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Myocardial ischemia management

Valeria Raparelli, Marco Proietti, Andrea Lenzi, Stefania Basili
Improvements in ischemic heart disease (IHD) management have been unbalanced between sexes, with coronary microvascular dysfunction considered the likely underlying reason. The Endocrine Vascular disease Approach (EVA) is an observational study ( NCT02737982) aiming to assess sex and gender interactions between coronary circulation, sexual hormones, and platelet function. Consecutive patients with IHD undergoing coronary angiography will be recruited: (1) to assess sex and gender differences in angiographic reperfusion indexes; (2) to evaluate the effects of estrogen/androgen on sex-related differences in myocardial ischemia; (3) to investigate the platelet biology differences between men and women with IHD; (4) to verify sex- and gender-driven interplay between response to percutaneous coronary intervention, platelets, sex hormones, and myocardial damage at baseline and its impact on 12-month outcomes...
December 3, 2018: Journal of Cardiovascular Translational Research
Xin Yu, Liang Ge, Liang Niu, Xin Lian, Haichun Ma, Lei Pang
Nitric oxide synthases (NOSs) are a family of enzymes that are responsible for the synthesis of nitric oxide (NO) from the amino acid L-arginine in the body. Among the three key NOSs, the expression of inducible NOS (iNOS) can only be induced by inflammatory stimuli and contribute to the large amount of NO production. iNOS-derived NO plays an important role in various physiological and pathophysiological conditions, including the ischemic heart disease. Nowadays, the development of specific iNOS inhibitors and the availability of iNOS knockout mice have provided substantial evidence to support the role of iNOS/NO signaling in the myocardium...
2018: Oxidative Medicine and Cellular Longevity
Georgios Tzanis, Alessandro Durante, Satoru Mitomo, Francesco Giannini
Coronary sinus Reducer represents a novel therapeutic option for refractory angina. As emerging evidence of both reduction in angina symptoms and reduction of myocardial ischemia burden might lead to increased Reducer implantations, knowledge on how to manage potential complications is of clinical importance. We report a successful management of scaffold migration in right atrium.
November 29, 2018: Catheterization and Cardiovascular Interventions
Anna Z Fashandi, J Hunter Mehaffey, Robert B Hawkins, Irving L Kron, Gilbert R Upchurch, William P Robinson
OBJECTIVE: Major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) at 30 days provide standardized metrics for comparison and have been adopted by the Society for Vascular Surgery's objective performance goals for critical limb ischemia. However, MALEs and MACEs have not been widely adopted within the claudication population, and the comparative outcomes after lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) remain unclear. The purpose of this study was to compare MALEs and MACEs after LEB and IEI in a contemporary national cohort and to determine predictors of MALEs and MACEs after revascularization for claudication...
December 2018: Journal of Vascular Surgery
R Brandon Stacey, Trinity Vera, Timothy M Morgan, Jennifer H Jordan, Matthew C Whitlock, Michael E Hall, Sujethra Vasu, Craig Hamilton, Dalane W Kitzman, W Gregory Hundley
BACKGROUND: Current guidelines for assessing the risk of experiencing a hospitalized cardiovascular (CV) event discourage stress testing of asymptomatic individuals; however, these recommendations are based on evidence gathered primarily from those aged < 60 years, and do not address the possibility of unrecognized "silent myocardial ischemia" in middle aged and older adults. METHODS: We performed dobutamine cardiovascular magnetic resonance (CMR) stress testing in 327 consecutively recruited participants aged > 55 years without CV-related symptoms nor known coronary artery disease, but otherwise at increased risk for a future CV event due to pre-existing hypertension or diabetes mellitus for at least 5 years...
November 22, 2018: Journal of Cardiovascular Magnetic Resonance
Basmah Safdar, Peter Ong, Paolo G Camici
Chest pain stands as one of the most frequent patient presentations in the emergency department (ED). Despite established diagnostic algorithms for identifying several important causes of chest pain, such as acute myocardial infarction (AMI), aortic dissection, and pulmonary embolism, guidance on managing patients with recurrent chest pain, one of the top 3 reasons for repeated hospitalization in the United States, is less defined. The assessment of symptoms, serial ECG, and necrosis biomarkers plays a major role in patient management...
November 2018: Clinical Therapeutics
Lorna Jane Daniels, Upasna Varma, Marco Annandale, Eleia Chan, Kimberley M Mellor, Lea Delbridge
SIGNIFICANCE: Energy stress in the myocardium occurs in a variety of acute and chronic pathophysiologic contexts including ischemia, nutrient deprivation, and diabetic disease settings of substrate disturbance. Although the heart is highly adaptive and flexible in relation to fuel utilization and routes of ATP generation, maladaptations in energy stress situations confer functional deficit. An understanding of the mechanisms which link energy stress to impaired myocardial performance is crucial...
