prevented the reduction in myocardial function parallel to blood flow diminution as measured with an ultrasonic technique. The drug further exerted significant ex vivo inhibition of collagen-induced platelet aggregation (p less than 0.01 vs. control from 4 h after onset of LCX stimulation). In addition to established hemodynamic effects of molsidomine there may also be a direct effect on platelet aggregation and thrombus formation in vivo which delays coronary artery narrowing and occlusion as one primary cause for myocardial ischemia.

Animals↗
PubMed1999

[Antiplatelet drugs for prevention of cerebral ischemic accidents].

Antiplatelet (AP) drugs play a major role in stroke prevention. Aspirin (50-1300 mg), ticlopidine (500 mg), clopidogrel (75 mg) and dipyridamole (400 mg) are effective in secondary prevention of atherothrombotic brain infarcts. Aspirin has been the most extensively studied drug and remains the most cost-effective one. The optimal dose is still debated; doses between 100 and 300 mg are the most widely used. The preventive efficacy of aspirin is already present at the acute phase of cerebral infarct. In primary prevention, aspirin nearly halves the risk of myocardial infarction but does not reduce that of stroke. Cardiac diseases with a high embolic risk require the use of oral anticoagulation. In non valvular atrial fibrillation, the choice of antithrombotic drugs depends on risk stratification: oral anticoagulants are indicated in high risk subjects whereas aspirin is recommended in low risk subjects and when oral anticoagulants are contraindicated. Studies with new associations of AP and with new drugs are required to increase the yield of the antiplatelet approach in high risk subjects; this should be done in parallel with efforts to detect and to treat the vascular risk factors associated with the development of a mass approach for stroke primary prevention.

Brain Ischemia↗
PubMed1980

Primary cardiomyopathies: classification, pathophysiology, clinical recognition and management.

In recent years, the definition of cardiomyopathy has been restricted to the idiopathic forms of myocardial disease and has been grouped into three general categories: (1) congestive or dilated cardiomyopathy, (2) hypertrophic cardiomyopathy, and (3) restrictive cardiomyopathy. The history and physical examination and echocardiography appear to be the most helpful in the clinical recognition of these disorders. In general, the prognosis of patients with congestive cardiomyopathy is guarded. Their survival primarily depends on the natural history and progression of the disease as well as the response to treatment with anticongestive drugs. The recent advent of vasodilator therapy has provided additional help to the patient with refractory congestive heart failure. Hypertrophic cardiomyopathy appears to be much more frequently recognized since the advent of echocardiography. The young patient has a much higher incidence of serious complications (combined right and left ventricular outflow obstruction, more generalized hypertrophic cardiomyopathy, and sudden death), and the patient presenting in later life appears to have fewer associated complications. There is a familial association with hypertrophic cardiomyopathy, although the true incidence and full expression of the association is not well understood at present. The majority of adult patients acieve prolonged survival with medical and/or surgical treatment. The restrictive cardiomyopathies are probably the least well understood. All three subgroups (Löffler's endocarditis, primary restrictive cardiomyopathy, and endomyocardial fibrosis) have a guarded prognosis. The acute form (Löffler's endocarditis) is characterized by a debilitating illness with death usually within a couple of months; however, a small percentage of these patients can have long survival and may actually evolve into a more chronic form, i.e., primary restrictive cardiomyopathy or endomyocardial fibrosis. The latter two restrictive myopathies usually have a slow indolent course, and their prognosis is primarily determined by the amount of myocardial damage and endocardial fibrosis.

Adolescent↗
PubMed2004

Cardiovascular protection with ace inhibitors--more HOPE for EUROPA?

BACKGROUND: Treatment with angiotensin converting enzyme (ACE) inhibitors reduces mortality and morbidity among patients with heart failure, left-ventricular dysfunction after myocardial infarction and with hypertension. In addition, they have been shown to slow the progression of chronic kidney disease and reduce the recurrence of stroke and vascular events. MATERIAL/METHODS: There has been an enormous interest in the potential cardioprotective effects of ACE inhibitors. This principle has been assessed in two landmark double blind placebo controlled clinical trials, HOPE and EUROPA. This article seeks to review and compare the important findings of these two clinical studies. RESULTS: In the HOPE study, ramipril once daily produced a 22% reduction in the primary composite endpoint of myocardial infarction, stroke, or cardiovascular death (P < 0.001) among an older cohort (>55 years) of patients at high risk of future cardiovascular complications. The EUROPA study assessed the effects of the ACE inhibitor perindopril in a larger group of lower risk patients with established stable cardiovascular disease. In EUROPA, once daily treatment with perindopril lead to a significant 20% relative risk reduction in the combined primary endpoint (cardiovascular mortality, non-fatal myocardial infarction, and resuscitated cardiac arrest; p = 0.0003). CONCLUSIONS: HOPE and EUROPA provide compelling evidence to suggest that all patients with evidence of stable cardiovascular disease or diabetes (plus one additional risk factor) should be treated with an ACE inhibitor.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2006

