The Stable Ischemic Heart Disease (SIHD) GUIDELINES Pocket Card is endorsed by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA). It is based on their latest guidelines. This practical quick-reference tool contains screening, risk assessment and diagnostic recommendations; multiple diagnostic and treatment tables and algorithms, drug and interventional therapy, patient education and follow-up recommendations. The Stable Ischemic Heart Disease GUIDELINES Pocket Cards provides all that is needed to make accurate clinical decisions at the point of care.. Whats Inside:. ...
Document is the second of the updated two-part criteria for coronary revascularization WASHINGTON (March 10, 2017) - The American College of Cardiology, along with several partnering organizations, today released updated appropriate use criteria for performing coronary revascularization in patients with stable ischemic heart disease.
Healio asked experts for their key takeaways from the ISCHEMIA and ISCHEMIA-CKD trials of invasive vs. conservative strategies in patients with stable ischemic heart disease.
To investigate the effects of age and disease on endogenous cardiac progenitor cells, we obtained right atrial and left ventricular epicardial biopsies from patients (n = 22) with chronic ischaemic heart disease and measured doubling time and surface marker expression in explant- and cardiosphere-derived cells (EDCs, CDCs). EDCs could be expanded from all atrial biopsy samples, but sufficient cells for cardiosphere culture were obtained from only 8 of 22 ventricular biopsies. EDCs from both atrium and ventricle contained a higher proportion of c-kit+ cells than CDCs, which contained few such cells. There was wide variation in expression of CD90 (atrial CDCs 5-92 % CD90+; ventricular CDCs 11-89 % CD90+), with atrial CDCs cultured from diabetic patients (n = 4) containing 1.6-fold more CD90+ cells than those from non-diabetic patients (n = 18). No effect of age or other co-morbidities was detected. Thus, CDCs from atrial biopsies may vary in their therapeutic potential.
This overview provides a guideline for the management of stable ischemic heart disease. It represents the work of a primary and secondary panel of participants from across Canada who achieved consensus on behalf of the Canadian Cardiovascular Society. The suggestions and recommendations are intended …
Treatment selection for stable ischemic heart disease patients remains a work in progress. The stable ischemic heart disease guidelines published in 2012 (1) address 2 pathways to progress from medical therapy only toward revascularization: unsatisfactorily controlled symptoms or high-risk features on the basis of noninvasive testing. For patients without compelling symptoms, the risk stratification by noninvasive ischemia testing provides the gateway to move beyond medical therapy only. The ongoing ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial (2) is using this measure in an attempt to identify a relatively high-risk group in whom revascularization may be beneficial. Much of the rationale for the trial springs from the failure of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial (3) or the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial (4) to show a ...
Our analysis of long-term exposure to the mass and constituents of PM2.5 and UF particles revealed several statistically significant associations with all-cause, cardiovascular, and IHD mortality. For PM2.5, high-sulfur content fuel combustion was associated with all three end points, and nitrates were associated with cardiovascular and IHD mortality. Several other constituents reached statistical significance with IHD mortality including PM2.5 mass, Cu, EC, and the SOAs, as well as the sources including gas- and diesel-fueled vehicles, meat cooking, and high-sulfur fuel combustion. Among the PM2.5 constituents, based on their associated IQRs, nitrate had the highest HR and provided the best fit of the data. For UFs, constituents such as SOA_ant, EC, and "other" metals exhibited statistically significant associations with IHD mortality, as did all of the mobile sources and high-sulfur fuel combustion. For both PM2.5 and UF particles, several constituents generated higher HRs based on their ...
The results of Bostick et al suggest that among postmenopausal women, the risk of dying of IHD may be reduced by consuming relatively high concentrations of calcium. This association seems plausible given the findings of previous research showing that higher consumption of calcium lowers blood cholesterol concentrations,1 may reduce blood pressure,2 and may prevent hypertension.. The strengths of this study are that it was prospective and included a large, well defined cohort derived from a general population. In addition, the validity of the nutritional questionnaire is impressive and well supported by published data. The limitations of the study are the many confounders related to the evaluation of the effects of vitamins and minerals on health or disease states. Data on possible confounders, such as sunlight exposure as a source of vitamin D, were not provided.. The findings suggest that there is no increase in IHD mortality as a result of increased calcium intake, provided the calcium does ...