November 12, 2018: Antioxidants & Redox Signaling
Hassan Tahir, Sajjad Ahmad, Muhammad U Awan, Bassam Omar, Joey Glass, Jason Cole
Congenital coronary anomalies are uncommon and are mostly asymptomatic; however, patients may have symptoms depending on the origin and course of anomalous artery. Very rarely, coronary anomalies can also lead to life-threatening complications especially in young athletes. A malignant course of the left main (LM) or left anterior descending (LAD) artery between aorta and pulmonary artery is considered the most significant risk factor for such complications. Various noninvasive tests are available to evaluate myocardial ischemia due to anomalous coronary artery...
August 28, 2018: Curēus
Masoud Mahdavian, Blake H Power, Shabnam Asghari, Jordan C Pike
Background: Recent studies have shown that patients diagnosed with asthma who have other chronic comorbidities have severely worse medical outcomes. However, the number of available published studies in this field is lacking. The aim of this study was to determine the effects of comorbidities in asthmatic patients based on hospitalization and mortality rates. Methods: A systematic review was conducted. Data were obtained from the electronic databases PubMed, CINAHL, and Cochrane until June 15, 2018...
2018: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Gurkirat Singh, Hemant Khemani, Rahul Singla, Shakil Shaikh, Vishal Patil, Narender Omprakash Bansal
Coronary artery aneurysm is defined as the localized dilatation of a coronary artery segment more than 1.5 times the size of adjacent normal segments. The aneurysms of the coronary arteries are rare. Coronary aneurysms can be congenital or acquired. The majority are atherosclerotic in origin. The primary complication is myocardial ischemia or infarction, sudden cardiac death with rupture being rare. Some aneurysms are diagnosed incidentally in arteries other than the culprit artery. Treatment options include medical management with anticoagulation, percutaneous intervention with covered stents or surgery...
October 2018: Cardiology Research
Thomas R Porter
In a study, published in this issue of Echo Research and Practice, Ntoskas et al. retrospectively analyzed the safety of a cardiac physiologist performing, and interpreting, Dobutamine stress echocardiography (DSE) in of 300 patients undergoing DSE for the detection of inducible reversible ischemia, myocardial viability and valvular heart disease. While safety during the tests themselves did not appear to be compromised with this unsupervised approach, the interpretation of these DSEs causes concerns regarding broad patient safety relative to misread results...
September 1, 2018: Echo Research and Practice
Cecil A Rambarat, Islam Y Elgendy, Eileen M Handberg, C Noel Bairey Merz, Janet Wei, Margo B Minissian, Michael D Nelson, Louise E J Thomson, Daniel S Berman, Leslee J Shaw, Galen Cook-Wiens, Carl J Pepine
BACKGROUND: In a prior trial of late sodium channel inhibition (ranolazine) among symptomatic subjects without obstructive coronary artery disease (CAD) and limited myocardial perfusion reserve index (MPRI), we observed no improvement in angina or MPRI, overall. Here we describe the clinical characteristics and myocardial perfusion responses of a pre-defined subgroup who had coronary flow reserve (CFR) assessed invasively. METHODS: Symptomatic patients without obstructive CAD and limited MPRI in a randomized, double-blind, crossover trial of ranolazine vs...
September 26, 2018: International Journal of Cardiology
Noriko Oyama-Manabe, Satoshi Yabusaki, Osamu Manabe, Fumi Kato, Hiromi Kanno-Okada, Kohsuke Kudo
Immunoglobulin G4 (IgG4)-related disease can affect the cardiovascular system, including the coronary arteries and pericardium and especially the walls of large and medium-sized vessels. The presence of coronary involvement is critical, as this condition can cause myocardial ischemia or sudden cardiac death. Although histopathologic examination remains the reference standard for detecting organ involvement and diagnosing IgG4-related disease, obtaining biopsy or surgical specimens from the vessel wall is still challenging...
November 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Thomas Godet, Romain Grobost, Emmanuel Futier
PURPOSE OF REVIEW: This review aims to discuss recent findings on the relationship between intraoperative arterial hypotension and organ dysfunction in surgical patients and examines the available evidence for personalizing blood pressure (BP) management as a strategy to improve patient outcome. RECENT FINDINGS: Hypotension contributes to oxygen supply-demand mismatch and may cause an ischemia-reperfusion injury which may manifest as organ dysfunction. Evidence is accumulating suggesting that hypotension is associated with acute postoperative myocardial and kidney injury, and increased risk of mortality in surgical patients...
