AnatomyOrganismsDiseasesChemicals and DrugsAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPhenomena and ProcessesInformation ScienceHealth Care
Myocardial RevascularizationMyocardiumIschemiaMyocardial IschemiaBrain IschemiaMyocardial InfarctionCoronary Artery BypassAngioplasty, Balloon, CoronaryCerebral RevascularizationTreatment OutcomeStentsMyocardial StunningTime FactorsCoronary DiseaseCoronary AngiographyHeartCoronary Artery DiseaseFollow-Up StudiesMyocardial Reperfusion InjuryDrug-Eluting StentsMyocardial ContractionVascular Surgical ProceduresReperfusion InjuryCoronary RestenosisCoronary CirculationTissue SurvivalCoronary StenosisAngina PectorisVascular PatencyProspective StudiesMyocardial ReperfusionCardiovascular AgentsLower ExtremityRetrospective StudiesAngioplastyTomography, Emission-Computed, Single-PhotonCoronary VesselsAngioplasty, BalloonPercutaneous Coronary InterventionPostoperative ComplicationsRisk FactorsCardiotonic AgentsRisk AssessmentVentricular Function, LeftVentricular Dysfunction, LeftArterial Occlusive DiseasesHeart VentriclesAmputationMesenteric Vascular OcclusionDogsLimb SalvageReperfusionPeripheral Vascular DiseasesLegKaplan-Meier EstimateElectrocardiographyDisease Models, AnimalPlatelet Aggregation InhibitorsDobutamineLaser TherapyPredictive Value of TestsIschemic Attack, TransientRenal Artery ObstructionSirolimusNeovascularization, PhysiologicThallium RadioisotopesSaphenous VeinHemodynamicsIschemic Preconditioning, MyocardialRecurrenceExercise TestEchocardiographyReoperationRetreatmentProportional Hazards ModelsGraft Occlusion, VascularRats, Sprague-DawleySeverity of Illness IndexMyocytes, CardiacPatient SelectionFemoral ArteryRats, WistarCoronary Artery Bypass, Off-PumpStroke VolumeWarm IschemiaTransmyocardial Laser RevascularizationAngiographyBlood Vessel Prosthesis ImplantationRegistriesAcute Coronary SyndromeAngina, UnstableSurvival AnalysisPopliteal ArteryInternal Mammary-Coronary Artery AnastomosisChi-Square DistributionShock, CardiogenicIschemic PreconditioningEndarterectomyCollateral CirculationSurvival Rate
ReperfusionAcuteConsistent with a reduction in ischemiaSurgical RevascularizationChronicDysfunctionTransmyocardial laser revascularizationInfarctionViable and hibernatinArea of myocardiumPercutaneousNoninvasiveRestriction in blood supplyPerfusionCardiac ischemiaLeft circumCABGVentricularMetabolicVesselAngina pectorisRecurrentPositron emission tOutcomesHibernatingOxygenPatientsArterialTissueEpicardiumSystolic and diastolicDifferentiateSymptomsHypoxiaTroponinHibernationInsufficientArteryLesionTherapiesTherapyDisease
Reperfusion12
  • Stunned myocardium is myocardium that suffers transient reversible myocardial contractile dysfunction that is caused by acute ischemia during which the blood supply is almost completely restored by reperfusion, with no metabolic deterioration. (medscape.com)
  • While effective early reperfusion of the criminal coronary artery after a confirmed AMI is the typical treatment at present, collateral myocardial ischemia-reperfusion injury (MIRI) and pertinent cardioprotection are still challenging to address and have inadequately understood mechanisms. (hindawi.com)
  • This coupled comorbidity of pathological ischemia and therapeutic reinjury of infarcted myocardium, namely, myocardial ischemia-reperfusion injury (MIRI), is particularly refractory to treatment [ 4 , 5 ]. (hindawi.com)
  • Conceptual diagram of the development and unknown mechanisms of myocardial ischemia-reperfusion injury. (hindawi.com)
  • Background: It has been demonstrated that myocardial ischemia/reperfusion (MI/R) causes renal damage. (sdu.edu.tr)
  • We reason that this term is inappropriate because it is suggestive of a single treatment effect of PCI and CABG (ie, the reestablishment of blood flow to ischemic myocardium) and obscures key mechanisms, such as the improvement in coronary flow capability in the absence of ongoing ischemia, the reperfusion in the presence of ischemia, and the prevention of myocardial infarction from CAD progression. (northwestern.edu)
  • Those factors include mechanical and reperfusion injuries, ischemia, various burns, UV rays, and radiation [ 4 - 6 ]. (hindawi.com)
  • Coenzyme Q10 is involved in the synthesis of ATP and hence is useful in preventing cellular damage during ischaemia-reperfusion injury. (drlauda.at)
