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Coronary artery spasm induced by 5-fluorouracil.  


The frequently used chemotherapeutic drug 5-fluorouracil (5-FU) is known to cause angina pectoris and arrhythmias; myocardial infarction and sudden cardiac death could occur. Potential reasons for these phenomena range from toxic/metabolic disturbances to coronary artery spasms. This report shows angiographically proven spasmophilia of the coronary arteries and contributes to the understanding of angina pectoris occurring during treatment with 5-FU. Thus, verapamil type calcium antagonists as well as nitrates should be administered primarily in patients with coronary artery disease and in all patients who had been symptomatic during 5-FU administration in order to prevent further episodes. PMID:15668828

Alter, P; Herzum, M; Schaefer, J R; Maisch, B



Intracoronary administration of a thromboxane A2 synthase inhibitor relieves acetylcholine-induced coronary spasm.  


This study sought to clarify the effectiveness of intracoronary administration of a thromboxane (TX) A2 synthase inhibitor, Ozagrel Na, to relieve coronary spasms induced by intracoronary injection of acetylcholine (ACh). An ACh spasm provocation test was performed in 92 consecutive patients with coronary spastic angina using incremental doses of 20, 50, and 80 microg into the right coronary artery, and 20, 50, and 100 microg into the left coronary artery within 20s. A coronary spasm was defined as TIMI 0 or 1 flow and an intracoronary injection of 20 mg Ozagrel Na was administered when it was provoked. Within 2 min of the administration of the TXA2 synthase inhibitor, ACh-induced coronary spasms were relieved (TIMI 3 flow) in 88.1% of procedures without complications. In only 4 cases (4.3%), it took more than 3 min to relieve the coronary spasms. Intracoronary administration of 20mg Ozagrel Na when ACh-induced spasms occurred, shortened the spasm relief time in all 7 patients (200 +/- 59s vs 111 +/- 23s, p < 0.01), improved the maximal ST segment elevation in 5 of them (3.9 +/- 3.7 mm vs 0.7 +/- 1.5 mm, p < 0.05), and stopped chest pain in 4 patients. In 4 patients who had ACh-induced coronary spasm of the left anterior descending artery, the TXB2 concentration in the coronary sinus decreased after intracoronary administration of Ozagrel Na into the left coronary artery (463 +/- 562 vs 96 +/- 45, p < 0.01). In conclusion, intracoronary administration of a TXA2 synthase inhibitor can relieve ACh-induced coronary spasms by inhibiting TXA2 synthesis in the local coronary circulation. PMID:12224820

Sueda, Shozo; Kohno, Hiroaki; Inoue, Katsuji; Fukuda, Hiroshi; Suzuki, Jun; Watanabe, Kouki; Ochi, Naoto; Kawada, Hiroyuki; Uraoka, Tadao



Coronary arterial spasm in classic angina pectoris.  


A 47-year-old black male who presented with classical angina pectoris and positive exercise test developed spasm of the right coronary artery in the vicinity of an atherosclerotic lesion resulting in transient total occlusion of the vessel. It seemed unlikely that spasm was catheter induced in this case, and the vessel relaxed promptly following nitroglycerin administration. The occurrence of severe spasm in proximity to atherosclerotic narrowing of coronary artery may contribute to stable and unstable angina, myocardial infaction, and sudden death in patients with these conditions coexisting. The awareness of such a phenomenon is necessary to avoid serious errors in the interpretation of coronary angiograms. PMID:816469

Chahine, R A; Raizner, A E; Luchi, R J



Ergonovine-Induced Alterations in Coronary Flow Velocity Preceding Onset of Occlusive Spasm in Patients Without Significant Coronary Artery Stenoses  

Microsoft Academic Search

This study examined serial changes in coronary flow velocity to elucidate the dynamic change of coronary circulation during coronary spasm. Twenty patients with variant angina and 27 control patients were studied. Coronary flow velocity was monitored using a Doppler guidewire following intracoronary ergonovine administration. In the control group, diastolic flow velocity either did not change or increased slightly in response

Tadakatsu Yamada; Mitsunori Okamoto; Takashi Sueda; Masaki Hashimoto; Hideo Matsuura; Goro Kajiyama



Comparison of electrocardiography and thallium-201 myocardial scintigraphy for the detection of ergonovine-induced coronary artery spasm: angiographic correlation  

SciTech Connect

This study was performed to determine the sensitivity of thallium imaging vs ECG monitoring for detecting coronary artery spasm noninvasively following intravenous ergonovine administration as compared to simultaneous coronary angiography. Thirty-two patients with insignificant coronary artery disease and chest pain underwent 12-lead ECG monitoring, thallium imaging, and coronary arteriography following the administration of 0.05, 0.1, 0.2, and 0.3 mg of ergonovine given 5 minutes apart or until chest pain occurred. One minute following the last dose of ergonovine, 2.5 mCi of thallium-201 was injected intravenously, and a final ECG was recorded and repeat coronary arteriography performed. Within 10 minutes following the injection of thallium, imaging was performed in the 40-degree and 70-degree left anterior oblique and anterior projections. The ECG, thallium study, and coronary arteriogram were read blindly and results were compared. The ECG, angiogram, and thallium study were read as positive if the following occurred, respectively: greater than or equal to 1 mm ST segment elevation, depression, or T wave reversal; greater than 50% vessel narrowing,; and reversible perfusion defect. Five patients were excluded from analysis because of either catheter-induced spasm, suboptimal thallium studies, or protocol violations. Of the 27 patients included for analysis, six had chest pain, five had a positive angiogram, five had a positive thallium study, and one had a positive ECG. The sensitivity of thallium vs ECG monitoring was 80% vs 25%, and the accuracy was 92% vs 80%. We conclude that thallium imaging greatly increases the noninvasive detection of ergonovine-induced coronary spasm as compared with the ECG with no loss of accuracy.

Shanes, J.G.; Pavel, D.; Blend, M.; Olea, E.; Krone, R.; Lacny, K.; Marmulstein, M.; Malik, R.; Meyer, C.; Kondos, G.T.



Coronary spasm reflects inputs from the adjacent esophageal system  

Microsoft Academic Search

ABSTRACT Mechanisms,underlying coronary spasm are still poorly understood. The aim of the study was to assess the hypothesis that fluctuations in the development,of coronary spasm might reflect inputs from the adjacent esophageal system. We enrolled patients admitted to thecoronary care unit for episodes of nocturnal angina. Seven patients with variant angina and 5 with coronary artery disease (CAD) had concurrent

Olivia Manfrini; Gabriele Bazzocchi; Alessandra Luati



Coronary spasm reflects inputs from adjacent esophageal system.  


Mechanisms underlying coronary spasm are still poorly understood. The aim of the study was to assess the hypothesis that fluctuations in the development of coronary spasm might reflect inputs from the adjacent esophageal system. We enrolled patients admitted to the coronary care unit for episodes of nocturnal angina. Seven patients with variant angina and five with coronary artery disease (CAD) had concurrent ECG and esophageal manometric monitoring. ECG monitoring documented 28 episodes of ST elevation in variant angina patients and 16 episodes of ST depression in CAD patients. Manometric analysis showed that esophageal spasms resulted remarkably more frequently in variant angina patients (143 total spasms; individual range 9-31) than in CAD patients (20 total spasms; individual range 0-9; P < 0.01). Time series analysis was used to assess fluctuations in the occurrence of abnormal esophageal waves and its relationship with spontaneous episodes of ST shift. Episodes of esophageal spasm in CAD were sporadic (<1 in 30 min) and not related to ECG-recorded ischemia. In the variant angina group, esophageal spasms were time related to ischemia (>1 into 5 min before ECG-recorded ischemia) (P < 0.05). A bidirectional analysis of causal effects showed that the influence processes between esophageal and coronary spasms were mutual and reciprocal (transfer function model, P < 0.05) in variant angina. We concluded that in variant angina patients, episodes of esophageal spasms and myocardial ischemia influenced each other. Mechanisms that cause esophageal spasm can feed back to produce coronary spasm. Coronary spasm may feed forward to produce additional episodes of esophageal spasm. PMID:16387792

Manfrini, Olivia; Bazzocchi, Gabriele; Luati, Alessandra; Borghi, Alberigo; Monari, Paola; Bugiardini, Raffaele



Ergonovine-provoked esophageal spasm during coronary angiography  

SciTech Connect

In many patients with chest pain of esophageal origin, findings are normal on routine esophageal manometry and dysmotility develops only upon provocation with ergonovine maleate. Unfortunately, ergonovine may induce myocardial ischemia in patients in whom coronary artery spasm did not occur during previous provocative testing in a cardiac laboratory - limiting its clinical usefulness. Esophageal pressure has been recorded simultaneously with ergonovine infusion during angiography in ten patients without significant arterial stenoses. In two patients their usual chest pain developed associated with esophageal spasm and without changes in coronary vessels. Simultaneous performance of angiography and manometry enhanced the diagnostic yield of provocative testing by showing esophageal motility changes. This method may detect significant changes in the esophageal motility, is easy to carry out and does not interfere with angiography. It maximizes the information gained from a single provocative test and avoids the risk of ergonovine infusion outside of a cardiac laboratory.

Lieberman, D.A.; Jendrzejewski, J.W.; McAnulty, J.H.



Evidence for emotionally-induced coronary arterial spasm in patients with angina pectoris  

Microsoft Academic Search

Twelve executives with typical angina pectoris, given a 12-minute quiz, designed to be psychologically stressful, responded with ST depressions of greater than or equal to 1.0 mm. Each of these patients was given an exercise tolerance test on an upright bicycle to induce an amount of ST depression equivalent to that observed during the quiz. A statistical analysis was made

F Schiffer; L H Hartley; C L Schulman; W H Abelmann



Possible role of high susceptibility of high-density lipoprotein to lipid peroxidative modification and oxidized high-density lipoprotein in genesis of coronary artery spasm  

Microsoft Academic Search

Recent study demonstrated high susceptibility of plasma LDL to lipid peroxidative modification in patients with variant angina. Oxidized stress state, especially oxidized LDL, may induce coronary artery spasm by its impairing effect of endothelium-dependent arterial relaxation, but precise mechanisms remain unclear. Study subjects included 93 patients who underwent coronary angiographic examination: 12 patients with coronary artery spasm provoked by ergonovine

Hirotoshi Ohmura; Yoshiro Watanabe; Chie Hatsumi; Hitoshi Sato; Hiroyuki Daida; Hiroshi Mokuno; Hiroshi Yamaguchi



Global coronary arteries spasm in a young patient  

PubMed Central

BACKGROUND Coronary artery spasm is a transient narrowing of coronary arteries that slows or stops blood flow through the artery. CASE REPORT We present a 42-year-smoker man without any medical problem who developed syncope. Coronary angiography revealed diffuse significant narrowing of proximal left anterior descending artery (LAD), 90% osteal stenosis of large obtuse marginal (OM), 90% diffuse narrowing of proximal right coronary artery (RCA), which was relieved by intracoronary administration of nitrate. He was discharged on calcium channel blockers and nitrates but one month later developed syncope again and died. CONCLUSION Multivessel coronary artery spasm should be considered in young smoker patients without any other coronary risk factors who present with syncope.

Falsoleiman, Homa; Bayani, Baktash; Dehghani, Mashalla; Moohebati, Mohsen; Rohani, Atoosheh



Alterations of Autonomic Nervous Activity Associated with Spontaneous Coronary Spasm in Patients with Variant Angina  

Microsoft Academic Search

Background and Objectives:It is now well known that coronary artery spasm plays an important role in the pathogenesis of variant angina. Previous studies have shown that stimulation of the sympathetic or para- sympathetic nervous system can provoke coronary artery spasms, although the precise causes of such spasms remain unclear. Power spectral analysis of heart rate variability has been proposed as

Nam-Ho Kim; Jin-Won Jeong; Eun Mi Park; Kyung Ho Yun; Nam Jin Yoo; Eun Mi Lee; Seok Kyu Oh; Ock Kyu Park



Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease  

PubMed Central

Background Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular CAS) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular CAS and the therapeutic efficacy of calcium channel blockers. Methods and Results Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test, with simultaneous measurements of transcardiac lactate production and of changes in the quantitative coronary blood flow. We diagnosed microvascular CAS according to lactate production and a decrease in coronary blood flow without epicardial vasospasm during the acetylcholine provocation test. We prospectively followed up the patients with calcium channel blockers for microvascular coronary artery disease. We identified 50 patients with microvascular CAS who demonstrated significant impairment of the endothelium-dependent vascular response, which was assessed by coronary blood flow during the acetylcholine provocation test. Administration of isosorbide dinitrate normalized the abnormal coronary flow pattern in the patients with microvascular CAS. Multivariate logistic regression analysis indicated that female sex, a lower body mass index, minor–borderline ischemic electrocardiogram findings at rest, limited–baseline diastolic-to-systolic velocity ratio, and attenuated adenosine triphosphate–induced coronary flow reserve were independently correlated with the presence of microvascular CAS. Receiver-operating characteristics curve analysis revealed that the aforementioned 5-variable model showed good correlation with the presence of microvascular CAS (area under the curve: 0.820). No patients with microvascular CAS treated with calcium channel blockers developed cardiovascular events over 47.8±27.5 months. Conclusions Microvascular CAS causes distinctive clinical features and endothelial dysfunction that are important to recognize as nonobstructive coronary artery disease so that optimal care with calcium channel blockers can be provided. Clinical Trial Registration URL: Unique identifier: UMIN000003839.

Ohba, Keisuke; Sugiyama, Seigo; Sumida, Hitoshi; Nozaki, Toshimitsu; Matsubara, Junichi; Matsuzawa, Yasushi; Konishi, Masaaki; Akiyama, Eiichi; Kurokawa, Hirofumi; Maeda, Hirofumi; Sugamura, Koichi; Nagayoshi, Yasuhiro; Morihisa, Kenji; Sakamoto, Kenji; Tsujita, Kenichi; Yamamoto, Eiichiro; Yamamuro, Megumi; Kojima, Sunao; Kaikita, Koichi; Tayama, Shinji; Hokimoto, Seiji; Matsui, Kunihiko; Sakamoto, Tomohiro; Ogawa, Hisao



Sumatriptan provokes coronary artery spasm in patients with variant angina: Possible involvement of serotonin 1B receptor  

Microsoft Academic Search

BackgroundSerotonin (5HT) can induce coronary artery spasm (CAS) in patients with variant angina (VA). We have previously reported that 5HT1B and 5HT2A receptors gene were expressed in human coronary arterial smooth muscle cells and that isolated coronary artery from a patient with VA showed the supersensitivity to sumatriptan (SMT), a 5HT1B\\/1D receptor agonist. The aim of the present study was

Masakatsu Shimizu; Katsuya Hata; Hideyuki Takaoka; Kenji Kanazawa; Toshiro Shinke; Hidenari Matsumoto; Satoshi Watanabe; Ryohei Yoshikawa; Hiroyuki Masai; Yoshitomo Miyamoto; Hozuka Akita; Mitsuhiro Yokoyama



Coronary artery spasm related to thiol oxidation and senescence marker protein-30 in aging.  


Abstract Background: Senescence marker protein-30 (SMP30) decreases with aging, and SMP30 knockout (KO) mice show a short life with increased oxidant stress. Aims: We assessed the effect of oxidant stress with SMP30 deficiency in coronary artery spasm and clarify its underlying mechanisms. Results: We measured vascular responses to acetylcholine (ACh) and sodium nitroprusside (SNP) of isolated coronary arteries from SMP30 KO and wild-type (WT) mice. In SMP30 KO mice, ACh-induced vasoconstriction occurred, which was changed to vasodilation by dithiothreitol (DTT), a thiol-reducing agent. However, N(?)-nitro-l-arginine-methyl ester, nitric oxide (NO) synthase inhibitor, or tetrahydrobiopterin did not change the ACh response. In isolated coronary arteries of WT mice, ACh-induced vasodilation occurred. Inhibition of glutathione reductase by 1, 3-bis(2-chloroethyl)-1-nitrosourea decreased ACh-induced vasodilation (n=10, p<0.01), which was restored by DTT. To evaluate the thiol oxidation, we measured the fluorescence of monochlorobimane (MCB) in coronary arteries, which covalently labels the total. The fluorescence level to MCB decreased in SMP30 KO mice, but with DTT treatment restored to a level comparable to that of WT mice. The reduced glutathione and total thiol levels were also low in the aorta of SMP30 KO mice compared with those of WT mice. Administration of ACh into the aortic sinus in vivo of SMP30 KO mice induced coronary artery spasm. Innovation: The thiol redox state is a key regulator of endothelial NO synthase activity, and thiol oxidation was associated with endothelial dysfunction in the SMP30 deficiency model. Conclusion: These results suggest that chronic thiol oxidation by oxidant stress is a trigger of coronary artery spasm, resulting in impaired endothelium-dependent vasodilation. Antioxid. Redox Signal. 19, 1063-1073. PMID:23320823

Yamada, Shinya; Saitoh, Shu-Ichi; Machii, Hirofumi; Mizukami, Hiroyuki; Hoshino, Yasuto; Misaka, Tomofumi; Ishigami, Akihito; Takeishi, Yasuchika



[Coronary artery spasms with normal coronary arteries as the cause of recurrent ventricular fibrillations].  


Coronary arterial spasms are thought to be responsible for acute myocardial infarction in some patients with normal coronary arteries. A report is presented on a patient with a history of Prinzmetal angina pectoris involving ST-segment elevations in the electrocardiogram and recurrent ventricular fibrillation. Selective coronary arteriography revealed normal coronary arteries. Administration of nifedipin and isosorbide dinitrate brought about prompt relief of pain. One year after cardiac catheterization the patient developed recurrent ventricular arrhythmias when administration of nifedipin was discontinued. It is concluded that coronary arterial spasms may occur in patients with normal coronaries and may cause transient myocardial ischemia with severe ventricular arrhythmias. A history of Prinzmetal angina pectoris is usually present and medical treatment consists in administration of nifedipin and isosorbide dinitrate. PMID:7256231

Hess, O M; Graf, C; Frey, R; Dettli, R; Siegenthaler, W



Perioperative coronary artery spasm leading to myocardial ischaemia after vein graft surgery.  