Cardiac anatomy was defined by gated nuclear magnetic resonance (NMR) imaging at a magnetic field strength of 3.5 kGauss in eight normal subjects and 10 patients with chronic myocardial infarctions. Multisectional imaging was performed with the spin-echo technique and encompassed most of the left ventricle in an imaging time of 5 to 12 min. In all subjects internal cardiac structure was well delineated without the use of any type of contrast medium. The myocardial wall-blood interface was sharply defined, resulting in visualization of trabeculations, papillary muscle, and chordal structures in both ventricles. In patients with ischemic heart disease, the extent of postinfarctional wall thinning, aneurysms, and mural thrombi were depicted on NMR images. Images obtained with the second spin-echo (delay time = 56 msec) demonstrated high signal intensity in regions of the left ventricular chamber adjacent to the site of aneurysms or infarctions; this finding suggested stasis of blood in a region of ...
Coronary computed tomography angiography (CCTA) has recently emerged as a noninvasive method to image the coronary arteries. CCTA has a negative predictive value of nearly 100% for the detection of coronary artery disease (demonstrated in the trial known as ROMICAT). This approach has been investigated recently as a means of helping sort out which patients presenting to an emergency department with chest pain are safe to treat and then discharge as opposed to treat urgently and then admit. It is a huge challenge.. In a nonurgent setting, the guidelines state CCTA may be reasonable for patients with an intermediate pretest probability of SIHD who have at least moderate physical functioning or no disabling comorbidity. CCTA is reasonable for these same patients with an intermediate pretest probability of SIHD who a) have continued symptoms with prior normal test findings, or b) have inconclusive results from prior exercise or pharmacological stress testing, or c) are unable to undergo stress with ...
Assessment of improvement in LV function after cell therapy may be a more difficult task than simply assessing a change in overall LVEF. This may be particularly true in the setting of acute myocardial infarction where hyperdynamic contraction of remote regions may elevate LVEF. Quantified measures of LV segmental myocardial strain may allow for better recognition of these early and subtle improvements in myocardial function in the peri-infarct region following cell therapy. For example, early after reperfusion for acute myocardial infarction, there was no significant difference in the improvement in LVEF comparing patients treated with cells and controls (9). However, strain of infarcted segments improved significantly more in the cell-treated group. In another pilot study, 12 patients who received intramyocardial autologous cells during coronary artery bypass surgery were evaluated with echocardiography before and 1 year after injection (44). On average, longitudinal strain increased 40% in ...
You can manage your cookie settings via your browser at any time. To learn more about how we use cookies, please see our cookies policy. ...
Primary physicians need to know more about the prognostic and therapeutic implications of silent (asymptomatic, painless) myocardial ischemia. There is growing concern that certain asymptomatic patients with coronary artery disease, who repeatedly have silent ischemia, may be at increased risk for a serious cardiac event. This concern is based on the large number of patients with coronary artery disease whose first clinical manifestation of that disease is sudden death or a myocardial infarction.. What is silent myocardial ischemia? Usually, we equate angina with myocardial ischemia, but the former is merely the subjective manifestation of the latter, and chest pain or ...
Question - What does Reversible Myocardial Ischaemia mean ?. Ask a Doctor about diagnosis, treatment and medication for Hypothyroidism, Ask a Cardiologist
We have previously shown that intracoronary delivery of recombinant adenoviruses encoding angiogenic proteins that contain signal peptides (fibroblast growth factor-4 and fibroblast growth factor-5) ameliorate myocardial ischemia. In the present paper, we test the hypothesis that the presence of the signal peptide is an important element in the favorable effects that transgene expression has on regional flow and function in an animal model of myocardial ischemia. We performed intracoronary delivery of two different recombinant adenoviruses encoding a fibroblast growth factor-2 variant, one with a signal peptide, FGF-2LI(+sp), and one without a signal peptide, FGF-2LI(-sp). In a model of stress-induced myocardial ischemia, intracoronary injection of these recombinants resulted in mRNA and protein expression of the transferred gene. Two weeks after gene transfer, regional abnormalities in stress-induced function and blood flow were improved after delivery of FGF-2LI containing the signal peptide. ...