  • Some animal investigations have demonstrated that emptying the left ventricle before reperfusion decreases infarct size despite the extended ischemia period. (nursingbird.com)
  • According to these investigations, the administration of Impella prior to revascularization triggers the neurohormonal cascade linked to reperfusion damage. (nursingbird.com)
  • In patients presenting with STEMI, there are three choices for acute revascularization: primary PCI, fibrinolytic therapy, and acute surgical reperfusion (used rarely). (thoracickey.com)
  • As time from symptom onset (artery occlusion) to reperfusion increases, the myocardium available to salvage decreases, which raises the risk of mortality ( 1 , 2 , 3 , 4 and 5 ). (thoracickey.com)
Acute14
  • Paralysis is a very late sign of acute arterial ischemia and signals the death of nerves supplying the extremity. (wikipedia.org)
  • Brain ischemia is insufficient blood flow to the brain, and can be acute or chronic. (wikipedia.org)
  • Inadequate blood supply to a limb may result in acute limb ischemia or chronic limb threatening ischemia. (wikipedia.org)
  • Venous problems like venous outflow obstruction and low-flow states can cause acute arterial ischemia. (wikipedia.org)
  • An aneurysm is one of the most frequent causes of acute arterial ischemia. (wikipedia.org)
  • Progenitor cell therapy is being investigated for the treatment of damaged myocardium resulting from acute or chronic cardiac ischemia and for refractory angina. (southcarolinablues.com)
  • For individuals who have acute cardiac ischemia who receive progenitor cell therapy, the evidence includes 2 randomized controlled trials (RCTs) with 200 patients, numerous small RCTs, and meta-analyses of these RCTs. (southcarolinablues.com)
  • Revascularization for Acute Coronary Syndromes Revascularization is the restoration of blood supply to ischemic myocardium in an effort to limit ongoing damage, reduce ventricular irritability, and improve short-term and long-term outcomes. (msdmanuals.com)
  • Clinical presentations include silent ischemia, angina pectoris, acute. (msdmanuals.com)
  • Acute ischemia is only a rare cause of sustained monomorphic ventricular tachycardia. (njfaint.com)
  • In the situation of acute coronary occlusion, the myocardium supplied by the occluded vessel is subject to ischemia and is referred to as the myocardium at risk (MaR). Single photon emission computed tomography has previously been used for quantitative assessment of the MaR. It is, however, associated with considerable logistic challenges for employment in clinical routine. (biomedcentral.com)
  • Hence, there is a need for more clinically feasible methods to assess MaR that can be performed after the acute revascularization. (biomedcentral.com)
  • Refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction that are usually due to an abrupt reduction in coronary blood flow. (wikem.org)
  • See also Acute coronary syndromes Two subtypes of troponin (cardiac troponin I and T) are very sensitive and specific indicators of damage to the heart muscle ( myocardium ). (wikidoc.org)
Consistent with a reduction in ischemia2
  • In animals that had TMR, there was a trend toward improved resting function and significantly improved regional stress function in the lased segments 6 months postoperatively, consistent with a reduction in ischemia. (duke.edu)
  • There was a significant improvement in regional stress function of the lased segments 6 months postoperatively in animals undergoing holmium:YAG and CO 2 laser TMR that was consistent with a reduction in ischemia. (elsevierpure.com)
Surgical Revascularization3
  • In general, surgical revascularization is recommended in more complex patients with a higher risk of myocardial infarction since it provides greater protection against future myocardial infarction. (latamlaces.org)
  • The recommendation of percutaneous revascularization for proximal/ostial lesions without significant additional coronary disease aims to reduce invasiveness, while surgical revascularization is preferred for distal lesions and complex coronary disease. (latamlaces.org)
  • Cells are delivered to specific ventricular locations by intracoronary infusion during percutaneous intervention or direct implantation with surgical revascularization. (jwatch.org)
Chronic9
  • Chronic ischemia of the brain may result in a form of dementia called vascular dementia. (wikipedia.org)