PubMed Central

Coronary artery spasm has been recognised recently as a possible cause of perioperative myocardial ischaemia after coronary artery bypass grafting. We report on one case and review the published reports. We emphasise the clinical picture of the patient who is liable to have spasm and the necessity for a prompt diagnosis and correct treatment. Images

Zingone, B; Salvi, A; Branchini, B



[Influence of cold-stimuli on hemodynamics and coronary diameters. Provocation of coronary artery spasm].  


In 32 patients with coronary heart disease the influence of different cold-stimuli on hemodynamic parameters and coronary artery diameter was examined during left heart catheterization. The cold pressor test (CPT) and the cold air inhalation test (CAIT) were applied to 16 patients in random sequence. 16 patients served as control group. Systolic and diastolic blood pressure increased more under CPT (by 15 and 10 mm Hg respectively) than under CAIT (by 10 and 3 mm Hg). Heart rate and left ventricular enddiastolic pressure did not change. Proximal and distal coronary segment diameters showed a slight, not statistically significant increase under cold-stimuli. All 4 patients with a history of angina pectoris at rest developed coronary spasm, some with ischemic ECG changes; spasm and symptoms disappeared spontaneously when the cold-stimulus was withdrawn. Patients with a history of angina pectoris under cold conditions showed no pathological reactions. It is concluded that two different mechanisms may cause angina pectoris under cold-stimuli. First, the oxygen-consuming effect of an increase in blood pressure, and secondly, an immediate coronary vasospastic reaction. The combined use of CPT and CAIT seems to be an effective and safe means of identifying patients with a tendency to coronary artery spasms. PMID:6837082

Wendt, T; Schulz, W; Kaltenbach, M; Kober, G



Rho-kinase inhibition with intracoronary fasudil prevents myocardial ischemia in patients with coronary microvascular spasm  

Microsoft Academic Search

ObjectivesWe sought to determine whether a potent Rho-kinase inhibitor fasudil prevents the occurrence of myocardial ischemia in patients with microvascular angina attributable to coronary microvascular spasm.

Masahiro Mohri; Hiroaki Shimokawa; Yoji Hirakawa; Akihiro Masumoto; Akira Takeshita



Myocardial ischemia due to coronary artery spasm during dobutamine stress echocardiography  

Microsoft Academic Search

Dobutamine stress echocardiography (DSE) is a useful and safe provocation test for myocardial ischemia. Until now, the test has been focused only on the organic lesion in the coronary artery, and positive DSE has indicated the presence of significant fixed coronary artery stenosis. The aim of the present study is to examine whether myocardial ischemia due to coronary spasm is

Hiroaki Kawano; Hiromi Fujii; Takeshi Motoyama; Kiyotaka Kugiyama; Hisao Ogawa; Hirofumi Yasue



Atropine injection followed by coronary artery spasm with ventricular tachycardia during spinal anesthesia -A case report-.  


Bradycardia may occur during spinal anesthesia with atropine commonly used as a treatment. A 44-year-old female with no known history of any underlying diseases, developed a coronary spasm following ventricular tachycardia when 0.5 mg of atropine was injected intravenously to treat bradycardia during spinal anesthesia. The imbalance caused by atropine in the sympathovagal activity may predispose the coronary artery to develop spasms with ventricular tachycardia. Therefore prudent use of atropine should be accompanied by close monitoring. PMID:23904942

Lee, Joon-Ho; Seok, Ji-Hye; Kim, Young-Lok; Lee, Ji-Hyang; Lee, Sang-Gon; Kim, Eun-Ju; Seo, Da-Mi



Ventricular fibrillation due to coronary spasm at the site of myocardial bridge -A case report-  

PubMed Central

Myocardial bridge is a congenital anomaly characterized by narrowing of some of the epicardial coronary arterial segments running in the myocardium during systole. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia, and might even trigger a myocardial infarction or malignant ventricular arrhythmias. We report a case of ventricular fibrillation due to coronary spasm at the site of myocardial bridge. A 56-year-old man who had suffered from bronchial asthma was given remifentanil combined with sevoflurane in general anesthesia for endoscopic sinus surgery. During the surgery, ventricular fibrillation occurred following coronary spasm with bradycardia, hypotension, bronchospasm. we found myocardial bridge that coincided with an area of coronary spasm after coronary angiography.

Choi, Jung Gi; Lee, Cheol Seung; Choi, June Seog



Simultaneous multivessel coronary artery spasm demonstrated by quantitative analysis of thallium-201 single photon emission computed tomography  

Microsoft Academic Search

Thallium-201 myocardial scintigraphy with quantitative analysis of emission computed tomography was performed during episodes of angina in 19 patients with variant angina and nearly normal coronary arteriographic findings. Eleven patients (group I) were shown by arteriography to have spasm in 2 or more large coronary arteries. Eight patients (group II) had spasm in only 1 coronary artery. In 7 patients

Kiyotaka Kugiyama; Hirofumi Yasue; Ken Okumura; Kotaro Minoda; Kyoji Takaoka; Koshi Matsuyama; Akihiro Kojima; Yukinori Koga; Mutsumasa Takahashi



Noninvasive ergonovine maleate provocative testing for coronary artery spasm: the need for routine thallium-201 imaging  

SciTech Connect

We administered ergonovine and used both electrocardiographic monitoring and thallium-/sup 201/ (/sup 201/Tl) imaging to detect reversible ischemia in 100 patients. Patients already established as having coronary artery spasm and those with nonbypassed, proximal, high-grade coronary artery stenosis were excluded. No complication occurred in any patient. The use of thallium imaging in addition to electrocardiographic monitoring resulted in a higher degree of sensitivity than did ECG monitoring alone. Fourteen patients demonstrated evidence of coronary artery spasm as documented by /sup 201/Tl imaging but of the 14, significant ECG changes occurred in only 50%, and classic ST segment elevation in 21%. Thus, in carefully selected patients the noninvasive provocation of coronary spasm can be accomplished safely, but ECG monitoring must be combined with thallium-/sup 201/ imaging to achieve an acceptable degree of sensitivity.

Shanes, J.G.; Krone, R.J.; Fisher, K.; Shah, B.; Eisenkramer, G.; Humphrey, J.R.



Spontaneous partial regression of coronary artery fistula following optimal medical therapy in a patient who had combined significant coronary artery spasm.  


Coronary artery fistulas (CAFs) are one of the most rare cardiac anomalies. Some patients with CAF may suffer from ischemic chest pain that originates from combined significant coronary artery spasm (CAS). Spontaneous regression of CAF has been reported in a few cases, almost all of which were infants. We report an adult patient who presented with ischemic chest pain due to multiple coronary arteries to pulmonary artery fistulas and combined significant CAS induced by intracoronary acetylcholine provocation test. Spontaneous regression of one of the fistulas was observed at 2-year angiography follow-up. PMID:23755084

Lee, Sunki; Rha, Seung-Woon; Kook, Hyungdon; Kim, Dong Hyeok; Oh, Suk-Kyu; Cho, Dong Hyuk; Kim, Woohyeun; Oh, Dong Joo



Spontaneous Partial Regression of Coronary Artery Fistula Following Optimal Medical Therapy in a Patient Who Had Combined Significant Coronary Artery Spasm  

PubMed Central

Coronary artery fistulas (CAFs) are one of the most rare cardiac anomalies. Some patients with CAF may suffer from ischemic chest pain that originates from combined significant coronary artery spasm (CAS). Spontaneous regression of CAF has been reported in a few cases, almost all of which were infants. We report an adult patient who presented with ischemic chest pain due to multiple coronary arteries to pulmonary artery fistulas and combined significant CAS induced by intracoronary acetylcholine provocation test. Spontaneous regression of one of the fistulas was observed at 2-year angiography follow-up.

Lee, Sunki; Kook, Hyungdon; Kim, Dong Hyeok; Oh, Suk-kyu; Cho, Dong Hyuk; Kim, Woohyeun; Oh, Dong Joo



Large myocardial infarction and a severe spasm of the left coronary artery.  


In patients presenting with an acute myocardial infarction, normal coronary arteries in the first coronary angiography lead to diagnostic uncertainty. We report the case of a 41-year-old woman with an acute anterior infarction and a severe spasm of the left coronary artery, which was treated with intracoronary nitroglycerine and verapamil. The new technique of contrast-enhanced cardiac magnetic resonance imaging was used to confirm the diagnosis. PMID:15599572

Mark, B; Scheidt, T; Zeymer, U



Two cases of non-intervention-related vascular intense spasm following stent implantation in the coronary artery  

PubMed Central

The clinical occurrence of non-intervention-related vascular spasm following coronary stenting is rare. In the present study, 2 cases are reported. One patient developed continuous spasms in the proximal segment of the left anterior descending (LAD) and left circumflex (LCX) arteries following LAD artery stenting. The second patient developed an intense spasm in the right coronary artery (RCA) following LAD artery stenting. Clinical course and prognosis are dangerous. The main treatment for this condition is a combination of repeated injections of nitroglycerin into the coronary artery and the administration of calcium antagonists. In the clinic, intervention-related vascular spasms are common in percutaneous coronary intervention (PCI) due to the mechanical stimulation caused by balloon dilatation or stent expansion. Injections of a vasodilator into the coronary artery are able to mitigate the spasms and the consequent prognosis is good.




A Patient with Repeated Catastrophic Multi-Vessel Coronary Spasm after Zotarolimus-Eluting Stent Implantation  

PubMed Central

Drug-eluting stents (DES) have gained great popularity because of extraordinarily low rates of restenosis. Despite these superior clinical outcomes, several cases regarding the severe multi-vessel coronary spasm, although rare, after the placement of first generation DES have been reported. We report a case of severe, multi-vessel coronary spasm that occurred two occasions after placement of a zotarolimus-eluting stent, one of the second generation DES, in a 42-year-old man with unstable angina. The first incidence was relieved by intracoronary nitroglycerin alone, and second incident, which had combined fixed stenosis was treated with intracoronary nitroglycerin and everolimus-eluting stent.

Rhew, Shi Hyun; Cho, Eun Ae; Kim, Min Sok; Jang, Su Young; Lee, Ki Hong; Lee, Min Goo; Park, Keun Ho; Sim, Doo Sun; Hong, Young Joon; Kim, Ju Han; Jeong, Myung Ho



Impact of hypertension on coronary artery spasm as assessed with intracoronary acetylcholine provocation test  

PubMed Central

Both hypertension and coronary artery spasm (CAS) are associated with endothelial dysfunction. Thus, a higher incidence of CAS is expected in hypertensive patients. We evaluated the impact of hypertension on CAS with intracoronary acetylcholine (ACh) provocation test. A total of 986 patients (685 hypertensive patients vs 301 normotensive patients) who underwent coronary angiography with ACh provocation test were enrolled. ACh was injected into the left coronary artery in incremental doses of 20, 50 and 100??g?min?1. Significant CAS was defined as a transient >70% luminal narrowing with concurrent chest pain and/or ST-segment changes. Although the incidences of significant ACh-induced CAS were similar between hypertensive and normotensive patients (35.8 vs 39.2%, P=0.303), multivariate logistic analysis showed that hypertension was negatively associated with ACh-induced CAS (odds ratio: 0.70, 95% confidence interval: 0.51–0.94, P=0.020). The angiographic characteristics of ACh-induced CAS were similar between these two groups. Subgroup analysis regarding the impact of the status of blood pressure control on CAS showed that hypertensive patients with controlled blood pressure had a significantly higher incidence of CAS than those with uncontrolled blood pressure (45.2 vs 27.9%, P<0.001), and that uncontrolled blood pressure was negatively associated with ACh-induced CAS (odds ratio: 0.56, 95% confidence interval: 0.40–0.79, P=0.001). In conclusion, despite the expected endothelial dysfunction, hypertension and uncontrolled blood pressure are negatively associated with CAS, suggesting that the mechanisms and risk factors of CAS may be significantly different from those of coronary artery disease.

Chen, K-Y; Rha, S-W; Li, Y-J; Poddar, K L; Jin, Z; Minami, Y; Saito, S; Park, J H; Na, J O; Choi, C U; Lim, H E; Kim, J W; Kim, E J; Park, C G; Seo, H S; Oh, D J



Hyperthyroidism-associated coronary spasm: A case of non-ST segment elevation myocardial infarction with thyrotoxicosis  

PubMed Central

Hyperthyroidism is associated with many heart diseases. Thyrotoxic state has a relationship with coronary spasm. We present a case of a non-menopausal woman with hyperthyroidism who complained of chest pain. The diagnosis of coronary spasm was confirmed by coronary angiography (CAG). She is treated well with anti-thyrotoxicosis and anti-anginal medication. We recommend not use CAG as the first diagnostic choice among the patients with medication-uncontrolled hyperthyroidism and chest pain.

Kuang, Xiao-Hu; Zhang, Shu-Yang



Inhibition of Myosin Phosphatase by Upregulated Rho-Kinase Plays a Key Role for Coronary Artery Spasm in a Porcine Model With Interleukin1b  

Microsoft Academic Search

Background—We recently demonstrated that the Rho-kinase-mediated pathway plays an important role for coronary artery spasm in our porcine model with interleukin-1b (IL-1b). In this study, we examined whether or not Rho-kinase is upregulated at the spastic site and if so, how it induces vascular smooth muscle hypercontraction. Methods and Results—Segments of the left porcine coronary artery were chronically treated from

Tadashi Kandabashi; Hiroaki Shimokawa; Kenji Miyata; Ikuko Kunihiro; Yoji Kawano; Yuko Fukata; Taiki Higo; Kensuke Egashira; Shosuke Takahashi; Kozo Kaibuchi; Akira Takeshita



Isolated Left Main Coronary Artery Spasm Detected by Multidetector Computed Tomography  

PubMed Central

Although atherosclerotic obstruction is the main cause of left main coronary artery (LMCA) disease, it can also be associated with vasospasm. We report a case of a 61-year-old male who presented with ostial stenosis of the LMCA, detected by 64-slice multi-detector computed tomographic coronary angiography (MDCT-CA). Careful review of MDCT and intravascular ultrasound findings showed suspicion of an isolated spasm of the LMCA without a significant atherosclerotic lesion. The patient was successfully treated with nitrates and a calcium channel blocker.

Kang, Min-Kyung; Yoon, Seong-Eun; Koh, Jin-Sin; Jung, Kwon Tae; Park, Yongwhi; Hwang, Seok-Jae; Kwak, Choong-Hwan; Jeon, Kyung-Nyeo; Hwang, Jin-Yong



A simple and effective regimen for prevention of radial artery spasm during coronary catheterization.  


Radial artery spasm occurs frequently during the transradial approach for coronary catheterization. Premedications with nitroglycerin and verapamil have been documented to be effective in preventing radial spasms. Verapamil is relatively contraindicated for some patients with left ventricular dysfunction, hypotension and bradycardia. We would like to know whether nitroglycerin alone is sufficient for the prevention of radial artery spasm. We conducted a randomized controlled trial to compare the spasmolytic effect between heparin alone, heparin plus nitroglycerin and heparin plus nitroglycerin and varapamil during transradial cardiac catheterization. In this study, a total of 406 patients underwent transradial cardiac catheterization and intervention. After successful cannulation and sheath insertion of radial arteries, 133 patients in group A received 3,000 units of heparin, 100 microg of nitroglycerin and 1.25 mg of verapamil via sheath, 135 patients in group B received 3,000 units of heparin and 100 microg of nitroglycerin, and 93 patients in group C received 3,000 units of heparin. Five patients in group A (3.8%), 6 patients in group B (4.4%) and 19 patients in group C (20.4%) showed radial spasms. There is no statistically significant difference between groups A and B (p = 0.804), but there are strong statistically significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.003). Intra-arterial premedication with 100 microg nitroglycerin and 3,000 units of heparin is effective in preventing radial spasms during transradial cardiac catheterization. PMID:16254422

Chen, Chih-Wei; Lin, Chin-Lon; Lin, Tin-Kwang; Lin, Chih-Da



Coronary spasm after completion of adenosine pharmacologic stress test  

Microsoft Academic Search

Adenosine is a frequently used pharmacologic stress agent in myocardial perfusion imaging. Its safety profile is well established,\\u000a and most of its side effects are mild and transient. Coronary vasospasm occurs occasionally during or after adenosine stress\\u000a test in rare cases, which may lead to seriously adverse outcomes. This study reported 3 such cases after completion of adenosine\\u000a pharmacologic stress

Ping-Ping Han; Yue-Qin Tian; Hong-Xing Wei; Qi Wang; Zuo-Xiang He


Recurrent ventricular fibrillation under sufficient medical treatment in patient with coronary artery spasm.  