[Glucose control in cardiac disease].

The early and differentiated optimization of glucose level is essential for the improvement of the cardiovascular outcome. In all stages of cardiac disease, the primary goal is to reach near-normoglycemia. The DIGAMI-1 and 2 studies as well as the Munich Myocardial Infarction Registry successfully demonstrate, that the intensification of treatment with insulin therapy reduces the mortality of myocardial infarction. Glucose-insulin-infusion is advantageous with regard to the use of a well-controllable therapeutic approach. In non-acute cardiac disease, oral treatment strategies and insulin therapy are successful alone or in combination. Acarbose and metformin have been shown to be able to successfully prevent cardiovascular disease. New evidence of positive effects of glitazones with regard to reduction of the rate of restenosis and optimization of endothelial function is currently emerging. Prognosis of cardiovascular disease is significantly influenced by glucose control. There is evidence that the relationship between glycemia and cardiovascular events extends far beyond the diabetic threshold. This can be detected even in impaired glucose tolerance and the non-diabetic range. There is evidence that postprandial glycemia is crucial for the extent of cardiovascular risk. This has also been emphasized by the DECODE-study.

Acarbose↗
PubMed1995

Physicians as patients. Choices regarding their own resuscitation.

BACKGROUND: Attitudes toward cardiopulmonary resuscitation have changed considerably during the last 30 years. Although physicians are routinely involved in the decision making about cardiopulmonary resuscitation for their patients, little is known about their collective preferences regarding it for themselves. METHODS: A questionnaire was distributed at an internal medicine primary care review course at an urban community hospital. Of the 111 physicians registered at the meeting, 72 (65%) completed the questionnaire and serve as the basis for the results. Physicians were asked if they would want cardiopulmonary resuscitation for themselves in the presence of an acute myocardial infarction, Alzheimer's disease, and nine other advanced chronic diseases at the projected ages of 40, 60, and 80 years. RESULTS: At all projected ages, physicians' desire for cardiopulmonary resuscitation with any advanced chronic disease was significantly less than with an acute myocardial infarction (P < or = .000001 except for rheumatoid arthritis). Fewer physicians wanted cardiopulmonary resuscitation at age 80 years than at 40 years for any disease (P < or = .002). The results did not differ when analyzed by respondents' age, gender, or primary care specialty, or the size of the community in which they practiced. CONCLUSIONS: The results of this initial survey indicate that most physicians would not want cardiopulmonary resuscitation with a variety of underlying chronic diseases and corresponding functional impairments--particularly with advancing age. Conversely, with an acute myocardial infarction, all physicians surveyed would desire cardiopulmonary resuscitation at age 40 years, and many would continue to desire it with advancing age.

Acute Disease↗
PubMed2001

The acute management of myocardial infarction.

Acute myocardial infarction (AMI) is a common and potentially fatal condition. Primary prevention by reducing the risk of developing coronary atheroma disease has had an important effect on the incidence of the disease. However, for many, the first clinical presentation of their coronary atheroma is the development of acute coronary occlusion. The acute nature of such presentation is the result of the dynamic nature of the plaque event. Thus while measures such as increasing public education in areas of primary prevention are always important it needs to be recognised that real differences in outcome need to and can be made even once the event has occurred. Individuals developing chest pain need to be encouraged to present early, especially if they have a history of ischaemic heart disease. Once they have arrived at point of medical contact, rapid triage, early diagnosis and the institution of therapies designed to reduce the extent of myocardial damage are paramount.

Angioplasty, Balloon, Coronary↗
PubMed1993

Clinical experience with ventricular assist systems in Japan.