  • The term hibernating myocardium is also used to indicate chronic myocardial contractile dysfunction due to ischemia, in which there is reduced coronary blood flow at rest and increased myocardial demand results in impaired contractility. (medscape.com)
  • Schematic representation of infarction (cell death), chronic ischemia with contractile dysfunction (hibernating myocardium), and transient ischemia (stunned myocardium) with restored blood flow with transient contractile dysfunction. (medscape.com)
  • Revascularization of chronic hibernating myocardium stimulates myocyte proliferation and partially reverses chronic adaptations to ischemia. (smw.ch)
  • In patients with chronic ischemia or left ventricular systolic dysfunction, this test can indicate whether the damaged myocardium is still viable and, therefore, whether revascularization would be beneficial. (ccjm.org)
  • For individuals who have chronic cardiac ischemia who receive progenitor cell therapy, the evidence includes a nonrandomized comparative trial and systematic reviews of smaller RCTs. (southcarolinablues.com)
  • The purpose of this study was to compare changes in myocardial blood flow and function 6 months after TMR with holmium:yttrium-aluminum-garnet (holmium:YAG), carbon dioxide (CO 2 ), and xenon chloride excimer lasers in a model of chronic ischemia. (elsevierpure.com)
  • Background: Chronic lower limb ischemia develops earlier and more frequently in patients with type 2 diabetes mellitus. (unav.edu)
  • Discussion: Chronic lower limb ischemia has limited therapeutic options and constitutes a public health problem in both developed and underdeveloped countries. (unav.edu)
Dysfunction4
  • Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue i.e. hypoxia and microvascular dysfunction. (wikipedia.org)
  • Delay in revascularization is associated with increased mortality rate in patients with severe left ventricular dysfunction and viable myocardium on fluorine 18-fluorodeoxyglucose positron emission tomography imaging. (smw.ch)
  • 29% had resting left ventricular (LV) dysfunction, and 25% had ischemia. (diabetesjournals.org)
  • Ischemia adds risk that is incremental to clinical risks and LV dysfunction. (diabetesjournals.org)
Transmyocardial laser revascularization5
Infarction7
  • When ischemia is severe and prolonged, it causes myocyte death and results in loss of contractile function and tissue infarction. (medscape.com)
  • Limited evidence on clinical outcomes has suggested that there may be benefits from improving left ventricular ejection fraction, reducing recurrent myocardial infarction, decreasing need for further revascularization, and perhaps even decreasing mortality, although a recent, large, individual patient data meta-analysis reported no improvement in these outcomes. (southcarolinablues.com)
  • In this manuscript, we focus on the broad aviation medicine considerations that are required to optimally manage aircrew with established coronary artery disease in those without myocardial infarction or revascularisation (both pilots and non-pilot aviation professionals). (bmj.com)
  • As previously discussed, the keys to achieving a good outcome in patients with cardiogenic shock are rapid diagnosis, prompt supportive therapy, and expeditious coronary artery revascularization in patients with myocardial ischemia and infarction. (medscape.com)
  • Patients with less complex left main disease have the option of surgical or percutaneous revascularization, considering the risk of myocardial infarction and adverse events. (latamlaces.org)
  • The clinical manifestations of ischaemic heart disease are diverse ranging from exertion-induced angina (or stable angina, when anginal symptoms occur after physical exertion) to angina at rest (or unstable angina) and myocardial infarction, where areas of heart muscle undergo death (necrosis) as a result of a marked and prolonged ischaemia. (lusofarmaco.it)
  • The resulting ischemia (restriction in blood supply) and ensuing oxygen shortage, if left untreated for a sufficient period of time, can cause damage or death ( infarction ) of heart muscle tissue ( myocardium ). (medicalxpress.com)
Viable and hibernatin2
  • The histology of viable and hibernating myocardium in relation to imaging characteristics. (smw.ch)
  • It may require new, more granular definitions for viable and hibernating myocardium, Rao proposed. (medscape.com)
Area of myocardium1