In cases of coronary artery spasm, life-threatening ventricular arrhythmias are possible and can lead to sudden cardiac death. Treatment for this condition includes implantable cardioverter defibrillators, but their effectiveness in patients who present with ventricular fibrillation is debated. Our patient presented with intractable ventricular fibrillation episodes that triggered shocks from her implanted defibrillator. At 2 years of follow-up, we placed her on 200 mg/day of oral amiodarone, after identifying short-coupled premature contractions as the trigger for the ventricular fibrillation. In the 2 years following initiation of this drug therapy, the patient had no further fibrillation episodes. PMID:23821622

Hiki, Masaru; Tokano, Takashi; Nakazato, Yuji; Daida, Hiroyuki



Simultaneous multivessel coronary artery spasm demonstrated by quantitative analysis of thallium-201 single photon emission computed tomography  

SciTech Connect

Thallium-201 myocardial scintigraphy with quantitative analysis of emission computed tomography was performed during episodes of angina in 19 patients with variant angina and nearly normal coronary arteriographic findings. Eleven patients (group I) were shown by arteriography to have spasm in 2 or more large coronary arteries. Eight patients (group II) had spasm in only 1 coronary artery. In 7 patients in group I, significant diffuse perfusion defects simultaneously appeared in multiple coronary artery regions on the scintigram (group IA). The extent and severity of the perfusion defect as measured by thallium-201 tomography were significantly greater in group IA than in group II (p less than 0.001 and p less than 0.01, respectively). The duration of transient ST-segment elevation during the attack in group IA was significantly longer than in group II (p less than 0.001). The incidence of ventricular arrhythmias, including ventricular tachycardia, or complete atrioventricular block during the anginal attack was significantly higher (p less than 0.05) in group IA than in group II. In all study patients, neither attack nor scintigraphic perfusion defect appeared on the repeat test after oral administration of nifedipine. In conclusion, multivessel coronary artery spasm simultaneously appears and causes the attack in many patients with variant angina and nearly normal coronary arteriographic findings, and myocardial ischemia due to simultaneous multivessel coronary spasm is likely to be more extensive and severe, persist longer and have a higher frequency of potentially dangerous arrhythmias than that due to spasm of only 1 coronary artery.

Kugiyama, K.; Yasue, H.; Okumura, K.; Minoda, K.; Takaoka, K.; Matsuyama, K.; Kojima, A.; Koga, Y.; Takahashi, M.



Persistent coronary artery spasm documented by follow-up coronary angiography in patients with symptomatic remission of variant angina.  


For patients with variant angina it is very important to start medical therapy using calcium-channel blockers. However, the decision of physicians regarding whether to decrease the dose of the drug or discontinue it is controversial. We investigated whether the nature of spasm is remissive and whether the termination of medications is safe. The subjects studied were included in the Vasospastic Angina in Catholic Medical Center Registry from March 2001 to December 2009. We analyzed 37 patients (62 lesions) with variant angina, diagnosed using coronary angiography (CAG) and he acetylcholine provocation test, without any organic coronary stenosis, whose symptoms were well controlled after medication. The follow-up CAG with provocation test was performed at a median interval of 44 months. The characteristics of spasm were analyzed on each pair of CAGs. The study group consisted of 23 men (62.2 %) and 14 women (37.8 %) with a mean age of 59 ± 11.1 years. The follow-up CAG with provocation test showed that the characteristics of the spasmodic nature were consistent with the first test in all patients. Although the patients with variant angina had no chest pain after medical treatment, the spasmodic nature of coronary arteries still remained. We may decrease the drug dosage after carefully checking the patient's symptoms but recommend not discontinuing therapy, even if the patient is asymptomatic. PMID:22526378

Seo, Suk Min; Kim, Pum Joon; Shin, Dong Il; Kim, Tae-Hoon; Kim, Chan Jun; Min, Jin-soo; Koh, Yoon Seok; Park, Hun Jun; Kim, Dong Bin; Her, Sung-Ho; Chang, Ki-Yuk; Baek, Sang Hong; Chung, Wook Sung; Seung, Ki-Bae



Cold Pressure Test Producing Coronary Spasm, Coronary Thrombosis and Myocardial Infarction in a Patient with IgM Antibodies against Coxsackie B Virus  

Microsoft Academic Search

Several lines of evidence have shown that viral infections are capable of causing coronary spasm and precipitating or mimicking clinical myocardial infarction. Here we report the case of a 41-year-old woman with recurrent angina who was admitted to our hospital because of ventricular tachycardia. Laboratory examination revealed positive IgM titers against Coxsackie B virus. Coronary angiography showed normal coronary arteries,

Werner Haberbosch; Norbert Roerich; Joerg Neuzner



Suppression of Coronary Artery Spasm by the Rho-Kinase Inhibitor Fasudil in Patients With Vasospastic Angina  

Microsoft Academic Search

Background—Increased activity of Rho-kinase causes hypercontraction of vascular smooth muscle and has been implicated as playing a pathogenetic role in divergent cardiovascular diseases such as coronary artery spasm. We examined whether an intracoronary infusion of fasudil, a selective Rho-kinase inhibitor, would attenuate coronary vasoconstrictor responses to acetylcholine (ACh) in patients with vasospastic angina. Methods and Results—We studied 20 consecutive patients

Akihiro Masumoto; Masahiro Mohri; Hiroaki Shimokawa; Lemmy Urakami; Makoto Usui; Akira Takeshita


Higher serum uric acid and lipoprotein(a) are correlated with coronary spasm.  


It has been reported that a major cause of coronary vasospastic angina (VSA) is endothelial dysfunction of the coronary artery. On the other hand, some studies showed that serum uric acid and lipoprotein(a) are correlated with endothelial dysfunction. Thus, we examined whether uric acid and lipoprotein(a), are correlated with VSA. Four hundred forty-one patients with suspected VSA who underwent a coronary angiogram with acetylcholine provocation (ACh test) during an 8-year period were enrolled. We divided them into a VSA group, who showed coronary spasm by the ACh test, and an atypical chest pain (ACP) group, who showed negative ACh test. We compared serum markers between the two groups, including low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a), fibrinogen, total plasminogen activator inhibitor-1, and uric acid. Uric acid, hs-CRP, and lipoprotein(a) were significantly higher in the VSA group than in the ACP group (all P < 0.05) while there were no significant differences in the other parameters. Multivariate analyses identified uric acid and lipoprotein(a) as significant independent markers for VSA. Uric acid and lipoprotein(a) are correlated with VSA, and medical intervention to decrease uric acid and lipoprotein(a) might be effective in controlling VSA. PMID:23552902

Nishino, Masami; Mori, Naoki; Yoshimura, Takahiro; Nakamura, Daisuke; Lee, Yasuharu; Taniike, Masayuki; Makino, Nobuhiko; Kato, Hiroyasu; Egami, Yasuyuki; Shutta, Ryu; Tanouchi, Jun; Yamada, Yoshio



Comparison of coronary hemodynamic and cardiac metabolic alterations during coronary artery spasm associated with ST segment elevation or depression.  


Coronary vasospasms are usually indicated by ST elevation or depression in the electrocardiogram (ECG). To test the hypothesis that ST elevation represents more severe myocardial ischemia than does ST depression, we determined the coronary sinus blood flow (CSBF) and the transcardiac lactate extraction ratio (LER) in 19 selected patients who had focal vasospasms in the left anterior descending artery. In 10 patients, ergonovine (0.11 +/- 0.02 mg, mean +/- SEM) provoked severe (total or subtotal) coronary vasospasm with ST elevation. Under these conditions, CSBF significantly decreased (from 97 +/- 8 ml/min to 79 +/- 5 ml/min, p less than 0.01) with a marked reduction in LER (from 29 +/- 5% to -14 +/- 6%, p less than 0.01). In contrast, 10 vasospastic events with ST depression after ergonovine (0.15 +/- 0.04 mg, NS) were recognized as mild spastic narrowing or severe spasms with well developed collateral circulation. Alteration of CSBF was significant in only a few patients and the overall CSBF response was non-significant (from 106 +/- 12 ml/min to 103 +/- 13 ml/min). The reduction in LER in this group was less pronounced than those in patients with ST elevation (p less than 0.05). These results indicate that coronary vasospasm with ST elevation may be related to the more pronounced reduction in coronary blood flow accompanied by more severe myocardial ischemia. Such observations may support the contention that some ischemic events associated with ST elevation or depression can be interpreted as a continuous spectrum of vasospastic disorders. PMID:4009929

Kodama, K; Yamagishi, M; Nanto, S; Kuzuya, T; Koretsune, Y; Tamai, J; Tada, M; Inoue, M



Value of noninvasive assessment of patients with atypical chest pain and suspected coronary spasm using ergonovine infusion and thallium-201 scintigraphy  

SciTech Connect

Twenty-six patients with known benign coronary anatomic characteristics and atypical chest pain syndromes were evaluated for the possibility of coronary spasm. Incremental intravenous ergonovine maleate infusions were administered, and thallium-201 scintigraphy was performed at the peak dosage and during recovery in the coronary care unit. With ergonovine therapy, 4 patients (16%) had chest pain associated with electrocardiographic (ECG) or scintigraphic changes. Nine patients (35%) had chest pain without associated ECG or scintigraphic changes, and 13 patients did not have chest pain in response to ergonovine administration, although 2 (8%) had ergonovine-induced scintigraphic defects. All 4 patients with ergonovine-induced chest pain and associated ECG or scintigraphic abnormalities had resolution or reduction of chest pain after medical treatment. However, 7 of the 9 patients with ergonovine-induced chest pain in the absence of ECG or scintigraphic abnormalities continued to have symptoms despite medical treatment a mean of 18 months later. In this limited study of a select group, bedside ergonovine provocation appeared safe. Many patients had chest pain, but few showed ECG or scintigraphic evidence of ischemia. Perfusion scintigraphy appears to have potential complementary value for the identification of an ischemic cardiac cause of atypical chest pain and provides a rationale for appropriate therapy.

DiCarlo, L.A. Jr.; Botvinick, E.H.; Canhasi, B.S.; Schwartz, A.S.; Chatterjee, K.



Myocardial infarction induced by coronary vasospasm after self-administration of epinephrine.  


A case of a 30-year-old man who developed a myocardial infarction after self-administering an Epi-Pen for an episode of idiopathic anaphylaxis is reported. The patient had numerous risk factors for coronary artery disease, and it was suspected that epinephrine-induced coronary spasm caused the infarct. The Epi-Pen Junior may be indicated in such adults with numerous risk factors for coronary artery disease who are at risk for recurrent anaphylaxis. PMID:8498731

Saff, R; Nahhas, A; Fink, J N



The impact of high sensitivity C-reactive protein level on coronary artery spasm as assessed by intracoronary acetylcholine provocation test.  


Purpose: High sensitive C-reactive protein (hs CRP) is well known as a strong risk factor of cardiovascular disease (CVD). The aim of this study is to evaluate the impact of elevated hs CRP on coronary artery spasm (CAS) as assessed by intracoronary acetylcholine (ACh) provocation test. Materials and Methods: A total of 1729 consecutive patients without significant CVD who underwent coronary angiography and intracoronary ACh test between November 2004 and August 2010 were analyzed. The patients were divided into five groups according to quintiles of hs CRP levels. Results: At baseline, the prevalence of elderly, hypertension, diabetes mellitus, current smoking, and lipid levels were higher in patients with higher hs CRP. During ACh test, the incidences of significant CAS, ischemic electrocardiography (EKG) change, multivessel, and diffuse CAS were higher in patients with higher hs CRP. Multivariate analysis showed that the old age (OR=1.01, CI; 1.0-1.02, p=0.0226), myocardial bridge (OR=3.34, CI; 2.16-5.17, p<0.001), and highest quintile hs CRP (OR=1.54, CI; 1.12-2.18, p=0.008) were independent predictors of ACh induced CAS. However, there was no difference in clinical outcomes up to 12 months. Conclusion: In conclusion, higher hs CRP was associated with higher incidence of CAS, worse angiographic characteristics and ischemic EKG change, but was not associated with clinical outcomes. PMID:24142631

Park, Ji Young; Rha, Seung-Woon; Li, Yong-Jian; Chen, Kang-Yin; Choi, Byoung Geol; Choi, Se Yeon; Ryu, Sung Kee; Choi, Jae Woong; Kim, Tae Kyun; Kim, Jeong Min; Bak, Yoon Suk; Lee, Jae Hoon; Im, Sung Il; Kim, Sun Won; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo



The Impact of High Sensitivity C-Reactive Protein Level on Coronary Artery Spasm as Assessed by Intracoronary Acetylcholine Provocation Test  

PubMed Central

Purpose High sensitive C-reactive protein (hs CRP) is well known as a strong risk factor of cardiovascular disease (CVD). The aim of this study is to evaluate the impact of elevated hs CRP on coronary artery spasm (CAS) as assessed by intracoronary acetylcholine (ACh) provocation test. Materials and Methods A total of 1729 consecutive patients without significant CVD who underwent coronary angiography and intracoronary ACh test between November 2004 and August 2010 were analyzed. The patients were divided into five groups according to quintiles of hs CRP levels. Results At baseline, the prevalence of elderly, hypertension, diabetes mellitus, current smoking, and lipid levels were higher in patients with higher hs CRP. During ACh test, the incidences of significant CAS, ischemic electrocardiography (EKG) change, multivessel, and diffuse CAS were higher in patients with higher hs CRP. Multivariate analysis showed that the old age (OR=1.01, CI; 1.0-1.02, p=0.0226), myocardial bridge (OR=3.34, CI; 2.16-5.17, p<0.001), and highest quintile hs CRP (OR=1.54, CI; 1.12-2.18, p=0.008) were independent predictors of ACh induced CAS. However, there was no difference in clinical outcomes up to 12 months. Conclusion In conclusion, higher hs CRP was associated with higher incidence of CAS, worse angiographic characteristics and ischemic EKG change, but was not associated with clinical outcomes.

Park, Ji Young; Li, Yong-Jian; Chen, Kang-Yin; Choi, Byoung Geol; Choi, Se Yeon; Ryu, Sung Kee; Choi, Jae Woong; Kim, Tae Kyun; Kim, Jeong Min; Bak, Yoon Suk; Lee, Jae Hoon; Im, Sung Il; Kim, Sun Won; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo



Intramural hemorrhage and endothelial changes in atherosclerotic coronary artery after repetitive episodes of spasm in x-ray-irradiated hypercholesterolemic pigs  

SciTech Connect

To assess whether coronary spasm affects the progression of atherosclerosis and results in evolution of myocardial infarction, the role of coronary spasm on the fine structure of conduit coronary arteries was studied morphologically. Goettingen miniature pigs were fed a semisynthetic diet containing 2% cholesterol and 1.1% sodium cholate. One month after being on this diet, the pigs were anesthetized and the endothelium of a branch of the left coronary artery was denuded using a balloon catheter. X-ray irradiation in a dose of 1,500 rad was given twice selectively to the area denuded, after 4 and 5 months of cholesterol feeding. Five months after endothelial denudation, transient (group A) and repetitive episodes (group B) of coronary spasm were provoked by single and periodic (five times every 5 minutes) intracoronary injections of serotonin (10 micrograms/kg/injection), respectively. The extent of spasm by serotonin at the previously denuded site was 84 +/- 4% (n = 4) and 90 +/- 5% (n = 6) narrowing in groups A and B (p = NS between groups), respectively. Forty minutes after the final administration of serotonin, the left coronary artery was relaxed by nitroglycerin, and the heart was isolated and perfuse-fixed under physiological pressure. Intramural hemorrhage was noted at the spastic site in six pigs of group B but not in group A. The average percent luminal narrowing, on cross sections at the spastic site in group B, was significantly greater than in group A (56 +/- 7% vs. 23 +/- 5%, p less than 0.01). Scanning electron micrographs revealed that the endothelial lining was intact at the nonspastic site in both groups. In addition to the appearance of intercellular bridges at the spastic site in both groups, squeezing of endothelial cells and adhesion of white blood cells were present at the spastic site exclusively in group B.

Nagasawa, K.; Tomoike, H.; Hayashi, Y.; Yamada, A.; Yamamoto, T.; Nakamura, M. (Kyushu Univ., Fukuoka (Japan))



Relaxation of carbocyclic thromboxane A 2 -induced contractions of isolated coronary arteries by nifedipine  

Microsoft Academic Search

Summary ± Carbocyclic thromboxame A2 (2.9×10?7 mol\\/l) contracted isolated rings of cat coronary artery. These contractions could be partly inhibited by low concentrations of nifedipine (50% inhibitory concentration —IC50=6.8×10?8 mol\\/l) and completely relaxed by papaverine. Relaxation of thromboxane-induced coronary spasm may contribute to the effectiveness of calcium antagonists in variant angina, which may be caused or exacerbated by thromboxane A2

R. Towart; Elisabeth Perzborn



Dobutamine-induced transmural myocardial ischemia in a patient with mild coronary lesions.  


A 70-year-old man was admitted for evaluation of retrosternal pain at rest. During infusion of dobutamine (25 micrograms/kg/min) the patient developed angina, ST-segment elevation in the inferior leads, and echocardiographic hypokinesia in the inferior-basal myocardial wall. Coronary angiography revealed insignificant (20-30%) stenosis of the right coronary artery and a normal remaining tree. This case suggests that dobutamine may induce transmural myocardial ischemia in patients with mild coronary lesions, probably by producing occlusive coronary spasm on a substrate of arterial endothelial dysfunction. PMID:8821426

Kardaras, F G; Bonou, M S; Kardara, D F; Kranidis, A I; Sioras, E P; Anthopoulos, L P



Coronary arteriography and left ventriculography during spontaneous and exercise-induced ST segment elevation in patients with variant angina  

Microsoft Academic Search

The present study is an angiographic demonstration of coronary artery spasm during both spontaneous and exercise-induced angina in three patients with variant angina. In each case, clinical, ECG, coronary angiographic, and left ventriculographic observations were made at rest, during spontaneous angina, and during exercise-induced angina. The character of chest pain was similar during spontaneous and exercise-induced episodes. ST segment elevation

Y. Matsuda; M. Ozaki; H. Ogawa; H. Naito; F. Yoshino; K. Katayama; T. Fujii; M. Matsuzaki; R. Kusukawa



Coronary arteriography and left ventriculography during spontaneous and exercise-induced ST segment elevation in patients with variant angina  

SciTech Connect

The present study is an angiographic demonstration of coronary artery spasm during both spontaneous and exercise-induced angina in three patients with variant angina. In each case, clinical, ECG, coronary angiographic, and left ventriculographic observations were made at rest, during spontaneous angina, and during exercise-induced angina. The character of chest pain was similar during spontaneous and exercise-induced episodes. ST segment elevation was present in the anterior ECG leads during both episodes. The left anterior descending coronary artery became partially or totally obstructed during both types of attacks. When coronary spasm was demonstrated during both types of attacks, left ventriculography disclosed akinetic or dyskinetic wall motion in the area supplied by the involved artery. In those patients with reproducible exercise-induced ST segment elevation and chest pain, thallium-201 scintigraphy showed areas of reversible anteroseptal hypoperfusion. Thus in selected patients exercise-induced attacks of angina were similar to spontaneous episodes.