In patients with an intermediate likelihood for the presence of coronary artery disease (CAD), most of todays guidelines require proof of myocardial ischemia before invasive angiography. Similarly, significant myocardial ischemia should be demonstrated before revascularization. The most recent European Society of Cardiology guidelines for patients with stable coronary artery disease leave the choice of the test to the practitioner on the basis of local expertise (1). The recently published multimodality appropriateness criteria for detection and risk assessment in stable ischemic heart disease have rated various imaging modalities on the basis of existing evidence, assuming they are equally available with appropriate quality and expertise, while suggesting to keep cost-effectiveness and value in mind when ordering such tests (2).. Direct comparisons between different imaging modalities are rare, as patients have to undergo both imaging modalities as well as an invasive reference standard to ...
Ischaemic heart disease is the number one cause of death in the United States, and it is one of the leading reasons for admittance to hospitals. Also known as myocardial ischaemia, it is the condition of restricted blood flow to the heart. This is typically the result of other heart disease, including atherosclerosis.. CAUSES OF ISCHAEMIC HEART DISEASE. "Ischaemic" refers to a restriction in blood supply to any organ, and the cause of ischaemic heart disease is restricted blood flow to the heart. This is typically caused by atherosclerosis, or hardening of the arteries, in which plaque (cholesterol) attaches to the walls of the arteries and impedes blood flow. When the heart does not get enough blood, parts of it can die or become dysfunctional. When blood cannot flow to the heart, fresh oxygen cannot be supplied.. SIGNS AND SYMPTOMS OF ISCHAEMIC HEART DISEASE. Ischaemic heart disease is frequently known as "the silent killer," as it affects fourteen million Americans every year, and three to ...
The major U.S. PM2.5 sources identified, their key tracer elements, and their mean nationwide PM2.5 impacts were: Soil (Ca, Si) 0.8 ug/m3; Metals (Pb, Zn) 0.2 ug/m3; Traffic (OC, EC, NO2) 4.6 ug/m3 ; Steel (Fe, Mn) , 0.1 ug/m3; Coal Combustion (As, Se) 1.1 ug/m3; Oil Combustion (V, Ni) 0.9 ug/m3; Salt (Na, Cl) 0.1 ug/m3; Biomass burning 1.3 ug/m3; Other Sulfates (S) 4.3 ug/m3; Other Nitrates (NO3 -) 0.6 ug/m3; and, Other Organic Carbon (OC) 0.5 ug/m3. While most industrial and fossil fuel combustion categories had relative risk (RR) estimates above 1.0 for IHD deaths, coal combustion and traffic emission-related particles were among the largest and strongest PM2.5-mortality associations.. ...
The Caerphilly Prospective Ischaemic Heart Disease (IHD) Study is based on a sample of 2512 men aged 45-59 years when first seen. Nutrient intakes, estimated using a self-administered semi-quantitative food frequency questionnaire, are available for 2423 men (96 %). Amongst these, 148 major IHD events occurred during the first 5 years of follow-up. Associations were examined between these events and baseline diet. Incident IHD (new events) was negatively associated with total energy intake: men who went on to experience an IHD event had consumed 560 kJ (134 kcal)/d (6%) less at baseline than men who experienced no event (P = 0.01). The relative odds of an IHD event was 1.5 among men in the lowest fifth of energy intake, compared with 1.3,1.2,0.9 and 1.0 respectively for the other four fifths (P , 0.05). The difference in energy intake was reflected in lower intakes of every nutrient examined. When expressed as a percentage of total energy, mean intakes of men who experienced an IHD event were ...