  • CABG may be performed as an emergency procedure in the context of an ST-segment elevation MI (STEMI) in cases where it has not been possible to perform percutaneous coronary intervention (PCI) or where PCI has failed and there is persistent pain and ischemia threatening a significant area of myocardium despite medical therapy. (medscape.com)
Percutaneous2
Noninvasive2
  • Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium. (smw.ch)
  • Many studies have attempted to identify IVUS criteria that are equivalent to FFR or noninvasive ischemia testing. (acc.org)
Restriction in blood supply1
  • Ischemia or ischaemia is a restriction in blood supply to any tissue, muscle group, or organ of the body, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). (wikipedia.org)
Perfusion6
  • Ischemia can be partial (poor perfusion) or total blockage. (wikipedia.org)
  • Importantly, the intensity of fluorescence and the magnitude of change in fluorescence intensity from a defined region of the myocardium is directly proportional to myocardial perfusion under controlled conditions. (medscape.com)
  • This study evaluated long-term changes in myocardial perfusion and contractile reserve after TMR in a model of hibernating myocardium. (duke.edu)
  • CONCLUSIONS: This study found improvements in myocardial perfusion and regional and global contractile reserve 6 months after TMR in a porcine model of hibernating myocardium. (duke.edu)
  • There are many thousands of patient-years of outcome data in the literature over the past few decades documenting the superiority of SPECT and PET-MPI [myocardial perfusion imaging] for prognostic evaluation of coronary heart disease and the assessment of effectiveness of lifestyle, medical, and revascularization therapies across a broad spectrum of clinical pretest risk. (radiologytoday.net)
  • Increased myocardial oxygen consumption and vascular tone may have unfavorable effects, such as impaired peripheral organ perfusion and an increase in myocardial ischemia, which can negatively influence clinical outcomes. (nursingbird.com)
Cardiac ischemia1
Left circum1
CABG1
  • We have spent the past 6 years using near-infrared fluorescence imaging technology to study the physiology of revascularization at the time of CABG. (medscape.com)
Ventricular4
  • The concomitant presence of myocardial necrosis with myocardial ischemia, stunning, or hibernation may complicate appraisal of left ventricular (LV) function and patient management. (medscape.com)
  • Sustained ventricular tachycardia should be considered a potentially malignant arrhythmia, usually representing reentry within the ventricular myocardium. (njfaint.com)
  • Polymorphic ventricular tachycardia (non-Torsades) should be considered secondary to ischemia or metabolic disturbances until proven otherwise. (njfaint.com)
  • In nondiabetic patients, a number of factors may be used to stratify the level of risk of coronary disease, including clinical history, resting ventricular function, exercise capacity, the presence and extent of ischemia at single-photon emission-computed tomography (SPECT), or stress echo. (diabetesjournals.org)
Metabolic3
  • Ischemia causes not only insufficiency of oxygen, but also reduced availability of nutrients and inadequate removal of metabolic wastes. (wikipedia.org)
  • Myocardial ischemia--metabolic pathways and implications of increased glycolysis. (smw.ch)
  • And that may involve alternative imaging modalities, such as positron emission tomography, which can disclose metabolic activity in myocardium. (medscape.com)
Vessel2
  • During injury stimulation, the major effects on the cardiac function may be those involving mitochondria-dominated events along with potential nucleus-governed genetic/epigenetic alternations within the cardiomyocytes as well as the macrophage-led inflammation and T-cell-led immune responses underlying the myocardium-vessel interactive cascade. (hindawi.com)
  • 1 IVUS has been "corrected" for vessel size, but IVUS has not been able to factor in the amount of subtended viable myocardium. (acc.org)
Angina pectoris2
Recurrent1
  • Compared with fibrinolytic therapy, primary PCI is able to achieve higher rates of TIMI grade 3 flow and infarct artery patency, and lower rates of reinfarction, recurrent ischemia, intracranial hemorrhage, and death in randomized clinical trials ( 5 ). (thoracickey.com)
Positron emission t1