Matsuda, Y.; Ozaki, M.; Ogawa, H.; Naito, H.; Yoshino, F.; Katayama, K.; Fujii, T.; Matsuzaki, M.; Kusukawa, R.



Metastatic Carcinoid Disease Inducing Coronary Vasospasm  

PubMed Central

Herein, we report a case of progressive coronary vasospasm in a 70-year-old man who had a long-standing history of metastatic gastrointestinal carcinoid tumor. Despite octreotide, nitrate, and calcium channel-blocker therapy, the patient's urinary 5-hydroxy-indole acetic acid level increased, coinciding with an increased frequency of flushing episodes with chest discomfort. In the cardiac catheterization laboratory, we captured an episode that was associated with diffuse right coronary artery spasm, ST-segment elevation, and intense symptoms. We attribute the patient's coronary vasospasm to his metastatic carcinoid disease.

Eapen, Danny J.; Clements, Stephen; Block, Peter; Sperling, Laurence



Are coronary artery spasm and progressive damage to the heart associated with the hyperventilation syndrome?  

Microsoft Academic Search

A case of coronary artery vasospasm was studied in a man with a four year history of angina. He had evidence of symptomatic hyperventilation during a spontaneous episode of chest pain. When asked to hyperventilate the pain in his chest and ST elevation were reproduced in the same leads as occurred during the spontaneous attack. This may be the first

Leisa J Freeman; P G F Nixon



Consumption of vitamin E in coronary circulation in patients with variant angina  

Microsoft Academic Search

Objectives: The plasma status of vitamin E has been suggested to be linked to the activity of coronary artery spasm. This study was designed to determine whether vitamin E is actually consumed in the coronary circulation in patients with active variant angina having repetitive spasm-induced transient myocardial ischemia and reperfusion. Methods: Blood samples were obtained simultaneously from the aortic root,

Kunihisa Miwa; Akihiko Igawa; Keiko Nakagawa; Tadakazu Hirai; Hiroshi Inoue


Infantile Spasms  


... has been approved by the U.S. Food and Drug Administration to treat infantile spasms in children ages one month to two years. Some children have spasms as the result of brain lesions, and surgical removal of these lesions may ...


Esophageal Spasms  


... is stuck in your throat (globus) The return of food and liquids back up your esophagus (regurgitation) When ... type of spasm is often accompanied by regurgitation of food or liquids. Nutcracker esophagus is the term for ...


Multivessel versus single vessel spasm, as assessed by the intracoronary acetylcholine provocation test, in Korean patients.  


1. Coronary artery spasm (CAS) is known to be a major cause of myocardial ischaemia. Multivessel coronary spasm (MVS) in particular is likely to induce more severe and prolonged myocardial ischaemia than single vessel spasm (SVS). 2. In the present study, a total of 1082 consecutive patients without significant coronary artery disease who underwent an acetylcholine (ACh) provocation test between March 2004 and April 2009 were investigated. Patients were divided into three groups: an MVS group (n = 275), an SVS group (n = 376) and a non-CAS group (n = 431). Differences in clinical and angiographic characteristics following the ACh provocation test were evaluated between the MVS, SVS and non-CAS groups. 3. At baseline, patients in the MVS group had the highest prevalence of peripheral artery disease (PAD), hyperlipidaemia, smoking and old age, as well as the highest triglyceride levels. Calcium channel blockers were most frequently prescribed in MVS patients before the ACh test. During the ACh test, the highest prevalence of chest pain, ischaemic electrocardiogram changes, baseline spasms and diffuse and severe spasms were observed in the MVS group. The response rate to lower ACh doses that induce CAS was also higher in the MVS group. Multivariate analysis showed that the presence of PAD (odds ratio (OR) 2.0; P = 0.006) and baseline spasm (OR 1.4; P = 0.045) were independent predictors of ACh-induced MVS. 4. In conclusion, ischaemic symptoms, diffuse and severe spasm and baseline spasm were more frequently associated with MVS patients, suggesting more intensive medical therapies and close clinical follow up would be required for this patient group. PMID:21933225

Park, Ji Young; Rha, Seung-Woon; Jin, Zhe; Poddar, Kanhaiya L; Ramasamy, Sureshkumar; Chen, Kang-Yin; Li, Yong-Jian; Choi, Byoung Geol; Ryu, Sung Kee; Choi, Jae Woong; Song, Eun Ju; Ryou, Ji Won; Elnagar, Amro; Kim, Yun Kyung; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo



Coronary artery spasm  

Microsoft Academic Search

Opinion Statement  \\u000a \\u000a \\u000a \\u000a \\u000a – \\u000a \\u000a Attacks of variant angina usually respond promptly to sublingual administration of short-acting nitrates (nitroglycerin, 0.3\\u000a to 0.4 mg, or isosorbide dinitrate, 5 to 10 mg), which may be repeated after 3 to 5 minutes if pain persists. In the rare\\u000a cases resistant to sublingual nitrates, sublingual nifedipine (5 to 10 mg) or, when readily available, intravenous nitrates

Gaetano Antonio Lanza; Attilio Maseri



Coronary artery spasm  


... and prevent a heart attack. A medicine called nitroglycerin can relieve an episode of pain. Your health ... or squeezing chest pain is not relieved by nitroglycerin. The pain may be due to a heart ...


Radiation-induced accelerated coronary arteriosclerosis  

Microsoft Academic Search

There is a paucity of information on radiation-induced coronary heart disease. A young patient with myocardial infarction following mediastinal irradiation is described. The role of radiotherapy and chemotherapy on the subsequent development of coronary heart disease is discussed.

B. Mittal; M. Deutsch; M. Thompson; H. Lee Dameshek



Spontaneous and simultaneous multivessel coronary spasm causing multisite myocardial infarction, cardiogenic shock, atrioventricular block, and ventricular fibrillation.  


A 57-year-old Taiwanese man with a past history of variant angina developed simultaneous anterior and inferior myocardial infarction, atrioventricular block, cardiogenic shock, and eventually ventricular fibrillation. Left coronary angiography revealed simultaneous occlusion of the left anterior descending and the left circumflex coronary arteries, which was relieved by intracoronary administration of isosorbide dinitrate. This is the first report of such a case in the English-language medical literature. PMID:19179777

Chuang, Yao-Tsung; Ueng, Kwo-Chang



Coronary vasospasm as a pathogenetic mechanism of coronary heart disease.  


An attempt is made to summarize recent available information on the coronary vasospasm as one of the pathogenetic mechanisms of coronary heart disease. The review focuses attention on the following topics: 1) spasm and the coronary artery microarchitecture; 2) spasm and the nervous system control of the coronary arteries; 3) spasm and clinical manifestations of coronary heart disease. Data are also presented on the influence of drugs on the coronary vasospasm. PMID:6990464

Velican, D


[Case of painful muscle spasm induced by thoracic vertebral fracture: successful treatment with lumbar sympathetic ganglia block].  


We report a 70-year-old man, who developed painful involuntary muscle contraction of the left leg after the lumbar discectomy, which exacerbated after a vertebral fracture of Th12. This involuntary movement was accompanied with the abnormal position of left leg simulating triple flexion response, and was induced by active or passive movement of his left knee and foot joints. Several drugs including benzodiazepines and dantrolene were ineffective, although treatment with baclofen or carbamazepine was effective. These findings suggest that hyperexcitability of the anterior horn cells following the disturbance of spinal inhibitory interneurons was involved. Electophysiological studies suggested the disturbance of left lumber nerve roots. The spinal root blocks from L3 to S1 were performed, after which the painful involuntary muscle spasm was resolved. The lumbar sympathetic ganglia block was also effective; suggesting that abnormal afferent neuronal input to spinal cord was caused by the nerve root trauma which triggered the formation of secondary abnormal network in the spine. Lumbar sympathetic ganglia block should be recommended to a therapeutic option for the refractory painful muscle spasm of the leg. PMID:19086429

Shimizu, Fumitaka; Kawai, Motoharu; Koga, Michiaki; Ogasawara, Jun-ichi; Negoro, Kiyoshi; Kanda, Takashi



Eating-induced epileptic spasms in a boy with MECP2 duplication syndrome: insights into pathogenesis of genetic epilepsies.  


Duplication of MECP2 causes a recently described X-linked mental retardation syndrome, of which the typical features are infantile hypotonia, poor speech development, recurrent infections, epilepsy, and progressive spasticity. Recently, the associated seizure semiology and interictal EEG features have been increasingly described, whereas ictal electroclinical features remain poorly defined. We report the case of a boy carrying a maternally-inherited MECP2 duplication and describe the video-EEG sequence of a cluster of eating-induced spasms, the only epileptic manifestation of the patient. This report expands our knowledge of the epileptic phenotype of MECP2 duplication syndrome and may contribute to a better definition and comprehension of the electroclinical spectrum of patients affected by this disease. It also supports the hypothesis that in some genetic epilepsies, the electro-clinical profile can correlate with the dysfunction of limited cortical regions despite the presence of a genetic mutation over the entire brain. [Published with video sequences]. PMID:23248047

de Palma, Luca; Boniver, Clementina; Cassina, Matteo; Toldo, Irene; Nosadini, Margherita; Clementi, Maurizio; Sartori, Stefano



Proteomic Analysis of Adrenocorticotropic Hormone Treatment of an Infantile Spasm Model Induced by N-Methyl-d-Aspartic Acid and Prenatal Stress  

PubMed Central

Infantile spasms is an age-specific epileptic syndrome associated with poor developmental outcomes and poor response to nearly all traditional antiepileptic drugs except adrenocorticotropic hormone (ACTH). We investigated the protective mechanism of ACTH against brain damage. An infantile spasm rat model induced by N-methyl-d-aspartate (NMDA) in neonate rats was used. Pregnant rats were randomly divided into the stress-exposed and the non-stress exposed groups, and their offspring were randomly divided into ACTH-treated spasm model, untreated spasm model, and control groups. A proteomics-based approach was used to detect the proteome differences between ACTH-treated and untreated groups. Gel image analysis was followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometric protein identification and bioinformatics analysis. Prenatal stress exposure resulted in more severe seizures, and ACTH treatment reduced and delayed the onset of seizures. The most significantly up-regulated proteins included isoform 1 of tubulin ?-5 chain, cofilin-1 (CFL1), synaptosomal-associated protein 25, malate dehydrogenase, N(G),N(G)-dimethylarginine dimethylaminohydrolase 1, annexin A3 (ANXA3), and rho GDP-dissociation inhibitor 1 (ARHGDIA). In contrast, tubulin ?-1A chain was down-regulated. Three of the identified proteins, ARHGDIA, ANXA3, and CFL1, were validated using western blot analysis. ARHGDIA expression was assayed in the brain samples of five infantile spasm patients. These proteins are involved in the cytoskeleton, synapses, energy metabolism, vascular regulation, signal transduction, and acetylation. The mechanism underlying the effects of ACTH involves the molecular events affected by these proteins, and protein acetylation is the mechanism of action of the drug treatment.

Wang, Jing; Wang, Juan; Zhang, Ying; Yang, Guang; Zhou, Wen-Jing; Shang, Ai-Jia; Zou, Li-Ping



FMLP provokes coronary vasoconstriction and myocardial ischemia in rabbits  

SciTech Connect

Recent pathological studies of coronary arteries from humans with suspected coronary spasm have revealed an augmented intramural burden of inflammatory cells. To test the hypothesis than inappropriate activation of inflammatory cells participates in the evolution of coronary vasospasm, the present experiment employed a newly developed coronary arteriographic technique for use in pentobarbital-anesthetized rabbits to evaluate the coronary vasomotor actions of the nonselective inflammatory cell stimulant, N-formyl-L-methionyl-L-leucyl-L-phenylalanine (fMLP). In 10 of 10 animals, selective left intracoronary injection of 200 ng fMLP evoked profound left coronary narrowing accompanied in all cases by ST segment deviation and dysrhythmias. Thallium-201 scintigraphy demonstrated hypoperfusion of the left ventricular free wall and septum supplied by the spastic coronary artery. The fMLP-induced epicardial vasoconstriction, ischemic electrocardiogram (ECG) changes, and thallium perfusion defects were reversed by intravenous nitroglycerin. Neither the right coronary artery nor its distribution were influenced by left coronary injection of fMLP. Additional experiments in isolated, salt solution-perfused rabbit hearts demonstrated that fMLP failed to exert direct coronary vasoconstrictor effects. These observations indicate that the nonselective inflammatory cell stimulant, fMLP, provokes arteriographically demonstrable coronary spasm with attendant myocardial hypoperfusion and ischemic ECG changes in anesthetized rabbits. Such a model may be useful in exploring the dynamic role of inflammatory cells in development of coronary spasm.

Gillespie, M.N.; Booth, D.C.; Friedman, B.J.; Cunningham, M.R.; Jay, M.; De Maria, A.N. (Univ. of Kentucky, Lexington (USA))



Hemifacial spasm: case report.  


A 53 year old lady with diabetes mellitus presented with right hemi-facial spasm (HFS). Brain MRI Scan revealed extensive pan-sinusitis and mild bilateral mastoiditis. She responded well to intravenous ceftriaxone therapy and the hemifacial spasm resolved. The symptoms of hemifacial spasm and pain over the right cheek and peri-orbital area recurred after three weeks. She was admitted to hospital for Functional Endoscopic Sinus Surgery (FESS); following findings on repeat para-nasal sinus CT-Scan. Several reviews over six month's period revealed complete resolution of hemi facial spasm symptoms save for mild intermittent right blepharospasm; particularly on exposure to wind. This is a very rare cause of hemifacial spasm and clinicians should be on the look out for infective/inflammatory aetiology of hemifacial spasm; particularly in patients who present with recent onset HFS and have features of infection and or inflammation in the cranium. PMID:17089501

Jowi, J O; Matende, J; Macharia, M I



Tetanus: pathophysiology, treatment, and the possibility of using botulinum toxin against tetanus-induced rigidity and spasms.  


Tetanus toxin, the product of Clostridium tetani, is the cause of tetanus symptoms. Tetanus toxin is taken up into terminals of lower motor neurons and transported axonally to the spinal cord and/or brainstem. Here the toxin moves trans-synaptically into inhibitory nerve terminals, where vesicular release of inhibitory neurotransmitters becomes blocked, leading to disinhibition of lower motor neurons. Muscle rigidity and spasms ensue, often manifesting as trismus/lockjaw, dysphagia, opistotonus, or rigidity and spasms of respiratory, laryngeal, and abdominal muscles, which may cause respiratory failure. Botulinum toxin, in contrast, largely remains in lower motor neuron terminals, inhibiting acetylcholine release and muscle activity. Therefore, botulinum toxin may reduce tetanus symptoms. Trismus may be treated with botulinum toxin injections into the masseter and temporalis muscles. This should probably be done early in the course of tetanus to reduce the risk of pulmonary aspiration, involuntary tongue biting, anorexia and dental caries. Other muscle groups are also amenable to botulinum toxin treatment. Six tetanus patients have been successfully treated with botulinum toxin A. This review discusses the use of botulinum toxin for tetanus in the context of the pathophysiology, symptomatology, and medical treatment of Clostridium tetani infection. PMID:23299659

Hassel, Bjørnar



Asymmetric spasms in west syndrome  

Microsoft Academic Search

We studied 6 patients with asymmetric spasms who comprised 16.2% of 37 patients with West syndrome (WS) who demonstrated clusters of tonic spasms on simultaneous video-EEG recordings. Neuroimaging studies showed diffuse cerebral abnormalities in 3 of 6 patients and unilateral hemispheric lesions in the remaining 3. In 3, the clusters of spasms occurred soon after a preceding partial seizure. Lateral

Yoshiko Haga; Kazuyoshi Watanabe; Tamiko Negoro; Kosaburo Aso; Masao Kitoh; Norihide Maeda; Takashi Ohki



Oxygen Free Radicals Enhance Ergonovine-Induced Canine Coronary Vasoconstriction  

Microsoft Academic Search

In order to examine the effects of oxygen free radicals on the ergonovine (EM)-induced coronary vasoconstriction in vivo,\\u000a we administered EM (50 ?g) into the ostium of the left coronary artery (LCA) and angiographically evaluated the change of\\u000a diameter of the left anterior descending (LAD) and the left circumflex (LCX) coronary artery in eight dogs before and after\\u000a selective administration

Taku Konno; Taku Matsubara; Shoichi Imai; Mikio Nakazawa; Yutaka Yoshida; Tomoyuki Hori; KeisukeA Suzuki; Toru Ida; Kotaro Higuchi; Yusuke Tamura; Masaru Yamazoe; Yoshifusa Aizawa


Pathophysiology of hemimasticatory spasm.  