In Japan, five types of ventricular assist system, including the government-approved National Cardiovascular Center type and the Tokyo University type, were applied to 202 patients as of September 30, 1991. Adult-sized ventricular assist systems were used in 194 patients and a pediatric one in 8. The major primary diagnosis was ischemic heart disease (52.5%). Sixty-three patients in cardiogenic shock with acute myocardial infarction were treated using a ventricular assist system, and the results were fairly good. The predominant indication was failure to be weaned from cardiopulmonary bypass (72.8%), and there was no case of bridging to heart transplantation. Left ventricular assist was performed in most patients (85.1%). The duration of ventricular assist system application ranged from 1 hour to 70 days, and the mean duration was 6.8 +/- 9.6 days. Duration of circulatory support had no relation to the results, and the longest support in survivors was 25 days. The weaning rate was 50.0%, and the survival rate was 26.2%. Main causes of death were heart failure, including unrecoverable heart failure, and multiple organ failure. It should be kept in mind that the decision to use a ventricular assist system should be made quickly, before major organs, including the heart itself, are irreversibly damaged.

Adolescent↗
PubMed1999

Cardiac function at rest in hypothyroidism evaluated by equilibrium radionuclide angiography.

OBJECTIVE: Previous studies have suggested that hypothyroidism affects both systolic and diastolic cardiac function. We have applied equilibrium radionuclide angiography to the study of heart function at rest in hypothyroidism. DESIGN: A prospective study, evaluating cardiac function at rest in primary hypothyroidism. METHODS: Cardiac function was studied by means of equilibrium radionuclide angiography. Screening echo-Doppler examinations were performed on each patient. PATIENTS: Twenty-six consecutive untreated hypothyroid patients without clinical or echocardiographic cardiac disease and 20 healthy matched controls. RESULTS: Between patients and controls, the time to peak emptying rate (161 +/- 6 msec vs. 144 +/- 6 msec, P < 0.05) and the time to peak filling rate (188 +/- 6 msec vs. 170 +/- 5 msec, P < 0.05), were the only discriminatory parameters. In hypothyroid patients, a trend towards a decrease in diastolic cardiac function, expressed as peak filling rate, was observed: 2.6 +/- 0.1 End Diastolic Volume (EDV)/s vs. 3.0 +/- 0.1 EDV/s, P = 0.06. Within the hypothyroid patient group, the time to peak emptying rate was more prolonged in patients with lower free thyroxine levels (R = -0.60, F = 13.5, P < 0.001). Peak filling rate was decreased in patients with lower free thyroxine levels (R = 0.51, F = 8.4, P < 0.01) whereas the time to peak filling rate was more prolonged (R = -0.62, F = 15, P < 0.001). CONCLUSION: In a large group of consecutive patients presenting with primary hypothyroidism, even in the absence of clinical cardiac disease and echocardiographic abnormalities, clear changes in myocardial performance at rest were observed. The most obvious effect of thyroid hormone deficiency on the heart was a lengthening of both systolic and early diastolic time characteristics. Diastolic rather than systolic cardiac function was influenced by hypothyroidism.

Adult↗
PubMedDate not supplied

Principal uses of myocardial perfusion scintigraphy in the management of patients with known or suspected coronary artery disease.

The use of myocardial perfusion single photon emission computed tomography (SPECT) has undergone considerable expansion and evolution over the past 2 decades. Although myocardial perfusion imaging was first conceived as a noninvasive diagnostic tool for determining the presence or absence of coronary artery disease, its prognostic value is now well established. Thus, identification of patients at risk for future cardiac events has become a primary objective in the noninvasive evaluation of patients with chest pain syndromes and among patients with known coronary artery disease. In particular, the ability of myocardial perfusion SPECT to identify patients at low (< 1%), intermediate (1% to 5%) or high (> 5%) risk for future cardiac events is essential to patient management decisions. Moreover, previous studies have conclusively shown the incremental prognostic value of myocardial perfusion SPECT over clinical and treadmill exercise data in predicting future cardiac events. This report addresses the current role and new developments, with respect to the use of myocardial perfusion imaging, in determining patient risk for cardiac events and the cost-effective integration of such information into patient management decisions.

Coronary Disease↗
PubMed1997

Pericardial involvement in systemic sclerosis.