The purpose of the ISCHEMIA trial is to determine the best management strategy for higher-risk patients with stable ischemic heart disease. This is a multicenter randomized controlled trial with a target enrollment of ~5000 patients with at least moderate ischemia on stress imaging. Patients will be assigned at random to a routine invasive strategy (INV) with cardiac catheterization (cath) followed by revascularization plus optimal medical therapy (OMT) or to a conservative strategy (CON) of OMT, with cath and revascularization reserved for those who fail OMT.. SPECIFIC AIMS. A. Primary Aim The primary aim of the ISCHEMIA trial is to determine whether an initial invasive strategy of cardiac catheterization followed by optimal revascularization, if feasible, in addition to OMT, will reduce the primary composite endpoint of cardiovascular death or nonfatal myocardial infarction in participants with SIHD and at least moderate ischemia over an average follow-up of approximately 4 years compared with ...
The purpose of the ISCHEMIA trial is to determine the best management strategy for higher-risk patients with stable ischemic heart disease. This is a multicenter randomized controlled trial with a target enrollment of ~5000 patients with at least moderate ischemia on stress imaging. Patients will be assigned at random to a routine invasive strategy (INV) with cardiac catheterization (cath) followed by revascularization plus optimal medical therapy (OMT) or to a conservative strategy (CON) of OMT, with cath and revascularization reserved for those who fail OMT.. SPECIFIC AIMS. A. Primary Aim The primary aim of the ISCHEMIA trial is to determine whether an initial invasive strategy of cardiac catheterization followed by optimal revascularization, if feasible, in addition to OMT, will reduce the primary composite endpoint of cardiovascular death or nonfatal myocardial infarction in participants with SIHD and at least moderate ischemia over an average follow-up of approximately 4 years compared with ...
Our study sheds light on why patients with mental stress ischemia were more likely to experience AECG ischemia during daily life activities. The heightened resting hemodynamics and more exaggerated peak hemodynamic response to mental stress in patients who experience daily life ischemia suggest that they may be in a chronic state of increased sympathetic arousal, and more prone to an exaggerated sympathetic systemic response to mental or exercise stress as well. The HR at rest and in response to stress was lower in our patients with daily life ischemia compared with the patients without daily life ischemia, which may represent a reflex response to the chronically increased EF and SV. We found no correlation between the level of serum epinephrine or norepinephrine at rest or at peak stress and the presence or absence of daily life ischemia, but these may not be an adequate gauge of either a chronic or an acute state of arousal or associated vascular effects.. The strong association between the ...
Market Research Future published a study report on Myocardial Ischemia Market. This report studies the global market size, industry status and forecast,
Analysis of rotational myocardial motion has been reported to be a sensitive index of myocardial ischemia. In this study, circumferential and radial myocardial strain and displacement was monitored during angioplasty balloon-induced myocardial ischemia in 8 patients undergoing percutaneous coronary intervention. The circumferential and radial variables were measured simultaneously in parasternal short-axis view at the papillary muscle level using the recently introduced speckle tracking echocardiography technique that allows 2-dimensional, angle-independent, real-time evaluation of the myocardial motion (2-dimensional strain modality). Acute regional myocardial ischemia caused a significant reduction of circumferential (-35.6 +/- 23.1%) and radial (-27.1 +/- 23.2%) strain and displacement (-49.6 +/- 27.2% and -43.2 +/- 26.8%, respectively). Simultaneously, time to the respective peak systolic values became significantly prolonged, the circumferential ischemic response in temporal domain being ...
The guidelines described here specifically address the clinical syndrome of stable ischaemic heart disease (SIHD), which is defined by the presence of confirmed obstructive coronary artery disease without recent (,1 year) acute coronary syndrome or percutaneous intervention. [2] Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2014;64:1929-1949. http://content.onlinejacc.org/article.aspx?articleid=1891717 http://www.ncbi.nlm.nih.gov/pubmed/25077860?tool=bestpractice.com This clinical syndrome includes patients with stable angina pain syndromes and patients with low-risk unstable angina. Angina is considered unstable if it occurs at rest, is new in onset, and is severe (occurs with walking 1 flight of stairs, or similar low level of exertion), or if it is increasing in severity or frequency requiring markedly less provocation in patients ...