PubMed Central

Two patients aged 21 and 50 years presented with facial hemiatrophy and unilateral spasms of the masticatory muscles. Masticatory muscle biopsy showed normal findings in both patients and facial skin biopsy specimens only showed atrophy, although morphoea (localised facial scleroderma) had been diagnosed nine years previously in the second patient. The involuntary movements consisted of brief twitches and prolonged contractions clinically and electromyographically similar to those of hemifacial spasm and cramps. The jaw jerk and the silent periods were absent in the affected muscles. Direct stimulation of the muscle nerve and transcranial stimulation of the trigeminal root demonstrated slowing of conduction and after-activity due to autoexcitation. Observations in other reported cases and these two patients suggest that hemimasticatory spasm is produced by ectopic activity secondary to focal demyelination of the trigeminal motor nerve fibres. The proposed cause of the neuropathy is focal damage to the masticatory nerves caused by compression, possibly resulting from the deep tissue changes that occur in facial hemiatrophy. Images

Cruccu, G; Inghilleri, M; Berardelli, A; Pauletti, G; Casali, C; Coratti, P; Frisardi, G; Thompson, P D; Manfredi, M



Acute ST-segment elevation myocardial infarction after amoxycillin-induced anaphylactic shock in a young adult with normal coronary arteries: a case report  

PubMed Central

Background Acute myocardial infarction (MI) following anaphylaxis is rare, especially in subjects with normal coronary arteries. The exact pathogenetic mechanism of MI in anaphylaxis remains unclear. Case presentation The case of a 32-year-old asthmatic male with systemic anaphylaxis, due to oral intake of 500 mg amoxycillin, complicated by acute ST-elevation MI is the subject of this report. Following admission to the local Health Center and almost simultaneously with the second dose of subcutaneous epinephrine (0.2 mg), the patient developed acute myocardial injury. Coronary arteriography, performed before discharge, showed no evidence of obstructive coronary artery disease. In vivo allergological evaluation disclosed strong sensitivity to amoxycillin and the minor (allergenic) determinants of penicillin. Conclusion Acute ST-elevation MI is a rare but potential complication of anaphylactic reactions, even in young adults with normal coronary arteries. Coronary artery spasm appears to be the main causative mechanism of MI in the setting of "cardiac anaphylaxis". However, on top of the vasoactive reaction, a thrombotic occlusion, induced by mast cell-derived mediators and facilitated by prolonged hypotension, cannot be excluded as a possible contributory factor.

Gikas, Aristofanis; Lazaros, George; Kontou-Fili, Kalliopi



Provocative Testing of Coronary Vasoconstriction  

Microsoft Academic Search

\\u000a It has been clearly shown that coronary artery spasm is the cause of Prinzmetal’s variant angina and an important mechanism\\u000a of acute myocardial ischemia in angina at rest. Moreover, a role for coronary spasm in the pathogenesis of myocardial infarction\\u000a has been postulated, especially in patients with normal coronary arteries. The diagnosis of vasospastic myocardial ischemia\\u000a should be based on

Mario Previtali; Paolo Barberis; Diego Ardissino


Botulinum toxin in the treatment of blepharospasm and hemifacial spasm  

Microsoft Academic Search

Summary  Blepharospasm and hemifacial spasm are the two most common craniofacial movement disorders. Blepharospasm is a syndrome characterized\\u000a by excessive or continuous eye closure related to overactivity of the orbicularis oculi and adjacent muscles bilaterally.\\u000a Hemifacial spasm is a peripherally-induced movement disorder typically caused by vascular compression of cranial nerve VII\\u000a (CN VII) leading to involuntary unilateral contractions of muscles used

C. Kenney; J. Jankovic



Usefulness of Ergonovine Echocardiography in Patients with Acute Coronary Syndrome and Suspected Variant Angina  

Microsoft Academic Search

Background and Objectives:It is well known that coronary spasm can cause acute coronary syndrome (ACS, such as unstable angina or acute myocardial infarction as well as variant angina. However, the role of coronary spasm as an initial presentation in ACS is difficult to demonstrate. Therefore, we investigated the validity and safety of ergonovine echocardiography in ACS with normal coronary angiogram

Tae Ho Park; Moo Hyun Kim; Eun Hee Park; Ki Tae Kang; Seong Geun Kim; Se Jun Jang; Su Hun Lee; Kwang Soo Cha; Young Dae Kim; Jong Seong Kim


Vascular spasm complicates continuous wave but not pulsed laser irradiation  

SciTech Connect

Preliminary clinical experience with laser angioplasty has suggested that arterial spasm may complicate attempts to employ laser light to accomplish vascular recanalization. The present study was designed to investigate the role of energy profile on the development of arterial spasm during laser angioplasty. Laser irradiation was delivered percutaneously in vivo to New Zealand white rabbits and to Yucatan microswine with or without atherosclerotic lesions induced by a combination of balloon endothelial denudation and atherogenic diet. Continuous wave (CW) laser irradiation from an argon ion gas laser (wavelength 488 to 514 nm) was applied to 23 arteries, while 16 arteries were irradiated using a pulsed xenon chloride (308 nm) or xenon fluoride (351 nm) excimer laser. Arterial spasm, defined as greater than 50% reduction in luminal diameter narrowing, complicated delivery of laser light to 17 (74%) of the 23 arteries irradiated with the CW argon laser. Spasm was consistently observed at powers greater than 2 W, at cumulative exposures greater than 200 seconds, and at total energy greater than 200 joules. Spasm was typically diffuse (including the length of the vessel) and protracted (lasting up to 120 minutes). Intra-arterial nitroglycerin (up to 300 micrograms) produced only temporary and incomplete resolution of laser-induced spasm. In contrast, spasm was never observed in any of the 16 arteries in which laser angioplasty was performed using a pulsed laser (0.95 to 6.37 joules/cm2, 10 to 50 Hz, 48 to 370 seconds). Thus CW but not pulsed laser angioplasty may be complicated by arterial spasm

Gal, D.; Steg, P.G.; Rongione, A.J.; DeJesus, S.T.; Clarke, R.H.; Isner, J.M. (Tufts Univ. School of Medicine, Boston, MA (USA))



Hemimasticatory spasm --a peripheral paroxysmal cranial neuropathy?  

PubMed Central

The clinical and electrophysiological features of a case of hemimasticatory spasm are presented. The findings are in many respects similar to those described in hemifacial spasm. A peripheral cranial neuropathy as proposed in hemifacial spasm also may be responsible for hemimasticatory spasm. Images

Thompson, PD; Carroll, WM



Mechanisms of coronary vasoconstriction induced by high arterial oxygen tension.  


In isolated rabbit hearts perfused with suspension of red blood cells, we investigated the role of the endothelium and of several substances in the coronary vasoconstriction induced by a high arterial blood oxygen tension (PaO2). Red blood cells in Krebs-Henseleit buffer were oxygenated to obtain control and high-PaO2 perfusates. Arterial oxygen content was kept constant in both perfusates by reducing hemoglobin concentration in the high-PaO2 perfusate. Coronary blood flow was kept constant so that oxygen supply would not vary with the rise in PaO2. Increases in perfusion pressure therefore reflected increased coronary resistance. The high PaO2-induced coronary vasoconstriction was not affected by administration of indomethacin, nordihydroguaiaretic acid, NG-nitro-L-arginine, or superoxide dismutase and catalase but was abolished after endothelium damage or by cromakalim. These results demonstrate that 1) the endothelium contributes to the high PaO2-induced coronary vasoconstriction; 2) this effect is independent of cyclooxygenase or lipoxygenase products, nitric oxide, or free radicals; and 3) the closure of ATP-sensitive K+ channels mediates this vasoconstriction. PMID:9038923

Mouren, S; Souktani, R; Beaussier, M; Abdenour, L; Arthaud, M; Duvelleroy, M; Vicaut, E



Histamine Induces Tissue Factor Expression Implications for Acute Coronary Syndromes  

Microsoft Academic Search

Background—Histamine can induce coronary vasospasm, leading to variant angina and acute myocardial infarction. However, the role of histamine in thrombus formation is ill defined. Hence, this study investigates whether histamine induces tissue factor (TF) expression in vascular cells. Methods and Results—Histamine (108 to 105 mol\\/L) induced TF expression in a concentration-dependent manner in human aortic endothelial and vascular smooth muscle

Jan Steffel; Alexander Akhmedov; Helen Greutert; Thomas F. Lüscher; Felix C. Tanner


Felodipine-induced dilatation of epicardial coronary arteries. A randomized, double-blind study.  


Dilatation of large coronary arteries is of potential value in the treatment of angina pectoris. In this double-blind study, the acute effect of felodipine or placebo on coronary artery dilatation was studied in patients with severe angina pectoris with the aid of coronary arteriography. There were two parallel groups, one with 9 patients who received felodipine, the other with 12 patients who received placebo. Measurements of vessel diameters were performed at a proximal position of the affected artery, at the site of the stenosis, and distal to the lesion. The mean plasma felodipine concentration was 17+/-6 nmol/l. The systolic blood pressure was reduced from 156+/-15 to 145+/-13 mm Hg after felodipine (p less than 0.05), but was unaffected by placebo. The heart rate and arterial catecholamine levels were basically unchanged in both groups of patients. The proximal arterial segment was dilated 7% after felodipine (p = 0.05), the stenosis area 9% (N.S.) and the distal part of the vessel 7% (p less than 0.05). There were no changes in coronary diameters in the placebo group. In conclusion, felodipine dilates large coronary arteries, and this mode of action may be valuable in the treatment of patients with coronary artery disease, especially in cases where coronary spasm is a prominent feature. PMID:3511772

Emanuelsson, H; Ekström, L; Hjalmarson, A; Jonsteg, C; Schlossman, D



Intercoronary Communication between the Circumflex and Right Coronary Arteries Coexisted with Coronary Vasospasm  

PubMed Central

Intercoronary arterial connection between normal coronary arteries is a rare variant of coronary anatomy in which there is open-ended circulation. It is distinguished from collaterals seen in the occlusive coronary artery disease. We report a case of bidirectional intercoronary communication between the left circumflex artery and the right coronary artery without occlusive coronary artery disease, but with left anterior descending artery spasm.

Kim, Soo Hyun; Kim, Dae-Hyeok; Choi, Woong Gil; Woo, Seoung Il; Choi, In Suk; Kwan, Jun; Park, Keum Soo



Contrast medium induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome: differences in STEMI and NSTEMI  

Microsoft Academic Search

\\u000a Abstract  The aim of this study was to assess the incidence, clinical predictors, and outcome of patients developing contrast medium\\u000a induced nephropathy (CIN) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS).\\u000a \\u000a \\u000a \\u000a Background  CIN is associated with significant higher morbidity and mortality after coronary intervention. Recently it was shown, that\\u000a patients undergoing percutaneous coronary intervention for acute myocardial infarction have a

Ingo Wickenbrock; Christian Perings; Petra Maagh; Ivo Quack; Marc van Bracht; Magnus W. Prull; Gunnar Plehn; Hans-Joachim Trappe; Axel Meissner



Modeling new therapies for infantile spasms  

PubMed Central

Summary Infantile spasms are the classical seizure type of West syndrome. Infantile spasms often herald a dismal prognosis, due to the high probability to evolve into intractable forms of epilepsies with significant cognitive deficits, especially if not adequately treated. The current therapies, high doses of adrenocorticotropic hormone, steroids or the GABA transaminase inhibitor vigabatrin, are often toxic and may not always be effective. The need to identify new therapies for spasms has led to the generation of a number of rodent models of infantile spasms. These include acute and chronic models of infantile spasms, with cryptogenic or symptomatic origin, many of which are based on specific etiologies. In this review, we will summarize the clinical experience with treating infantile spasms, the main features of the new animal models of infantile spasms and discuss their utility in the preclinical development of new therapies for infantile spasms.

Chudomelova, Lenka; Scantlebury, Morris H.; Raffo, Emmanuel; Coppola, Antonietta; Betancourth, David; Galanopoulou, Aristea S.



Vigabatrin monotherapy for infantile spasms.  


Infantile spasms syndrome (IS) (also known as West syndrome) is an epileptic encephalopathy with a heterogeneous etiology. One of the most common specific causes is tuberous sclerosis, diagnosed in almost 10% of the affected infants. Adrenocorticotropic hormone or steroids have been the preferred treatments for IS for several decades. Clinical studies have shown that vigabatrin is superior to placebo in decreasing the frequency of infantile spasms. In tuberous sclerosis, vigabatrin may be considered the first-line treatment for IS. The mode of action is increasing concentrations of the inhibitory neurotransmitter GABA in the brain. The use of vigabatrin is limited by a serious adverse effect, permanent visual field constriction, which may affect 6-7% of exposed infants. Treatment choices are based on balancing the potential adverse effects against the risk of catastrophic cognitive and behavioral outcomes caused by uncontrolled spasms. PMID:22364326

Gaily, Eija



Infantile Spasms and Lennox-Gastaut Syndrome  

Microsoft Academic Search

Infantile spasms and Lennox-Gastaut syndrome are rare but are important to child neurologists because of the intractable nature of the seizures and the serious neurologic comorbidities. New antiepileptic drugs offer more alternatives for treating both infantile spasms and Lennox-Gastaut syndrome. Selected children with infantile spasms are candidates for epilepsy surgery. Vagus nerve stimulation, corpus callosotomy, and the ketogenic diet are

Edwin Trevathan



Hemifacial Spasm: A Neurosurgical Perspective  

PubMed Central

Hemifacial spasm (HFS) is characterized by tonic clonic contractions of the muscles innervated by the ipsilateral facial nerve. Compression of the facial nerve by an ectatic vessel is widely recognized as the most common underlying etiology. HFS needs to be differentiated from other causes of facial spasms, such as facial tic, ocular myokymia, and blepharospasm. To understand the overall craniofacial abnormalities and to perform the optimal surgical procedures for HFS, we are to review the prevalence, pathophysiology, differential diagnosis, details of each treatment modality, usefulness of brainstem auditory evoked potentials monitoring, debates on the facial EMG, clinical course, and complications from the literature published from 1995 to the present time.

Kong, Doo-Sik



Diffuse Esophageal Spasm: Not Diffuse but Distal Esophageal Spasm (DES)  

Microsoft Academic Search

Diffuse esophageal spasm is an uncommon motility disorder that is found in less than 5% of patients undergoing esophageal motility testing for dysphagia. It is defined manometrically by the presence of 20% or more simultaneous contractions in the distal esophageal body with normal peristalsis. This motility abnormality has been traditionally identified as occurring primarily in the smooth muscle portion of

Monicca Sperandio; Radu Tutuian; R. Matthew Gideon; Philip O. Katz; Donald O. Castell



Cigarette smoking-induced coronary vasoconstriction in atherosclerotic coronary artery disease and prevention by calcium antagonists and nitroglycerin.  


In patients with coronary artery disease, cigarette smoking increases myocardial oxygen demand but may cause an inappropriate alpha-adrenergically mediated fall in myocardial oxygen supply. This study was performed to determine if smoking-induced coronary vasoconstriction is prevented by nitroglycerin, verapamil or nifedipine treatment. In 25 smokers with coronary artery disease (20 men, 5 women, aged 32 to 65 years), heart rate-systolic arterial pressure double product and coronary sinus blood flow (thermodilution) were measured before and during smoking both before and 30 to 60 minutes after administration of saline solution (n = 5, control subjects); nifedipine, 10 mg sublingually (n = 6); verapamil, 10 mg intravenously (n = 7); or nitroglycerin, 0.4 mg sublingually (n = 7). During the first smoking period, double product increased, but coronary sinus flow did not change or decreased. During the second smoking period, in the control subjects double product and coronary sinus flow responded in a manner similar to that observed previously. In those given nifedipine, double product did not change, but coronary sinus flow increased (-4 +/- 5% during the first smoking period [before nifedipine] and 17 +/- 12% during the second period [after nifedipine], p less than 0.01). In those given verapamil, double product and coronary sinus flow increased during smoking (-12 +/- 8% during the first smoking period [before verapamil], 10 +/- 9% during the second period [after verapamil], p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3101478

Winniford, M D; Jansen, D E; Reynolds, G A; Apprill, P; Black, W H; Hillis, L D



Psychogenic Mechanism of Hemifacial Spasm  

Microsoft Academic Search

Introduction: Due to its manifested visual and verbal disabilities, hemifacial spasm (HFS) can lead to significant social embarrassment and adversely affect quality of life. Because of these grave effects, it important to address all potential causes of HFS in order to effectively treat this condition. HFS may have a strong psychogenic component that may be neglected in patients with or

A Husain; A Khaja


Acute Myocardial Infarction Induced by Alternating Exposure to Heat in a Sauna and Rapid Cooling in Cold Water  

Microsoft Academic Search

We describe a patient with acute myocardial infarction, which was thought to result from plaque rupture or thrombosis because of coronary artery spasm. The vasospasm was most likely induced by stimulation of the ?-adrenergic receptors during alternating heat exposure during sauna bathing and rapid cooling during cold water bathing. This report emphasizes the dangers of rapid cooling after sauna bathing

Yukiko Imai; Sachihiko Nobuoka; Junzo Nagashima; Toru Awaya; Jiro Aono; Fumihiko Miyake; Masahiro Murayma



Mutation of ARHGAP9 in patients with coronary spastic angina  

Microsoft Academic Search

Coronary artery spasm has an important function in the etiology of variant angina and other acute coronary syndromes. Abnormal activation of Rho-family GTPases has been observed in cardiovascular disorders, but the function of genetic variability in Rho-family GTPases remains to be evaluated in cardiovascular disorders. We examined the genetic variability of Rho-family GTPases and their regulators in coronary artery spasm.

Mikito Takefuji; Hiroyuki Asano; Kazutaka Mori; Mutsuki Amano; Katsuhiro Kato; Takashi Watanabe; Yasuhiro Morita; Akira Katsumi; Toshiki Itoh; Tadaomi Takenawa; Akihiro Hirashiki; Hideo Izawa; Kozo Nagata; Haruo Hirayama; Fumimaro Takatsu; Tomoki Naoe; Mitsuhiro Yokota; Kozo Kaibuchi



Two Cases of Bezold-Jarisch Reflex Induced by Intra-Arterial Nitroglycerin in Critical Left Main Coronary Artery Stenosis  

PubMed Central

The Bezold-Jarisch reflex, a well-described phenomenon, occurs upon the stimulation of intracardiac mechanoreceptors and is mediated by vagal afferent nerve fibers. Several factors can sensitize the cardiovascular system to develop this reflex, including acute myocardial ischemia, natriuretic peptides, and, rarely, nitroglycerin administration in the setting of acute myocardial infarction. The development of the Bezold-Jarisch reflex in the presence of severe coronary artery stenosis, specifically left main coronary artery stenosis, has not been described. We report 2 cases of patients who underwent elective coronary angiography and were given intra-arterial nitroglycerin during radial sheath insertion to reduce radial artery spasm. In both patients, bradycardia and hypotension developed along with diaphoresis, consistent with the Bezold-Jarisch reflex. Coronary angiography revealed critical (>90%) left main coronary artery stenosis in both patients. Critical left main coronary artery stenosis might sensitize mechanoreceptors or vagal afferents to the development of the Bezold-Jarisch reflex after intra-arterial nitroglycerin use; however, the mechanism of this possible relationship is unclear. In addition to discussing our patients' cases, we review the medical literature relevant to the Bezold-Jarisch reflex.