  • After 2 weeks in the low-flow state, positron emission tomography and dobutamine stress echocardiography were performed to document ischemic, viable (hibernating) myocardium in the left circumflex distribution. (duke.edu)
Outcomes3
  • Hibernating myocardium: diagnosis and patient outcomes. (smw.ch)
  • That the extent of hibernating myocardium, which is viable but dysfunctional, didn't predict clinical outcomes or LV functional recovery "is disruptive of current practice and challenges a view that's been held for decades. (medscape.com)
  • Cell therapy is currently emerging as a potential new treatment for post MI patients with the assumption that recolonization of the areas of scarred myocardium with exogenously supplied surrogates or precursors of cardiomyocytes can restore function and ultimately affect clinical outcomes. (escardio.org)
Hibernating10
  • In hibernating myocardium, contractile function can be partially or totally restored by improving coronary blood flow or by reducing oxygen demand of the myocardium. (medscape.com)
  • Rahimtoola suggested that hibernating myocardium is characterized by a state of persistently impaired myocardial and LV function at rest due to reduced coronary blood flow that can be partially or completely restored to normal by improving blood flow or by reducing oxygen demand (see the image below). (medscape.com)
  • Clinically, discerning the etiology of depressed myocardial contractile function is difficult, whether due to stunned myocardium, silent ischemia, or hibernating myocardium. (medscape.com)
  • The hibernating myocardium. (smw.ch)
  • Temporal and spatial variations in structural protein expression during the progression from stunned to hibernating myocardium. (smw.ch)
  • Hibernating myocardium: an incomplete adaptation to ischemia. (smw.ch)
  • So the analysis "seems to call into question what the definitions of viability and hibernating myocardium really are. (medscape.com)
  • The whole concept of hibernating myocardium implies that the muscle is sort of waiting for more blood flow in order to become normal. (medscape.com)
  • Extent of myocardial viability was defined 3 ways: volume of hibernating heart muscle, total volume of viable myocardium, and scar burden - all expressed as a percentage of total LV volume. (medscape.com)
  • Dobutamine stress echocardiography after 2 weeks of low-flow demonstrated severe hypocontractility at rest in the left circumflex region of all animals, with a biphasic response to dobutamine consistent with hibernating myocardium. (duke.edu)
Oxygen3
  • The PVA of measured pressure-volume loops is lower, indicating that the myocardium consumes less oxygen. (nursingbird.com)
  • The typical symptom is angina, which occurs when the oxygen supply to the myocardium is insufficient to meet its oxygen demands, and thus the heart undergoes what is called ischaemia. (lusofarmaco.it)
  • This dilation increases the oxygen supply to the myocardium in patients with coronary artery spasm (variant or Prinzmetal angina) and attenuates tobacco-induced coronary vasoconstriction. (elipesa.com)
Patients12
  • For example, patients with myocardial ischemia have a decreased blood flow to the heart and are prescribed with medications that reduce chronotrophy and ionotrophy to meet the new level of blood delivery supplied by the stenosed vasculature so that it is adequate. (wikipedia.org)
  • Diamond et al found that resting wall motion abnormalities in patients with coronary artery diseases (CADs) improve after administration of an inotropic agent (dobutamine or epinephrine) or after coronary revascularization in some vascular territories with depressed contractile function, and that such territories eventually improve after revascularization. (medscape.com)
  • All the patients had shown viable but dysfunctional myocardium that could potentially be revascularized. (medscape.com)
  • Three randomized clinical trials (RCTs), DEFER (Deferral Versus Performance of PTCA in Patients Without Documented Ischemia), FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation), and FAME 2 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2), established fractional flow reserve (FFR) as the gold standard to assess the significance of a non-left main coronary artery (LMCA) lesion. (acc.org)
  • Patients who will experience little benefit from coronary revascularization are also excluded. (medscape.com)