TY - JOUR. T1 - Prevalence of silent myocardial ischaemia during exercise stress testing. Its relation to effort tolerance and myocardial perfusion abnormalities. AU - Fragasso, G.. AU - Sciammarella, M. G.. AU - Rossetti, E. E.. AU - Xuereb, R. G.. AU - Xuereb, M.. AU - Bonetti, F.. AU - Carandente, O. M.. AU - Margonato, A.. AU - Chierchia, S. L.. PY - 1992. Y1 - 1992. N2 - The number of underperfused myocardial segments, the extent of coronary artery disease and the severity of impairment of coronary flow reserve were compared in 147 consecutive patients exhibiting painful or painless ischaemic ST segment depression on exercise testing. Of 147 patients, only 61 (41%) experienced angina (group 1) whilst 86 (59%) did not (group 2). In the two groups coronary disease was comparable for both extent and distribution, and neither the location of transient perfusion defects nor their relation to areas of old myocardial necrosis appeared to influence the presence or absence of chest pain. However, ...
Introduction The cardiac localization of hydatid cyst (HC) is rare and little known. It is exceptionally primary and isolated. Myocardial ischemia remains an exceptional and unusual manifestation of this localization. We report the original observation of cardiac HC revealed by acute myocardial ischemia in a young subject. Observation A 35-year-old patient with no notable pathological history was admitted to our department via the emergency room for acute anterior chest pain. The somatic examination was without abnormalities as well as the baseline biological tests. The electrocardiogram demonstrated epicardial ischemia in the infero-lateral territory without other abnormalities. The cardiac troponin I was slightly elevated (32ng/l, N|19ng/l). Subsequent controls after 30min, 60min and 180min did not show significant variations. Subsequent investigations (CT, coro-CT, coronary angiography) led to the diagnosis of intramyocardial HC of the left ventricle, with no abnormalities of the coronary arteries.
We have evaluated an intracardiac technique for the study of the electrophysiological patterns of early or subendocardial ischaemia in man. Simultaneous recordings of the paced endocardial evoked response and monophasic action potentials were obtained during pacing stress testing in 10 patients with reversible myocardial ischaemia. Early patterns of change occurred in both these recordings in response to regional ischaemia. Abnormal rate corrected shortening of the local repolarisation time in the paced endocardial evoked response from the left ventricular ischaemic zone diverging from control non-ischaemic values by a mean of 10.6% was paralleled by decreases in the simultaneous paced monophasic action potentials duration. A differential delay in the local activation time and conduction was also documented by the paced endocardial evoked response and monophasic action potential electrodes. Non-ischaemic control zones showed no changes in the pattern of activation and repolarisation. Disparate ...
During the more than 15 years since the conduct of the COURAGE trial, the evaluation and management of coronary disease continued to evolve, and our assessment of the risk of transitioning from stable to unstable ischemic disease shifted from the importance of what has been termed hemodynamically significant stenoses, even as defined using fractional flow reserve (12), to total atherosclerotic burden, which can be assessed noninvasively with coronary calcium scoring (13, 14). At the same time, invasive and medical therapies for stable disease significantly improved with the use of drug-eluting stents, better antithrombotic regimens, and more aggressive lipid-lowering therapies and goals.. Thus, the stage was set then for the ISCHEMIA trial, addressing the same questions in the current era (2). Dr. Hochman and her collaborators studied, in stable patients with moderate or severe ischemia on a stress test, whether there was a benefit of performing coronary angiography and, if feasible, ...