Shah, Sachin P.; Waxman, Sergio



[Kinesitherapy in the treatment of muscle spasm].  


Muscular spasm is type of the increased muscle tone which is common in the upper motor neuron lesion and it can be developed due to disease (stroke, MS, tumors, infection, intoxication) and trauma. This research included 30 patients with muscular spasm after upper motor neuron lesion. All of the patients were treated by passive exercises and stretching of agonists and antagonists. All patients were males, with age between 25 and 45 years (average 26.9 years). Applying t-test, in testing significant differences in changing muscular spasm, in relationship to the length of the kinesitherapy treatment, there were no significant differences between 1st and 15th day of treatment. Significant difference in spasm grades was after 30th day of treatment compare to 1st and 15th day. This research showed that decreasing muscle spasm we could be expected by applying the kinesitherapy procedures for a longer time. PMID:12693346

Avdi?, Dijana; Skrbo, Armin



The use of a hydrophilic-coated catheter during transradial cardiac catheterization is associated with a low incidence of radial artery spasm  

Microsoft Academic Search

Background: Radial artery spasm (RAS) is a common complication of transradial approach (TRA) to percutaneous coronary angiography (CAG) and coronary intervention. Lower friction resistance between catheter and RA wall may reduce RAS upon insertion, manipulation, and withdrawal of the catheter. The aim of this study was to investigate whether the use of a hydrophilic-coated (HC) catheter, which has lower friction

Seiji Koga; Satoshi Ikeda; Keisuke Futagawa; Koichiro Sonoda; Takatoshi Yoshitake; Yoshiyuki Miyahara; Shigeru Kohno



Intravenous Immunoglobulin as Adjunctive Therapy for Juvenile Spasms  

Microsoft Academic Search

Intravenous immunoglobulin has been reported to be an effective treatment for infantile spasms. Juvenile spasms are electrically and clinically similar to infantile spasms but occur in a later age group. We retrospectively reviewed the charts of five children (aged 4.5—11.5 years) at our institution. Their primary seizure type was juvenile spasms and they were treated with a single inpatient course

Ulrike Bingel; Joseph D. Pinter; Márcio Sotero de Menezes; Jong M. Rho



Basal release of endothelium-derived nitric oxide at site of spasm in patients with variant angina  

Microsoft Academic Search

Objectives. The aim of this study was to investigate the basal release of nitric oxide at spastic sites in patients with variant angina.Background. We previously reported that endothelium-dependent dilator responses to acetylcholine, substance P and bradykinin are preserved at the site of coronary artery spasm. However, it is not known whether the basal release of endothelium- derived nitric oxide is

Kensuke Egashira; Yousuke Katsuda; Masahiro Mohri; Takeshi Kuga; Tatuya Tagawa; Hiroaki Shimokawa; Akira Takeshita



Release of endothelin 1 and angiotensin II induced by percutaneous transluminal coronary angioplasty.  


Endothelial injury plays critical roles in acute and chronic complications after percutaneous transluminal coronary angioplasty (PTCA). We investigated coronary endothelial injury and the release of vasoactive substances induced by PTCA. We examined 44 patients with ischemic heart disease who underwent elective PTCA to isolated stenotic lesions in left coronary arteries. Eleven patients received balloon angioplasty (BA), 14 percutaneous transluminal rotational atherectomy (PTRA), and 19 stent implantation. Blood samples were drawn from the coronary sinus immediately before and after as well as 4 hr and 24 hr after PTCA. Plasma levels of endothelin (ET) 1, angiotensin (ANG) II, von Willebrand factor (vWF), and thrombomodulin (TM) were measured. Seven control subjects who underwent diagnostic coronary angiography (CAG) were used as controls. In all patients, ET-1 levels in the coronary sinus blood significantly increased immediately after PTCA. ANG II levels and vWF activity showed significant increases 4 hr after PTCA. Changes in levels of these markers were similar among the BA, PTRA, and stent groups. TM levels were elevated in all groups of patients, including those simply undergoing diagnostic CAG. Changes in ET-1, ANG II, and vWF levels in the coronary sinus reflect coronary endothelial injury induced by PTCA. PMID:10973017

Hojo, Y; Ikeda, U; Katsuki, T; Mizuno, O; Fukazawa, H; Kurosaki, K; Fujikawa, H; Shimada, K



Muscle metaboreflex-induced coronary vasoconstriction limits ventricular contractility during dynamic exercise in heart failure.  


Muscle metaboreflex activation (MMA) during dynamic exercise increases cardiac work and myocardial O2 demand via increases in heart rate, ventricular contractility, and afterload. This increase in cardiac work should lead to metabolic coronary vasodilation; however, no change in coronary vascular conductance occurs. This indicates that the MMA-induced increase in sympathetic activity to the heart, which raises heart rate, ventricular contractility, and cardiac output, also elicits coronary vasoconstriction. In heart failure, cardiac output does not increase with MMA presumably due to impaired ability to improve left ventricular contractility. In this setting actual coronary vasoconstriction is observed. We tested whether this coronary vasoconstriction could explain, in part, the reduced ability to increase cardiac performance during MMA. In conscious, chronically instrumented dogs before and after pacing-induced heart failure, MMA responses during mild exercise were observed before and after ?1-adrenergic blockade (prazosin 20-50 ?g/kg). During MMA, the increases in coronary vascular conductance, coronary blood flow, maximal rate of left ventricular pressure change, and cardiac output were significantly greater after ?1-adrenergic blockade. We conclude that in subjects with heart failure, coronary vasoconstriction during MMA limits the ability to increase left ventricular contractility. PMID:23355344

Coutsos, Matthew; Sala-Mercado, Javier A; Ichinose, Masashi; Li, Zhenhua; Dawe, Elizabeth J; O'Leary, Donal S



Pattern reversal evoked potentials in infantile spasms.  


Visual evoked potentials in response to sinusoidal gratings of various spatial frequencies, alternating in contrast at 8 Hz were recorded from infants affected by an idiopathic form of infantile spasms (West syndrome). In two infants in whom the spasms began at 3 and 5 months of age, respectively, the VEP's were found to be depressed in amplitude at and around a spatial frequency of 3 and 5 c/deg, respectively. This midfrequency depression, which has never been reported in the literature for normal infants, suggests that infantile spasms in idiopathic patients may interfere at least temporarily with the development of visual function. PMID:6480435

Taddeucci, G; Fiorentini, A; Pirchio, M; Spinelli, D



Ecstasy-induced acute coronary syndrome: something to rave about.  


Ecstasy or 3,4-methylenedioxymethamphetamine is a commonly used illicit recreational drug, enjoying popularity for its stimulant effects. Although acute coronary syndrome is recognized after cocaine and methamphetamine use, association with Ecstasy use has rarely been reported. We report three cases of significantly delayed acute coronary syndrome and ST elevation myocardial infarction related to ingestion of Ecstasy. PMID:22672176

Hoggett, Kerry; McCoubrie, David; Fatovich, Daniel M



Morphologic changes induced by acetylcholine infusion in normal and atherosclerotic coronary arteries.  


Low doses of acetylcholine induce "endothelium-dependent" dilatation in normal coronary arteries and constriction of diseased vessels. This study investigated morphologic changes induced by perfusion of normal and diseased coronary arteries with low and high doses of acetylcholine. Vessels were excised from a series of beating hearts explanted at transplantation for idiopathic dilated cardiomyopathy and coronary artery disease. Coronary arteries from other explanted hearts, perfused with saline solution under similar conditions were taken as controls. Samples were studied using conventional histopathologic and immunohistochemical methods. Coronary arteries were grouped according to presence or absence of histologically detectable structural modifications of any type and extent. Low doses of acetylcholine induced changes in all but 1 structurally diseased coronary artery, whereas no change was induced in any but 1 histologically normal coronary artery. High doses of acetylcholine induced contraction changes in both normal and diseased vessels. Changes observed in the wall of the contracted vessels were: (1) endothelial cell contraction with protruding nuclei and detachment of their intercellular junctions with exposure of subjacent collagen to flow, (2) contraction of plaque smooth muscle cells, (3) formation of cushions protruding into vessel lumens causing blunt microchannels. Contraction in both intimal and plaque cells occurred even in diseased vessel segments with intimal denudation. These effects seemed to be dose-dependent in structurally normal vessels because low doses of acetylcholine did not produce any morphologically detectable changes in histologically normal coronary arteries, while low doses of acetylcholine induced similar reactions in vessels affected by both atherosclerosis and subintimal fibrocellular thickening. PMID:8517381

Arbustini, E; Grasso, M; Diegoli, M; Bellini, O; Ghio, S; De Servi, S; Martinelli, L; Viganò, M; Specchia, G



Caring for muscle spasticity or spasms  


High muscle tone - care; Increased muscle tension - care; Upper motor neuron syndrome - care; Muscle stiffness - care ... Muscle spasticity, or spasms, causes your muscles to become stiff or rigid. It can also cause exaggerated ...


Changes in myocardial and coronary sinus blood oxygen tension induced by asphyxia and reoxygenation.  


1. This study analyzes variations of oxygen tension induced by asphyxia in the myocardium (MpO2) and coronary sinus blood (CSpO2) of the anesthetized open-chest dog. Oxygen tension was measured polarographically and arterial blood pressure and coronary blood flow were recorded simultaneously. 2. Asphyxia increased arterial pressure and coronary blood flow but decreased both MpO2 and CSpO2. 3. During the reoxygenation phase, arterial pressure and coronary flow decreased gradually. Reoxygenation induced a rapid but transient increase in CSpO2 above control levels. In contrast, MpO2 returned gradually to the basal state. 4. The mechanism(s) involved in the differential effects of asphyxia followed by reoxygenation on MpO2 and CSpO2 remain to be elucidated. PMID:3228642

Cicogna, A C; Spadaro, J; Tucci, P J; Bregagnollo, E A; Rodrigues, M A; Curi, P R; Lucchiari, P H



Increased constrictor response to acetylcholine of the isolated coronary arteries from patients with variant angina  

Microsoft Academic Search

The aim of this study was to determine whether isolated coronary arteries from patients with variant angina show hyperreactivity and\\/or supersensitivity to acetylcholine in vitro. Coronary arterial rings were obtained at autopsy within 3 h after death from six coronary arteries having spasm in four patients with variant angina and from 22 coronary arteries in 14 control patients with non-cardiac

Kiyotaka Kugiyama; Toyoaki Murohara; Hirofumi Yasue; Tadashi Kimura; Naritsugu Sakaino; Masamichi Ohgushi; Seigo Sugiyama; Ken Okumura



Persistence of Recruitable Coronary Collaterals in the Absence of Coronary Vasospasm in a Patient with Variant Angina  

SciTech Connect

Recruitable coronary collaterals may appear when spasm suddenly occludes the coronary artery. We report a patient with variant angina who had visible collateral vessels on a control coronary angiogram, despite the presence of normally appearing coronary arteries. These collaterals disappeared after intracoronary administration of nitroglycerin. These findings suggest that recruitable collateral vessels can remain patent long after spontaneous attacks of angina have resolved, and become visible when there is a pressure difference between two small coronary arteries.

Yamashita, Kazuhito; Takeuchi, Masaaki; Nakashima, Yasuhide [Second Department of Internal Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu, Fukuoka 807 (Japan)



Exercise-induced silent myocardial ischemia and coronary morbidity and mortality in middle-aged men  

Microsoft Academic Search

OBJECTIVESWe investigated the prognostic significance of exercise-induced silent myocardial ischemia in both high and low risk men with no prior coronary heart disease (CHD).BACKGROUNDSilent ischemia predicts future coronary events in patients with CHD, but there is little evidence of its prognostic significance in subjects free of CHD.METHODSWe investigated the association of silent ischemia, as defined by ST depression during and

Jari A Laukkanen; Sudhir Kurl; Timo A Lakka; Tomi-Pekka Tuomainen; Rainer Rauramaa; Riitta Salonen; Jaakko Eränen; Jukka T Salonen



Coronary angioplasty induces rise in Chlamydia pneumoniae-specific antibodies.  


Chlamydia pneumoniae is frequently found in atherosclerotic lesions, and high titers of specific antibodies are associated with increased risk for acute myocardial infarction. However, a causative relation has not been established yet. We performed a prospective study of 93 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) to investigate whether angioplasty influences Chlamydia-specific antibody titers and whether there is an association with restenosis. Blood samples were obtained before and 1 and 6 months after angioplasty. Antibodies against chlamydial lipopolysaccharide and against purified C. pneumoniae elementary bodies were measured by enzyme-linked immunosorbent assay (ELISA). After angioplasty, the prevalence of antibodies to lipopolysaccharide rose from 20 to 26% for immunoglobulin A (IgA), from 53 to 64% for IgG, and from 2 to 7% for IgM (P = 0.021, 0.004, and 0.046, respectively). There was a rapid increase of mean antibody titers of all antibody classes within 1 month of PTCA. During the following 5 months, antibody titers decreased slightly but were still higher than baseline values. Results of the C. pneumoniae-specific ELISA were essentially the same. The rise of anti-Chlamydia antibodies was not caused by unspecific reactivation of the immune system, as levels of antibodies against cytomegalovirus did not change. Neither seropositivity nor antibody titers were related to restenosis. However, increases in mean IgA and IgM titers were restricted to patients who had suffered from myocardial infarction earlier in their lives. In conclusion, we show that PTCA induces a stimulation of the humoral immune response against C. pneumoniae. These data support the idea that plaque disruption during angioplasty might make hidden chlamydial antigens accessible to the immune system. PMID:10074519

Tiran, A; Tio, R A; Ossewaarde, J M; Tiran, B; den Heijer, P; The, T H; Wilders-Truschnig, M M



Coronary Angioplasty Induces Rise in Chlamydia pneumoniae-Specific Antibodies  

PubMed Central

Chlamydia pneumoniae is frequently found in atherosclerotic lesions, and high titers of specific antibodies are associated with increased risk for acute myocardial infarction. However, a causative relation has not been established yet. We performed a prospective study of 93 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) to investigate whether angioplasty influences Chlamydia-specific antibody titers and whether there is an association with restenosis. Blood samples were obtained before and 1 and 6 months after angioplasty. Antibodies against chlamydial lipopolysaccharide and against purified C. pneumoniae elementary bodies were measured by enzyme-linked immunosorbent assay (ELISA). After angioplasty, the prevalence of antibodies to lipopolysaccharide rose from 20 to 26% for immunoglobulin A (IgA), from 53 to 64% for IgG, and from 2 to 7% for IgM (P = 0.021, 0.004, and 0.046, respectively). There was a rapid increase of mean antibody titers of all antibody classes within 1 month of PTCA. During the following 5 months, antibody titers decreased slightly but were still higher than baseline values. Results of the C. pneumoniae-specific ELISA were essentially the same. The rise of anti-Chlamydia antibodies was not caused by unspecific reactivation of the immune system, as levels of antibodies against cytomegalovirus did not change. Neither seropositivity nor antibody titers were related to restenosis. However, increases in mean IgA and IgM titers were restricted to patients who had suffered from myocardial infarction earlier in their lives. In conclusion, we show that PTCA induces a stimulation of the humoral immune response against C. pneumoniae. These data support the idea that plaque disruption during angioplasty might make hidden chlamydial antigens accessible to the immune system.

Tiran, Andreas; Tio, Rene A.; Ossewaarde, Jacobus M.; Tiran, Beate; den Heijer, Peter; The, T. Hauw; Wilders-Truschnig, Martie M.



Tremor in hemifacial spasm patients.  


Tremor often accompanies dystonia and some other movement disorders. There are no reports describing tremor in patients with hemifacial spasm (HFS). The aim of the study was to assess the occurrence, type and parameters of tremor in HFS patients. The study included 47 HFS patients (mean age: 58.6 ± 10.7-years-old) and 48 healthy volunteers matched by sex and age. Tremor was assessed clinically and objectively using a triaxial accelerometer and EMG. A load test with 500 g weight was performed in order to identify physiological tremor. The Clinical Global Impression-Severity scale (CGI-S) was used to assess the severity of HFS. Neurological examination revealed tremor in 19 patients and 5 control subjects, and the objective methods postural and kinetic hand tremor was confirmed. Among the patients we identified: one case of psychogenic tremor, two patients were diagnosed with essential tremor, six patients had essential tremor in one hand and enhanced physiologic tremor in the other, seven patients had essential tremor in both hands and three patients had physiological tremor in both hands. Five control subjects revealed enhanced the physiological tremor type. The occurrence of hand tremor was associated with higher severity of HFS, as assessed by CGI score. Tremor accompanies HFS in 40% of cases and 10% of control subjects. The aetiology of hand tremor in patients with HFS is unknown. However, it may be associated with compression of the tremor oscillator located in the medulla. PMID:21161713

Rudzi?ska, Monika; Wójcik, Magdalena; Hartel, Marcin; Szczudlik, Andrzej



Increased Tissue Angiotensin-Converting Enzyme Activity Impairs Bradykinin-Induced Dilation of Coronary Arterioles in Obesity  

PubMed Central

Background Bradykinin (BK) is a key mediator regulating coronary blood flow. It is degraded by angiotensin-converting enzyme (ACE), but what is unknown is whether enhanced tissue ACE activity interferes with BK-induced coronary vasodilation in obesity. Methods and Results Coronary arterioles (~100 ?m) were isolated from rats on a normal or high-fat diet (HFD) and from lean or obese patients undergoing heart surgery (n=74). We found that BK-induced dilation was diminished in the coronary arterioles of HFD rats, when compared with controls. When administered in vitro, the ACE inhibitor, captopril, restored the coronary dilation response to BK in HFD rats, but did not affect control responses. Abundant ACE expression was detected in coronary endothelium, which was associated with increased ACE activity in HFD arterioles, as measured by increased response to the ACE substrate, angiotensin I. Moreover, we found that in the coronary arterioles of obese patients, BK-induced dilation was augmented by in vitro captopril administration. Correspondingly, ACE activity was increased in the coronary arterioles of obese patients when compared with the non-obese. Logistic regression analysis revealed that obese patients taking ACE inhibitors prior to surgery exhibited an enhanced dilation response to BK. Conclusions We demonstrated augmented tissue ACE activity in the coronary arterioles of obese subjects, which leads to reduced coronary dilation response to BK. We provide a rationale for ACE inhibitor therapy in obese patients to improve dilatation of coronary microvessels.