  • In patients with unstable angina, radionuclide testing is indicated in the identification of ischemia within the distribution of the "culprit" lesion or in remote areas. (cnr.it)
  • A further strategy would be to screen patients for existing evidence of coronary disease, with the intent of myocardial revascularization in those at greatest risk. (diabetesjournals.org)
  • sex and lipids levels are less predictive in diabetic than nondiabetic patients ( 4 ), and silent ischemia is more common ( 5 ). (diabetesjournals.org)
  • Persistence of angina is commonly observed after revascularization, as demonstrated by the high number of patients who continue to take antianginal drugs and/or still complain of angina. (lusofarmaco.it)
  • These data are confirmed by the fact that, in clinical trials evaluating the use of antianginal drugs before and after revascularization, it was shown that many patients continued to take antianginal drugs, even after a considerable period of time following revascularization. (lusofarmaco.it)
  • The aim of this study is to evaluate the feasibility, safety, and efficacy of cell therapy based on mesenchymal stromal cells derived from adipose tissue intramuscular administration to patients with type 2 diabetes mellitus with critical limb ischemia and without possibility of revascularization. (unav.edu)
  • The level of troponin is measured in the bloodstream and it is used to differentiate between unstable angina (no elevation of troponin, the myocardium is not irreversibly damaged) versus either non ST elevation MI or ST elevation MI (heart attack) in patients with chest pain . (wikidoc.org)
Arterial2
  • Ischemia is a vascular disease involving an interruption in the arterial blood supply to a tissue, organ, or extremity that, if untreated, can lead to tissue death. (wikipedia.org)
  • Arterial revascularization in coronary artery bypass surgery. (hoppalmihaly.hu)
Tissue2
Epicardium1
  • Thereafter, the infarcted area will increase by transmural progression from the endocardium to the epicardium with increasing duration of ischemia, referred to as the wavefront phenomenon[ 11 ]. (biomedcentral.com)
Systolic and diastolic1
  • Injection of myoblasts into infarcted myocardium has been shown to augment systolic and diastolic functions in experimental animal studies (7). (escardio.org)
Differentiate1
  • The theory of repopulating weakened and scarred myocardium with precursors that will differentiate into new, functioning heart muscle is intuitively exhilarating. (jwatch.org)
Symptoms2
  • The signs and symptoms of ischemia vary, as they can occur anywhere in the body and depend on the degree to which blood flow is interrupted. (wikipedia.org)
  • A sudden, brief episode (symptoms lasting only minutes) of ischemia affecting the brain is called a transient ischemic attack (TIA), often called a mini-stroke. (wikipedia.org)
Hypoxia2
  • Because nerves are extremely sensitive to hypoxia, limb paralysis or ischemic neuropathy may persist after revascularization and may be permanent. (wikipedia.org)
  • The pathophysiological nature of MIRI is the short-term disturbance of myocardial energy and metabolism caused by reflow after ischemia and hypoxia in the coronary artery and the dynamic changes in apoptosis and the prosurvival signaling pathways in response to related injury factors. (hindawi.com)
Troponin1
  • Troponin elevation in the absence of clinical evidence of ischemia should prompt a search for other causes of cardiac damage, such as myocarditis. (medscape.com)
Hibernation1
  • This finding shows that ischemic but noninfarcted myocardium can exist in a state of hibernation without cell death. (medscape.com)
Insufficient1
Artery3
Lesion1
  • Is a lesion significant and ischemia producing and, therefore, should it be treated? (acc.org)
Therapies1
  • Current developments in revascularization strategies and medical therapies such as beta-blockers and medications interfering with the action of renin-angiotensin aldosterone system have focused on remodeling. (escardio.org)
Therapy1
  • Two studies presented at the American Heart Association meeting showing only the safety and feasibility, not efficacy, of stem cell therapy in ischemia-induced heart failure evoked loud acclaim by the national media. (jwatch.org)
Disease1
  • Ischemia is the most common cause of cardiovascular disease and myocardial damage in the developed world. (southcarolinablues.com)