TY - JOUR. T1 - Current perspectives therapeutic approach in patients with stable angina. AU - Lettino, Maddalena. AU - Falcone, Colomba. AU - Tavazzi, Luigi. PY - 2005/1. Y1 - 2005/1. N2 - Which therapeutic strategy among medical, interventional and surgical options should be preferred in patients with chronic stable ischemic heart disease is an important public health problem. The available scientific evidence does not help much to facilitate the choice among the three available strategies of medical treatment, percutaneous coronary intervention and coronary artery bypass grafting. In this area practice-based medicine overwhelms evidence-based medicine. However, existing findings are discussed. The present experience in diabetic patients is highlighted; in such patients surgery is generally recommended but the results obtained by percutaneous coronary intervention with the currently available tools are improving markedly. Pharmacological therapy is also improving, particularly in the ...
Introduction: Stem cell therapy is a new strategy for chronic ischemic heart disease in patients, however, no consensus exists on the most optimal delivery strategy.. Hypothesis: This randomized study was designed to assess cell delivery efficiency of intracoronary (IC), transendocardial (TE) and surgical delivery in a chronic pig model of ischemia-reperfusion injury.. Methods: Twenty-one animals underwent delivery of 107 autologous Indium-oxine labeled bone marrow-derived mesenchymal stem cells (MSC) 4 weeks after infarction and were randomized to 1 of 3 groups (n=7 each group): IC, TE using electromechanical mapping guidance (NOGA) or surgical delivery. Primary endpoint was defined as percentage (%) of injected dose per organ and assessed by in vivo gamma-emission counting.. Results: No significant difference in hemodynamics was observed. Troponin and intracoronary flow (Thrombolysis in Myocardial Infarction score) did not differ between the percutaneous groups. Blinded endpoint analysis ...
It is difficult now to perceive why coronary thrombosis was regarded 25 years ago as an inconstant and irrelevant consequence of acute infarction rather than its prime cause. Once angiography was carried out soon after the onset of infarction, and it was realised that the subtending artery was totally blocked but spontaneously reopened with time in many cases (and that this reopening was accelerated by fibrinolytic treatment), thrombosis was seen as a major causal factor in occlusion. Suddenly the clinical world found thrombi to be both dynamic and important. Pathologists had thought thrombi were important but did not realise how dynamic they could be. Sequential angiograms taken over some years in patients with chronic ischaemic heart disease also changed perceptions. It was realised that a significant proportion of the thrombotic occlusions causing infarction did not develop at sites where there was pre-existing high grade stenosis, or even a plaque identified at all. Sixty eight per cent of ...
F. Appreciate the competing modalities for detection of chronic ischemic heart disease including myocardial perfusion scintigraphy, stress echo, stress MRI, cardiac CT, exercise ECG and PET. Be able to enlist advantages and disadvantages of each ...
PubMed comprises more than 30 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.
The word is finally in from the massive multicenter, international ISCHEMIA trial: For patients with severe but stable ischemic heart disease, invasive treatment with PCI or bypass surgery offers no benefit above optimal medical therapy alone ...
TUESDAY, March 31, 2020 (HealthDay News) -- Folks with clogged arteries do as well with medication and lifestyle changes as they do after undergoing invasive procedures to reopen their blood vessels, a major new clinical trial reports.. Bypass surgery, balloon angioplasty and stenting are no better than drugs, eating right and exercising at reducing the risk of heart attack and death in people with stable ischemic heart disease, a condition where theres been no heart attack but the heart is under strain from clogged arteries, trial results show.. "No matter how you look at it, theres no statistically significant difference overall," said study chair Dr. Judith Hochman, senior associate dean for clinical sciences at the NYU Grossman School of Medicine.. These results indicate that tens of thousands of elective procedures to reopen clogged arteries are performed on people whose health wont benefit from it, Hochman noted.. The best that can happen is people suffering daily or weekly chest pain ...