Feher, Attila; Cassuto, James; Szabo, Andras; Patel, Vijay; Kamath, M. Vinayak; Bagi, Zsolt



Dipyridamole-induced ST segment depression during thallium-201 imaging in patients with coronary artery disease: angiographic and hemodynamic determinants  

Microsoft Academic Search

To examine the angiographic and hemodynamic determinants of dipyridamole-induced ST segment depression in patients with coronary artery disease, 41 patients with angiographically documented coronary disease who underwent dipyridamole-thallium-201 myocardial scintigraphy were studied. Dipyridamole-induced ST depression occurred in 14 (34%) of the 41 patients. Stepwise multivariate logistic regression was performed to compare the predictive value of angiographic findings (good coronary collateral

Charles E. Chambers; Kenneth A. Brown



Myocardial blood flow distribution during ischemia-induced coronary vasodilation in the unanesthetized dog.  


This study was designed to determine whether coronary vasodilation distal to a flow-limiting coronary artery stenosis could result in redistribution of myocardial blood flow to produce subendocardial underperfusion. Studies were performed in 10 awake dogs chronically prepared with electromagnetic flow-meters and hydraulic occluders on the left circumflex coronary artery. Regional myocardial blood flow was measured using radionuclide-labeled microspheres, 7-10 mum in diameter, injected into the left atrium. A 5(-s) coronary artery occlusion was followed by reactive hyperemia with excess inflow of arterial blood effecting 375+/-20% repayment of the blood flow debt incurred during occlusion. When, after a 5(-s) occlusion, the occluder was only partially released to hold arterial inflow to the preocclusion level for 20 s before complete release, the delayed reactive hyperemia was augmented (mean blood flow repayment = 610+/-45%, P < 0.01). This augmentation of the reactive hyperemia suggested that ischemia was continuing during the interval of coronary vasodilation when coronary inflow was at the preocclusion level. Measurements of regional myocardial blood flow demonstrated that endocardial flow slightly exceeded epicardial flow during control conditions. When arterial inflow was limited to the preocclusion rate during vasodilation after a 5(-s) total coronary artery occlusion, however, flow to the subepicardial myocardium was increased at the expense of underperfusion of the subendocardial myocardium. Thus, in the presence of a flow-limiting proximal coronary artery stenosis, ischemia-induced coronary vasodilation resulted in redistribution of myocardial blood flow with production of subendocardial ischemia in the presence of a net volume of arterial inflow which, if properly distributed, would have been adequate to prevent myocardial ischemia. PMID:4279928

Bache, R J; Cobb, F R; Greenfield, J C



A case report of very late stent thrombosis with peri-stent coronary artery aneurysm and stent-related coronary vasospasm.  


We describe a 42-year-old man with very late stent thrombosis (VLST) 35 months after implantation of a sirolimus-eluting stent (SES). Three months after the VLST episode, a follow-up angiography showed a formation of peri-stent coronary artery aneurysm. Sixty-five months after SES implantation, the patient suffered an out-of-hospital cardiac arrest. We performed spasm provocation test using acetylcholine to evaluate coronary vasomotor response and the coronary segments adjacent to the SES showed significant vasoconstriction. Intracoronary pretreatment of Rho-kinase inhibitor, fasudil, markedly attenuated acetylcholine-induced vasoconstriction. This report documents a unique case suffering from multiple fatal complications after SES implantation. PMID:23277349

Takeda, Morihiko; Shiba, Nobuyuki; Takahashi, Jun; Shimokawa, Hiroaki



Coronary Angioplasty Induces Rise in Chlamydia pneumoniae-Specific Antibodies  

Microsoft Academic Search

Chlamydia pneumoniae is frequently found in atherosclerotic lesions, and high titers of specific antibodies are associated with increased risk for acute myocardial infarction. However, a causative relation has not been established yet. We performed a prospective study of 93 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) to investigate whether angioplasty influences Chlamydia-specific antibody titers and whether there is an association




Alterations in contrast medium-induced coronary reactive hyperemia after bepridil in patients with coronary artery disease.  


The acute effects of an intravenous infusion of bepridil (BEP) (4 mg . kg-1) on left ventricular (LV) hemodynamics, coronary sinus blood flow (CSBF), and myocardial metabolism were studied in eight patients with coronary artery disease. In contrast with data previously reported with calcium channel blockers, BEP induced an elevation in LV end-diastolic pressure from 12.0 +/- 7.1 to 20.1 +/- 7.2 mm Hg (mean +/- SD, p less than 0.001) and a fall in LV dp/dt max from 1339 +/- 302 to 1177 +/- 251 mm Hg . sec-1 (p less than 0.01). This significant alteration in LV function is likely to be explained by the lack of effect on heart rate and aortic pressure observed after an acute intravenous infusion of BEP. Myocardial oxygen consumption (MVO2) increased from 448 +/- 272 to 498 +/- 273 mumol . min-1/100 g LV (p less than 0.05) as did CSBF from 79.5 +/- 42.7 to 92.1 +/- 45.1 ml X min-1/100 g LV (p less than 0.01). Lactate extraction fell from 0.33 +/- 0.17 to 0.15 +/- 0.17 (p less than 0.05). A contrast medium-induced coronary reactive hyperemia (HPR) evidenced an increased hyperemic volume from 9.5 +/- 3.6 to 12.1 +/- 4.5 ml/100 g LV (p less than 0.01) and HPR duration from 23.3 +/- 6.9 to 32.3 +/- 15.4 sec (p less than 0.05) after BEP. However, the peak/resting CSBF ratio was blunted after BEP from 1.74 +/- 0.18 to 1.61 +/- 0.12 (p less than 0.05), evidencing a net effect of BEP on HPR.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3871297

Foult, J M; Nitenberg, A; Blanchet, F; Zouiouèche, S; Huyghebaert, M F



[Detection of stress-induced myocardial ischemia in isolated coronary ectasia and aneurysm (dilatative coronaropathy)].  


Forty eight patients with bilateral isolated non-stenotic coronary artery ectasia or aneurysm without associated cardiac defects ("dilated coronaropathy") were identified in consecutive diagnostic cardiac catheterizations between 1986-6/1994 (angiographic incidence 0.44%). Ectasia was defined as a luminal dilatation of the 1.5-2-fold, aneurysm of more than double the normal limits. In 16 patients a myocardial infarction (5 non-q-infarctions/11 q-wave-infarctions) was the indication for coronary angiography, a thrombotic occlusion of the infarct vessel was documented in 8/16 patients. In patients without myocardial infarction (study group) an evaluation of exercise-induced myocardial ischemia was performed by means of a coronary sinus lactate study, treadmill ergometry and Thallium-201-scintigraphy. A corresponding coronary insufficiency was objective in all tests in the study group. An exercise-induced myocardial ischemia was found in 21/31 in the coronary sinus study, 19/29 in the treadmill ergometry and 13/26 patients in the scintigraphy; significant differences were found in comparison to the results of a control group of patients without heart disease (n = 29, p < 0.001). After administration of 0.8 mg nitroglycerin (NTG) a further significant deterioration of myocardial ischemia was measured in the 21 patients with pathologic lactate metabolism developing a frank cardiac lactate production (p < 0.03). The extent of myocardial ischemia in the coronary sinus study was significantly correlated to the coronary diameters of the proximal and middle segments of the Ramus interventricularis anterior and the middle segment of the Ramus circumflexus (r = 0.87, p < 0.02). A differentiation between ectasia and aneurysm therefore seems to be of functional relevance. Angiographic stigmata of an impaired coronary blood flow such as a segmental to and from movement and a local deposition of dye were found significantly more often with increasing coronary diameters (p < 0.04). "Dilated coronaropathy" is an entity of non-stenotic, ischemic coronary artery disease. NTG was of no therapeutic benefit or led to an aggravation of the exercise-induced myocardial ischemia. Because of this potential adverse effect the administration of NTG should be avoided in "dilated coronaropathy". PMID:8767365

Krüger, D; Stierle, U; Potratz, J; Diederich, K W; Sheikhzadeh, A



Intermittent left bundle branch block caused by coronary vasospasm.  


Intermittent left bundle branch block (LBBB) has been reported in the literature following certain conditions such as cardiac blunt trauma, myocardial infarction (MI) or exercise induced LBBB. In the majority of cases, the patients usually have underlying coronary arteries disease. LBBB often prevents the electrocardiographic diagnosis of acute MI; therefore, new LBBB in the setting of chest pain is usually treated as transmural MI. We describe a case of patient who presented with intermittent LBBB associated with chest pain, and subsequently the patient was taken to the catheterization laboratory for emergency coronary angiogram, which revealed 80% spasm in left anterior descending artery, which was totally relieved by nitroglycerin infusion. No other significant CAD was noted. PMID:23930243

Alhaji, Mohammad



Behavior of right and left ventricles during episodes of variant angina in relation to the site of coronary vasospasm  

Microsoft Academic Search

The effects of single-vessel coronary occlusion on simultaneously evaluated right (RV) and left ventricular (LV) performance were assessed and compared with LV perfusion patterns in 25 patients with variant angina. Coronary spasm involved the right coronary artery in 15 patients (group 1) and the left anterior descending coronary artery in 10 patients (group 2). Biventricular function was assessed by radionuclide

D. Neglia; O. Parodi; P. Marzullo; G. Sambuceti; C. Marcassa; C. Michelassi; A. LAbbate



Ischemia-induced depressed systolic thickening is transiently augmented by remote coronary occlusion.  


To determine if ischemia-induced depressed myocardial thickening can be augmented by remote coronary occlusion, posterior wall function (pulsed Doppler crystal) was measured before and after left anterior descending coronary artery occlusion in the presence of reduced circumflex coronary artery flow (of sufficient severity to reduce resting function) in an anesthetized open-chest canine preparation in which the circumflex was pump-perfused with carotid arterial blood. Left anterior descending coronary occlusion elicited an immediate significant increase in posterior bed thickening fraction (TF%) (3.7 +/- 1.5 to 5.9 +/- 1.3%), but by 135 sec TF% had again deteriorated. The transient increase in thickening was not caused by increased flow to the posterior bed (microspheres, n = 3), nor was it related to a Frank-Starling mechanism (echocardiography, n = 3). Despite an ischemic-induced reduction in systolic shortening, systolic thickening can be transiently augmented by remote coronary occlusion. The etiology may be related to systolic unloading. PMID:1571984

Gascho, J A; Copenhaver, G L; Davidson, W R



Intracarotid Phenoxybenzamine for Cerebral Arterial Spasm  

Microsoft Academic Search

Phenoxybenzamine was injected into the carotid artery of 23 patients after operations on their cerebral arterial aneurysms. Rapid improvement was seen in three cases with pronounced neurological disability. The other 20 were treated prophylactically in an attempt to prevent the onset of spasm. These results would appear to indicate that intracarotid phenoxybenzamine may be of value in the treatment of

B. H. Cummins; H. B. Griffith



Gabapentin as Treatment for Hemifacial Spasm  

Microsoft Academic Search

Hemifacial spasm, a life-long condition characterized by involuntary unilateral contractions of the facial muscles, is a disabling disorder often resulting in patient irritation and social embarassment. Its probable etiology is neurovascular compression of the facial nerve at its root exit zone. The current medical treatment consists of either baclofen or anticonvulsant drugs, with limitation due to side effects or low

Fabio Bandini; Luca Mazzella



Physical activity opposes coronary vascular dysfunction induced during high fat feeding in mice  

PubMed Central

The study's purpose was to investigate if physical activity initiated with the start of high-fat feeding would oppose development of endothelial dysfunction, and if it does, then to determine some potential mechanisms. C57BL/6 female mice were randomly divided into three groups: (1) control low-fat diet (LF-SED; 15% of calories from fat), (2) high-fat diet (HF-SED; 45% of calories from fat), and (3) HF diet given access to a voluntary running wheel (HF-RUN). Our hypothesis was that HF-RUN would differ in multiple markers of endothelial dysfunction from HF-SED after 10 weeks of 45%-fat diet, but would not differ from LF-SED. HF-RUN differed from HF-SED in nine determinations in which HF-SED either had decreases in (1) acetylcholine (ACh)-induced and flow-induced vasodilatations in isolated, pressurized coronary arterioles, (2) heart phosphorylated endothelial nitric oxide synthase (p-eNOS/eNOS) protein, (3) coronary arteriole leptin (ob) receptor protein, (4) phosphorylated signal transducer and activator of transcription 3 (p-STAT3/STAT3) protein, and (5) coronary arteriole superoxide dismutase 1 protein; or had increases in (6) percentage body fat, (7) serum leptin, (8) coronary arteriole suppressor of cytokine signalling 3 (SOCS3) protein, and (9) coronary arteriole gp91phox protein. Higher endothelium-dependent vasodilatation by ACh or leptin was abolished with incubation of NOS inhibitor NG-nitro-l-arginine-methyl ester (l-NAME) in LF-SED and HF-RUN groups. Further, impaired ACh-induced vasodilatation in HF-SED was normalized by apocynin or TEMPOL to LF-SED and HF-RUN. These findings demonstrate multiple mechanisms (eNOS, leptin and redox balance) by which voluntary running opposes the development of impaired coronary arteriolar vasodilatation during simultaneous high-fat feeding.

Park, Yoonjung; Booth, Frank W; Lee, Sewon; Laye, Mathew J; Zhang, Cuihua



Detailing radio frequency heating induced by coronary stents: a 7.0 Tesla magnetic resonance study.  


The sensitivity gain of ultrahigh field Magnetic Resonance (UHF-MR) holds the promise to enhance spatial and temporal resolution. Such improvements could be beneficial for cardiovascular MR. However, intracoronary stents used for treatment of coronary artery disease are currently considered to be contra-indications for UHF-MR. The antenna effect induced by a stent together with RF wavelength shortening could increase local radiofrequency (RF) power deposition at 7.0 T and bears the potential to induce local heating, which might cause tissue damage. Realizing these constraints, this work examines RF heating effects of stents using electro-magnetic field (EMF) simulations and phantoms with properties that mimic myocardium. For this purpose, RF power deposition that exceeds the clinical limits was induced by a dedicated birdcage coil. Fiber optic probes and MR thermometry were applied for temperature monitoring using agarose phantoms containing copper tubes or coronary stents. The results demonstrate an agreement between RF heating induced temperature changes derived from EMF simulations versus MR thermometry. The birdcage coil tailored for RF heating was capable of irradiating power exceeding the specific-absorption rate (SAR) limits defined by the IEC guidelines by a factor of three. This setup afforded RF induced temperature changes up to +27 K in a reference phantom. The maximum extra temperature increase, induced by a copper tube or a coronary stent was less than 3 K. The coronary stents examined showed an RF heating behavior similar to a copper tube. Our results suggest that, if IEC guidelines for local/global SAR are followed, the extra RF heating induced in myocardial tissue by stents may not be significant versus the baseline heating induced by the energy deposited by a tailored cardiac transmit RF coil at 7.0 T, and may be smaller if not insignificant than the extra RF heating observed under the circumstances used in this study. PMID:23185498

Santoro, Davide; Winter, Lukas; Müller, Alexander; Vogt, Julia; Renz, Wolfgang; Ozerdem, Celal; Grässl, Andreas; Tkachenko, Valeriy; Schulz-Menger, Jeanette; Niendorf, Thoralf



Detailing Radio Frequency Heating Induced by Coronary Stents: A 7.0 Tesla Magnetic Resonance Study  

PubMed Central

The sensitivity gain of ultrahigh field Magnetic Resonance (UHF-MR) holds the promise to enhance spatial and temporal resolution. Such improvements could be beneficial for cardiovascular MR. However, intracoronary stents used for treatment of coronary artery disease are currently considered to be contra-indications for UHF-MR. The antenna effect induced by a stent together with RF wavelength shortening could increase local radiofrequency (RF) power deposition at 7.0 T and bears the potential to induce local heating, which might cause tissue damage. Realizing these constraints, this work examines RF heating effects of stents using electro-magnetic field (EMF) simulations and phantoms with properties that mimic myocardium. For this purpose, RF power deposition that exceeds the clinical limits was induced by a dedicated birdcage coil. Fiber optic probes and MR thermometry were applied for temperature monitoring using agarose phantoms containing copper tubes or coronary stents. The results demonstrate an agreement between RF heating induced temperature changes derived from EMF simulations versus MR thermometry. The birdcage coil tailored for RF heating was capable of irradiating power exceeding the specific-absorption rate (SAR) limits defined by the IEC guidelines by a factor of three. This setup afforded RF induced temperature changes up to +27 K in a reference phantom. The maximum extra temperature increase, induced by a copper tube or a coronary stent was less than 3 K. The coronary stents examined showed an RF heating behavior similar to a copper tube. Our results suggest that, if IEC guidelines for local/global SAR are followed, the extra RF heating induced in myocardial tissue by stents may not be significant versus the baseline heating induced by the energy deposited by a tailored cardiac transmit RF coil at 7.0 T, and may be smaller if not insignificant than the extra RF heating observed under the circumstances used in this study.