December 2018: Current Opinion in Critical Care
Guihua Tian, Yang Sun, Shuo Liu, Chengyu Li, Shiqi Chen, Ruijin Qiu, Xiaoyu Zhang, Youping Li, Min Li, Hongcai Shang
Cardiovascular diseases (CVDs) are the major public health problem and a leading cause of morbidity and mortality on a global basis. Wenxin Keli (WXKL), a formally classical Chinese patent medicine with obvious efficacy and favorable safety, plays a great role in the management of patients with CVDs. Accumulating evidence from various animal and cell studies has showed that WXKL could protect myocardium and anti-arrhythmia against CVDs. WXKL exhibited its cardioprotective roles by inhibiting inflammatory reaction, decreasing oxidative stress, regulating vasomotor disorders, lowering cell apoptosis, and protection against endothelial injure, myocardial ischemia, cardiac fibrosis, and cardiac hypertrophy...
2018: Frontiers in Pharmacology
Jenn Rachelle U Santos, Alessandra Brofferio, Bruna Viana, Karel Pacak
Pheochromocytomas and paragangliomas (PHEOs) are rare neuroendocrine tumors. Clinical manifestations include different cardiovascular signs and symptoms, which are related to excessive secretion of catecholamines. Catecholamine-induced cardiomyopathy in PHEO (CICMPP) is a rare but dreaded complication of PHEO. Once patient is diagnosed with this condition, the prognosis is worse and a surgical risk is much higher than expected. This article focuses on how catecholamines affect the heart and the pathophysiologic mechanism of CICMPP...
September 18, 2018: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
John J Wang, Olle Pahlm, James W Warren, John L Sapp, B Milan Horáček
BACKGROUND: Criteria for electrocardiographic detection of acute myocardial ischemia recommended by the Consensus Document of ESC/ACCF/AHA/WHF consist of two parts: The ST elevation myocardial infarction (STEMI) criteria based on ST elevation (ST↑) in 10 pairs of contiguous leads and the other on ST depression (ST↓) in the same 10 contiguous pairs. Our aim was to assess sensitivity (SE) and specificity (SP) of these criteria-and to seek their possible improvements-in three databases of 12‑lead ECGs...
August 13, 2018: Journal of Electrocardiology
Sripal Bangalore, David J Maron, Jerome L Fleg, Sean M O'Brien, Charles A Herzog, Gregg W Stone, Daniel B Mark, John A Spertus, Karen P Alexander, Mandeep S Sidhu, Glenn M Chertow, William E Boden, Judith S Hochman
BACKGROUND: Patients with chronic kidney disease (CKD) and stable ischemic heart disease are at markedly increased risk of cardiovascular events. Prior trials comparing a strategy of optimal medical therapy (OMT) with or without revascularization have largely excluded patients with advanced CKD. Whether a routine invasive approach when compared with a conservative strategy is beneficial in such patients is unknown. METHODS: ISCHEMIA-CKD is a National Heart, Lung, and Blood Institute-funded randomized trial designed to determine the comparative effectiveness of an initial invasive strategy (cardiac catheterization and optimal revascularization [percutaneous coronary intervention or coronary artery bypass graft surgery, if suitable] plus OMT) versus a conservative strategy (OMT alone, with cardiac catheterization and revascularization [percutaneous coronary intervention or coronary artery bypass graft surgery, if suitable] reserved for failure of OMT) on long-term clinical outcomes in 777 patients with advanced CKD (defined as those with estimated glomerular filtration rate <30 mL/min/1...
August 1, 2018: American Heart Journal
Jessica K Zègre-Hemsey, Larisa A Burke, Holli A DeVon
Early diagnosis is critical in the management of patients with acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI), because effective therapies are time-dependent. Aims of this secondary analysis were to determine: (i) the prognostic value of symptoms for an ACS diagnosis in conjunction with electrocardiographic (ECG) and troponin results; and (ii) if any of 13 symptoms were associated with prehospital delay in those presenting to the emergency department (ED) with potential ACS...
October 2018: Research in Nursing & Health
Jae Kwan Song
Coronary artery vasospasm (CVS) is an important mechanism of myocardial ischemia and produces any of the manifestations of coronary artery disease from silent myocardial ischemia, to effort-induced angina and variant angina, to acute coronary syndrome including myocardial infarction or sudden cardiac death. The pathogenesis, characteristic clinical features, diagnosis, and treatment of CVS are summarized. Emphasis is placed on correct diagnosis of CVS using pharmacological spasm provocation test, either during coronary angiography or with echocardiographic monitoring of ventricular wall motion...
September 2018: Korean Circulation Journal
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