Invasive procedures such as bypass surgery and stenting-commonly used to treat blocked arteries-are no better at reducing the risk for heart attack and death in patients with stable ischemic heart disease than medication and lifestyle changes alone
An animal model of stress-induced regional myocardial ischemia was used to test the hypothesis that intracoronary delivery of an adenovirus encoding fibroblast growth factor Type 5 (FGF5) would result in improved blood flow, function and neovascularization in the ischemic region of the heart. These data indicated that this approach could be used safely and effectively in resolving regional myocardial ischemia in the ameroid model. Additional unpublished studies confirmed that a similar effect was achievable through use of other angiogenic transgenes, including FGF Type 4 (FGF4). The published studies using direct intracoronary delivery of adenovirus vectors to the heart is reviewed, with a focus on safety and efficacy. A multicenter Phase 1/Phase 2 clinical trial of intracoronary delivery of FGF4 in patients with angina pectoris was initiated under joint sponsorship of Collateral Therapeutics, Incorporated, Berlex Biosciences and Schering AG. Results of this trial are reviewed. The results of this
As a member of the AUC technical panel, I am familiar with the reasoning that underlies the matrix constructed for stable ischemic heart disease (SIHD): according to the COURAGE trial, there should be no incremental survival benefit to a stent versus optimal medical therapy in my patients circumstances despite greater cost. But are body and greenback counts the only endpoints we should recognize? Reducing or eliminating symptoms and enhancing quality of life (irrespective of whether the symptoms are disabling or if medical therapy has been attempted first) are important from our patients perspective and ought to be part of the decision-making process. Why shouldnt patients participate in defining the goals of their treatment? And, why should physicians have to choose between serving the patients expectations or violating the AUC criteria? Shouldnt these be on a parallel path? From my patients viewpoint, the treatment strategy I advised was truly a patient-centered approach, and one he ...
The patient presented in the first case developed ECG changes that were initially interpreted as nonspecific, until elevated cardiac enzymes were found. At that time, he was asymptomatic, and remained that way during his hospital course. He experienced only intraoperative and brief postoperative hypotension. Nevertheless, his laboratory results indicated the presence of "silent" myocardial infarction. The ECG, is a cornerstone in the diagnosis of acute and chronic ischemic heart disease, when it fails to show conclusive evidence of infarction, the crucial step in ruling in/out the diagnosis of AMI is the measurement of myocardial enzymes in the serum. The rate of release of specific proteins differs depending on their intracellular location, molecular weight, and the local blood and lymphatic flow. The temporal pattern of marker protein release is of diagnostic importance (Graph 1). Ruling out AMI requires a test with high diagnostic sensitivity, whereas ruling in AMI requires a test with high ...
We conducted a retrospective cohort study based on a case note review to determine whether there are differences in the treatment pathways followed for men and women admitted with acute myocardial ischemia and infarction after adjusting for differences in case mix. Women were as likely as men to receive thrombolysis, but were less likely...
Abstract: Mental stress-induced myocardial ischaemia is a recognized phenomenon in patients with cardiovascular diseases. Ludwig Angina is rapidly progressive and lethal in nature. This is a case report of a 74-year-old Chinese male with ischaemic heart disease presented with severe dental infection and early signs of Ludwig Angina. The patient underestimated the severity of his own dental condition and was uncooperative. The operator attempted to inform the patient of the consequences of Ludwig Angina progression, but was stopped by the patients wife, who insisted that it would cause emotional stress and provoke acute cardiovascular event. Ultimately, the operator complied to the wifes request of not telling the patient the truth. Extraction of the infected tooth with drainage of pus via socket, antibiotics prescription and close monitoring of the patient were performed. The acute infection eventually subsided, but the patient still had not heard of the term Ludwig Angina or how his underestimation
In our rat model for ICM, pharmacological inhibition of CatA activity did not significantly improve LV global systolic function at rest; however, it did prevent wall thinning and preserve more viable myocardium in the LV infarct area and the LV noninfarcted remote myocardium without reducing LV fibrosis. In each of these parameters, SAR was more efficacious than ramipril.. We showed that this antiremodeling effect occurred not only in the ventricular infarct area and noninfarcted remote myocardium but also in the atrium. Inhibition of CatA activity hampered LA fibrosis formation and reduced gene expression of fibrillary collagen types I and III, which are known to be dysregulated in cardiac disease (14,30,31). In the heart, the predominant fibrillary collagens are the rigid type I (80%) and the elastic type III (11%), providing structure and elasticity to the ECM (14,31). The extent of this remodeling process is controlled by the balance between ECM synthesis and degradation, which is tightly ...