OBJECTIVE: To determine the frequency and histological characteristics of pericardial involvement in systemic sclerosis. METHOD: Necropsy sections of pericardium from 44 patients with systemic sclerosis were studied, together with sections from 19 age/sex matched controls. Sections were stained with haematoxylin and eosin, acid toluidine blue, and elastic van Gieson. Mast cells were counted in 10 random high power fields and the degree of fibrosis was quantified using a Chalkley count. RESULTS: Chronic pericarditis was seen in 31 (77.5%) of the systemic sclerosis cases, but in only one of the controls. The characteristic changes of uraemic pericarditis were not seen. The degree of fibrosis was greater in those with systemic sclerosis, though numbers of mast cells, thought to be important in fibrogenesis, were similar in both groups. Myocardial fibrosis was seen in 15 (37.5%) of systemic sclerosis cases but in none of the controls. CONCLUSION: The incidence of pericarditis and myocardial fibrosis is much greater than in controls. The results indicate that pericarditis is a primary disease (rather than secondary to uraemia).

Adolescent↗
PubMed1987

Alterations in cardiac sarcolemmal Ca2+ pump activity during diabetes mellitus.

Diabetes mellitus is frequently associated with a primary cardiomyopathy. The mechanisms responsible for this heart disease are not clear, but an alteration in myocardial Ca2+ transport is believed to be involved in its development. Even though sarcolemma plays a crucial role in cellular Ca2+ transport, little appears to be known about its Ca2+ transporting capability in the diabetic myocardium. In this regard, we have examined the status of the cardiac sarcolemmal Ca2+ pump during diabetes mellitus. Purified sarcolemmal membranes were isolated from male Wistar diabetic rat hearts 8 wk after streptozotocin injection (55 mg/kg iv). Ca2+ pump activity assessed by measuring its Ca2+-stimulated adenosine triphosphatase and Ca2+-uptake ability in the absence and presence of calmodulin was significantly depressed in the diabetic myocardium relative to controls. These results did not appear to have been influenced by the minimal sarcoplasmic reticular and mitochondrial contamination of this membrane preparation. Hence, it appears that the sarcolemmal Ca2+ pump is defective in the diabetic myocardium and may be involved in the altered Ca2+ transport of the heart during diabetes mellitus.

Adenosine Triphosphatases↗
PubMed2026

Sex Differences in Postoperative Recovery and Mortality After High-Risk Cardiac Surgery: A Propensity Score-Matched Post Hoc Analysis of the SUSTAIN-CSX Trial.

BACKGROUND: Sex-related differences after cardiac surgery remain controversial because women often present with higher baseline risk and complexity than men. We performed a post hoc propensity score-matched analysis of the SUSTAIN-CSX (Sodium Selenite Administration in Cardiac Surgery) trial to evaluate sex differences in mortality, postoperative complications, and recovery after high-risk cardiac surgery. METHODS: Of 1394 trial participants, 1386 had complete data. Women were matched 1:1 to men using nearest-neighbor propensity score matching based on age and European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), with exact matching on surgical category, yielding 327 female-male pairs. Prespecified sensitivity analyses adjusted for frailty, baseline hemoglobin, renal disease, left ventricular ejection fraction, previous myocardial infarction, preoperative medications, and baseline creatinine. RESULTS: In the primary matched analysis, 180-day survival did not differ between women and men (log-rank P=0.086; unadjusted hazard ratio, 1.80 [95% CI, 0.91-3.55]; P=0.091). In descriptive matched comparisons, women had numerically longer intensive care unit stay (median, 3&#x2009;days [quartile 1, quartile 3 (Q1, Q3)=1, 6&#x2009;days] versus 2&#x2009;days [Q1, Q3=1, 5&#x2009;days]) and hospital stay (median, 10&#x2009;days [Q1, Q3=7, 18&#x2009;days] versus 9&#x2009;days [Q1, Q3=6, 16&#x2009;days]; P=0.292), whereas major postoperative complications were similar. In adjusted sensitivity analyses accounting for the matched design and residual imbalance, female sex remained associated with longer intensive care unit stay (adjusted incidence rate ratio [IRR], 1.8 [95% CI, 1.2-2.9]; P=0.009) and hospital stay (adjusted IRR, 1.4 [95% CI, 1.0-1.9]; P=0.031). Mortality sensitivity analyses were model-dependent. CONCLUSIONS: In this propensity score-matched cohort of high-risk cardiac surgery patients, women showed a longer postoperative recovery trajectory in adjusted analyses, whereas mortality findings were sensitive to model specification and should be interpreted cautiously. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02002247.

Aged↗