This is Digital Version of (Ebook) 978-0898383805 Silent Myocardial Ischemia: Proceedings of the Symposium on New Drugs and De Product Will Be Deliver
Many Americans may have ischemic episodes without knowing it. These people have ischemia without pain - silent ischemia. They may have a heart attack with no prior warning. People with angina also may have undiagnosed episodes of silent ischemia. In addition, people who have had previous heart attacks or those with diabetes are especially at risk for developing silent ischemia ...
BACKGROUND: We sought to investigate whether the paucity of anginal symptoms in patients with ischemic cardiomyopathy reflects a reduction in the severity of stress-induced myocardial ischemia. METHODS AND RESULTS: We selected 38 patients with coronary artery disease and severe left ventricular dysfunction (ejection fraction [EF ...
SAN CARLOS, Calif. -BioCardia®, Inc. [OTC: BCDA], a leader in the development of comprehensive solutions for cardiovascular regenerative therapies, today reported filing a second Investigational Device Exemption with the Food and Drug Administration (FDA) for the CardiAMP Chronic Myocardial Ischemia Trial to treat patients with refractory angina.. This second potential indication for CardiAMP investigational cell therapy of chronic myocardial ischemia (CMI) and refractory angina follows the companys FDA-approved Phase III clinical trial of CardiAMP in ischemic heart failure, which is currently enrolling patients.. Despite improvements in revascularization techniques, there is a growing population of patients with chronic angina not amenable to further revascularization that suffer with severely limiting symptoms. Recent studies suggest that as many as 15 percent of all patients undergoing cardiac catheterization have significant disease that is not amendable to revascularization. These ...
SAN CARLOS, Calif. -BioCardia®, Inc. [OTC: BCDA], a leader in the development of comprehensive solutions for cardiovascular regenerative therapies, today reported filing a second Investigational Device Exemption with the Food and Drug Administration (FDA) for the CardiAMP Chronic Myocardial Ischemia Trial to treat patients with refractory angina.. This second potential indication for CardiAMP investigational cell therapy of chronic myocardial ischemia (CMI) and refractory angina follows the companys FDA-approved Phase III clinical trial of CardiAMP in ischemic heart failure, which is currently enrolling patients.. Despite improvements in revascularization techniques, there is a growing population of patients with chronic angina not amenable to further revascularization that suffer with severely limiting symptoms. Recent studies suggest that as many as 15 percent of all patients undergoing cardiac catheterization have significant disease that is not amendable to revascularization. These ...
An apparatus and method for detecting myocardial ischemia in a subject monitors the systemic vascular resistance of the subject and detects the presence of myocardial ischemia when the systemic vascular resistance increases by at least sixty percent over a base line value. Particular apparatus describe providing a measurement corresponding to the systemic vascular resistance of the cardiovascular system. A particular invasive pressure measuring apparatus uses a flexible catheter tube insertable into the artery of the subject and a micro-manometer embedded into the outer face of the wall of the catheter tube. The outer face of the embedded micro-manometer is directly exposed to the blood in an artery and the inner face of the embedded micro-manometer is covered by the inner face of the catheter tube wall.
I have read with interest the large and long follow-up study by McCallum et al1 concerning the risk of low serum chloride on the mortality in 12 968 patients with hypertension. They concluded that an increase of the serum chloride by 1 mEq/L was associated with a 1.5% reduction of the all-cause mortality, cardiovascular disease (CVD) mortality, ischemic heart disease (IHD) mortality, and non-CVD mortality after adjusting for confounding variables. The authors recognized a bias by excluding 2000 individuals without data on the serum chloride, and also accepted that the association between low serum chloride and mortality remains unclear. Although the statistical power was satisfactory and time-dependent Cox … ...