Santoro, Davide; Winter, Lukas; Muller, Alexander; Vogt, Julia; Renz, Wolfgang; Ozerdem, Celal; Grassl, Andreas; Tkachenko, Valeriy; Schulz-Menger, Jeanette; Niendorf, Thoralf



Role of Caspases in Ox-LDL-Induced Apoptotic Cascade in Human Coronary Artery Endothelial Cells  

Microsoft Academic Search

Oxidized low-density lipoprotein (ox-LDL) induces apoptosis in endothelial cells. However, steps leading to ox-LDL-induced apoptosis remain unclear. We examined the role of ox-LDL and its newly described receptor LOX-1 in the expression of intracellular pro- and antiapoptotic proteins and caspase pathways in human coronary artery endothelial cells (HCAECs). Cells were cultured and treated with different concentrations (10 to 80 g\\/mL)

Jiawei Chen; Jawahar L. Mehta; Nezam Haider; Xingjian Zhang; Jagat Narula; Dayuan Li



A Case of Distal Embolization of Left Ventricular Thrombus due to Blunt Chest Trauma-Induced Coronary Artery Occlusion  

PubMed Central

Chest trauma can lead to various cardiac complications ranging from simple arrhythmias to myocardial rupture. A variety of injuries to the coronary arteries, including laceration, thrombosis, intimal dissection, arteriovenous fistula and pseudoaneurysm formation following blunt trauma have been rarely reported. We report a very unusual case of distal embolization of left ventricular thrombus due to blunt chest trauma-induced coronary artery occlusion.

Kim, Ji-Hwan



Hypoxia-induced hyperpolarization is not associated with vasodilation of bovine coronary resistance arteries.  


The effect of reduced PO2 on the transmembrane potential and diameter of small cannulated coronary resistance arteries was evaluated by microelectrode and videomicroscopic methods. Bovine coronary resistance arteries (158 +/- 8 microm ID) were cannulated with glass micropipettes and perfused and superfused with physiological salt solution. Lowering the PO2 of the physiological salt solution from 140 +/- 4 to 36 +/- 2 mmHg increased the smooth muscle cell transmembrane potential from -51 +/- 2 to -62 +/- 2 mV in both endothelium-intact and -denuded coronary resistance arteries. This hyperpolarization was blocked by superfusion with the K+-channel blocker glibenclamide (1 microM). However, low PO2 did not significantly dilate either endothelium-intact or -denuded coronary resistance arteries, although superfusion with 1 microM cromakalim, a K+-channel activator, induced a 6-mV hyperpolarization and increased the diameter by 33 +/- 10 microm. These results suggest that reduced PO2 directly hyperpolarizes the vascular smooth muscle of coronary resistance arteries by activation of glibenclamide-sensitive K+ channels, but other nonvascular mechanisms may mediate the vasodilation response to low PO2. PMID:9087625

Gauthier-Rein, K M; Bizub, D M; Lombard, J H; Rusch, N J



[Accordion effect--a rare pseudocomplication of coronary angioplasty. A case report].  


Accordion effect is a rare pseudocomplication of coronary angioplasty created by straightening of tortuous coronary artery with a guidewire. Its morphology is nearly identical with vessel dissection, spasm or thrombosis but no special treatment is needed. Immediate and correct diagnosis of accordion effect prevents consequences of unnecessary dilatation of normal coronary segment. PMID:15004633

Ciszewski, Andrzej; Ma?ecka, Longina; Cedro, Krzysztof



Effects of histamine H1-receptor stimulation on coronary hemodynamics in man.  


Exogenous histamine in man induces significant cardiovascular effects mediated by activation of H1 and H2-receptors present on human heart and on coronary arteries. We studied the effects of selective H1-receptor stimulation on human coronary hemodynamics in 10 patients undergoing cardiac catheterization. All patients were pretreated with cimetidine before the histamine infusion (0.5 micrograms/kg/min i.v. for 5 min). Six of these patients had normal coronary arteries and four had single vessel coronary artery disease (CAD) and vasospastic angina. During the study heart rate was held constant (100 beats/min) by coronary sinus pacing. We measured mean aortic pressure (MAP), coronary sinus blood flow (CSBF), coronary vascular resistance (CVR) and myocardial oxygen consumption (MVO2) at rest, during histamine infusion, and 10 min after the end of the infusion. During infusion, MAP decreased from 103 +/- 5 to 85 +/- 6 mmHg (p less than 0.02) and CVR from 1.00 +/- 0.16 to 0.81 +/- 0.14 mmHg/ml/min (p less than 0.05); CSBF and MVO2 did not significantly change. All parameters returned to baseline at the end of the infusion. The response was similar in patients with normal coronary arteries and in 3 patients with CAD. Only one patient with CAD developed angina with ST segment elevation in D3, reduction in CSBF and an increase in CVR. These results indicate that H1-receptor stimulation in man induces significant coronary dilatation and that histamine infusion after cimetidine pretreatment is unlikely to provoke coronary spasm in patients with vasospastic angina. PMID:4083178

Vigorito, C; Poto, S; Triggiani, M; Rispoli, M; Marone, G



Coronary and left ventricular hemodynamic responses following reversal of flunitrazepam-induced sedation with flumazenil in patients with coronary artery disease.  


The effects of reversal of flunitrazepam-induced sedation with flumazenil on coronary hemodynamics, myocardial oxygen consumption (MVO2), and left ventricular (LV) performance were investigated, in a double-blind trial, in 12 patients with stable coronary artery disease undergoing cardiac catheterization. Coronary sinus blood flow was measured by continuous thermodilution. Arterial and coronary sinus blood were analyzed for oxygen and lactate contents. The determinants of LV performance were obtained from the cardiac output measured by thermodilution and from left heart catheterization data. To reverse flunitrazepam-induced sedation, patients were randomly allocated to receive placebo or flumazenil (by increment, up to 1 mg) at the end of procedure. In the placebo group, no significant hemodynamic changes were observed. In the flumazenil group, heart rate, cardiac index, maximum velocity of shortening, and relaxation time constant were not significantly altered. By contrast, mean aortic pressure and LV end-diastolic pressure (baselines: 90 +/- 5 and 7.3 +/- 4.1 mmHg, respectively) increased (9%, P less than 0.05 and 67%, P less than 0.05, respectively) after flumazenil administration, but these changes represented mainly a return toward presedation values. MVO2 and coronary resistance were not significantly altered, whereas CSBF increased slightly (baseline: 119 +/- 20 ml/min; increase 10%, P less than 0.05). No electrocardiographic evidence of myocardial ischemia was observed during the study. These data show that reversal of benzodiazepine effects with flumazenil is not associated with a major alteration of LV systolic function, relaxation, or coronary hemodynamics in patients with coronary artery disease. Nevertheless, it should be cautiously used when LV end-diastolic pressure is increased at the time of its administration. PMID:1986661

Marty, J; Nitenberg, A; Philip, I; Foult, J M; Joyon, D; Desmonts, J M



Primary hemifacial spasm: a neurophysiological study.  

PubMed Central

A series of 53 cases of primary hemifacial spasm have been evaluated by means of blink reflexes and their results compared with a normal control group. Reflex responses were obtained by percutaneous electrical stimulus of both the supraorbital nerve (trigemino-facial reflex), and the facial nerve at the stylo-mastoid region (facio-facial reflex). The R2 response was considered abnormal when its latency was shortened (hyperactivity) or delayed (hypoactivity). Thirty-six out of 53 cases with primary hemifacial spasm showed abnormal responses, with a combination of facial nerve impairment (delayed R2 in the facio-facial reflex) and trigeminal-facial hyperactivity (shortened R2 in the trigemino-facial reflex). Five cases showed hyperactivity in both the trigemino-facial reflex and the facio-facial reflex reflexes. These results suggest a state of hyperexcitability, probably at the level of the facial nucleus, combined with a peripheral facial nerve involvement in a high proportion of patients with primary hemifacial spasm. Images

Esteban, A; Molina-Negro, P



Repeat microvascular decompression for hemifacial spasm  

PubMed Central

Objective: To report our experience with repeat microvascular decompression (MVD) for hemifacial spasm (HFS) in patients who have failed their first operation. Methods: The authors describe 41 redo MVDs for HFS in 36 patients performed over a 3 year period. Seven patients underwent early re-operation after an aborted seventh nerve decompression. Eight patients underwent early re-operation for clinical failure. Eighteen patients underwent late re-operation for spasm recurrence long after their original MVD. Eight MVDs were performed on patients who had already undergone at least two prior operations. Results: Twenty four patients experienced complete spasm resolution (70.6%), eight patients had near total resolution (23.5%), and two patients failed re-operation (5.9%). Two patients were lost to follow up (5.6%). A favourable outcome was reported by 82.4% of patients at a mean follow up interval of 18 months. A total of 91.7% of patients 50 years of age or younger were cured at follow up versus 59.1% of patients older than 50 (p = 0.04). Patients undergoing early re-operation were significantly more likely to be cured or improved than patients undergoing late re-operation (p = 0.03). Conclusions: Repeat MVD for HFS is effective in experienced hands. Younger patients respond better to repeat MVD. Late repeat MVD for HFS is a reasonable treatment option, although results are less favourable than for early re-operation.

Engh, J; Horowitz, M; Burkhart, L; Chang, Y; Kassam, A



[TENS in the treatment of muscle spasm].  


This study deals with 60 patients with muscle spasm after the lesion of upper motor neurone. Thirty patients were treated by battery operated TENS unit, which produce biphasic impulses, with possibility of individual determination of impulse duration (0.05-0.25 msec), frequency (2-100 Hz) and intensity (0-80 mA). The electrodes were put on the motor points of m. tibialis anterior and m. extensor digitorum. The parameters of stimulation where determined individually, using the impulses that elicit dorsal flexion of the ankle joint and fingers. In the control group, consisted of 30 patients, passive exercises were performed (increasing range of motion, stretching of the agonistic and antagonistic muscles). At the end of the research, the authors report statistically significant decrease of muscles spasm in patients treated by TENS (p < 0.05), as well as improvement of the passive range of motion in ankle joint in both groups. Reducing of the muscle spasm is more pronounced if longer period of stimulation is applied. PMID:10872277

Avdi?, D; Buljina, A



Family occurrence of achalasia and diffuse spasm of the oesophagus.  

PubMed Central

In view of the unknown aetiology of achalasia and diffuse oesophageal spasm we report four families (father/son, mother/son, brother/brother, cousin/cousin) with achalasia and oesophageal spasm examined by radiology, endoscopy and manometry. Family occurrence of oesophageal motor disorders supports the hypothesis that a genetic trait may play a role in the pathogenesis. The family coincidence of achalasia and oesophageal spasm supports a close relationship between the two diseases. Images Fig. 2 Fig. 3

Frieling, T; Berges, W; Borchard, F; Lubke, H J; Enck, P; Wienbeck, M



Hemimasticatory spasm treated with microvascular decompression of the trigeminal nerve.  


Hemimasticatory spasm is a very rare disorder of the trigeminal nerve characterized by paroxysmal involuntary contraction of the jaw-closing muscles. The mechanisms leading to hemimasticatory spasm are still unclear. Recently, injection of botulinum toxin has become the treatment of choice due to its excellent results. We report a case of a successful treatment of hemimasticatory spasm via microvascular decompression of the motor branch of the trigeminal nerve. PMID:22576267

Chon, Kyu-Hyon; Lee, Jong-Myong; Koh, Eun-Jeong; Choi, Ha-Young



A Rare Case of Acute Myocardial Infarction due to Coronary Artery Dissection and Heparin-Induced Thrombocytopenia  

PubMed Central

Although both coronary artery dissection and heparin-induced thrombocytopenia may provoke myocardial infarction, it is extremely rare for both conditions to develop simultaneously in a single patient. We report a case of a 69-year-old woman who sustained a head-on motor vehicle accident with associated chest trauma. During a subsequent hospitalization, she was exposed to subcutaneous heparin and developed significant thrombocytopenia. Shortly thereafter, she re-presented with an acute myocardial infarction. Coronary angiography revealed a spiral dissection with superimposed thrombosis within the right coronary artery, while laboratory testing confirmed the diagnosis of heparin induced thrombocytopenia. She was treated with catheter-based thrombectomy and adjunctive direct thrombin inhibitor therapy, followed by three months of systemic anticoagulation with warfarin. To our knowledge, this represents the first published case of a native vessel myocardial infarction due to the combination of coronary artery dissection and heparin-induced thrombocytopenia.

Fradley, Michael G.; Drachman, Douglas E.



Relationship between regional myocardial blood flow and thallium-201 distribution in the presence of coronary artery stenosis and dipyridamole-induced vasodilation  

Microsoft Academic Search

This study assesses the relationship between the distribution of thallium-201 and myocardial blood flow during coronary vasodilation induced by intravenous dipyridamole in canine models of partial and complete coronary artery stenosis. 10 dogs were chronically instrumented with catheters in the left atrium and aorta and with a balloon occluder and electromagnetic flow probe on the proximal left circumflex coronary artery.

A. E. Jr. Mays; F. R. Cobb



Closure of guide wire-induced coronary artery perforation with a two-component fibrin glue.  


Perforation or rupture of a coronary artery with subsequent pericardial effusion and cardiac tamponade is a potentially life-threatening complication of percutaneous coronary intervention (PCI). Several emergency treatment strategies exist to close the perforation including reversal of anticoagulation, prolonged balloon inflation, implantation of stent grafts, local injection of thrombogenic molecules, placement of microcoils, or open heart surgery. Here we report on a 66-year-old patient who underwent urgent PCI for acute stent thrombosis in the proximal LAD. The artery was reopened, a new stent implanted successfully, and a GPIIb/IIIa-antagonist was given. Shortly thereafter the patient suffered from cardiac tamponade requiring pericardiocentesis and pericardial drainage. The coronary angiogram indicated a severe guide wire-induced perforation and pericardial effusion originating from a distal diagonal branch segment. Prolonged balloon inflation did not stop the leakage. Therefore the monorail balloon was exchanged for an over-the-wire balloon. A two-component commercial fibrin glue consisting of fibrinogen and thrombin was rapidly but separately injected through the wire channel of the balloon into the distal segment of the diagonal branch. The coronary leak was successfully closed and the patient recovered quickly. In comparison with the previously reported cases of thrombin injection important differences should be noticed: (1) a two-component hemostatic seal was used without reversal of anticoagulation, (2) rapid injection instead of prolonged infusion of the hemostatic drugs was performed, and (3) the rescue technique was applied in a cath lab that routinely uses monorail catheter systems. Therefore we consider this a novel and effective approach for closure of coronary ruptures. PMID:17420994

Störger, Hans; Ruef, Johannes



Trimetazidine in the prevention of contrast induced nephropathy after coronary angiogram.  


This prospective randomized, controlled trial was done to evaluate the efficacy of trimetazidine in the prevention of contrast induced nephropathy in patients with raised serum creatinine levels undergoing coronary angiogram. This study was performed in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from April 2009 to March 2010. Contrast-induced nephropathy (CIN) is a serious complication of coronary angiography that is associated with considerably increased mortality and morbidity, including the need for short-term haemodialysis, extended hospitalisation and permanent impairment of renal function. Trimetazidine (TMZ) has been described as a cellular anti-ischaemic agent. This study was trial with 400 patients. Among them 200 patients treated with trimetazidine plus hydration with normal saline and 200 patients (control) given hydration by normal saline only. It was found that the incidence of CIN was significantly (p<0.05) reduced by trimetazidine administration with saline in comparison with saline alone in patients undergoing coronary angiogram (4% vs. 14%). PMID:22561774

Rahman, M M; Haque, S S; Rokeya, B; Siddique, M A; Banerjee, S K; Ahsan, S A; Rahman, F; Mahmood, M; Ahmed, K; Bhuiyan, M M; Joarder, A I; Debnath, R C



Coronary artery diameter increase induced by a phosphodiesterase 5 inhibitor, E4021, in conscious pigs.  


The effects of intravenous infusions of 1, 3 and 10 microg/kg/min of the phosphodiesterase 5 inhibitor, E4021, at 30-min intervals on coronary artery diameter were studied in 8 conscious pigs monitored with a pair of piezoelectric crystals. The highest dose increased the diameter by 2.9 +/-0.5% (P <0.01 vs vehicle) of the baseline diameter, with a significant decrease in mean pulmonary arterial pressure. However, there were no changes in mean aortic pressure and heart rate. Additionally, E4021 significantly prolonged the duration of the diameter increase induced by nitroglycerin. Thus, phosphodiesterase 5 inhibition causes coronary artery diameter increase and produces an amplifying effect with nitroglycerin. PMID:9639065

Adachi, H; Nishino, M



Lower threshold for adenosine-induced chest pain in patients with angina and normal coronary angiograms  

PubMed Central

Objective—To investigate whether patients with angina-like chest pain and normal coronary angiograms are more sensitive to adenosine as an inducer of chest pain. Design—Increasing doses of adenosine were given in a single blind study as intravenous bolus injections. Chest pain and the electrocardio?raphic findings were noted. Patients—Eight patients with anginalike chest pain but no coronary stenoses (group A), nine patients with angina and coronary stenoses (group B), and 16 healthy volunteers (group C). Results—In the absence of ischaemic signs on the electrocardiogram adenosine provoked angina-like pain in all patients in groups A and B. The pain was located in the chest, and its quality and location were described as being no different from the patient's habitual angina. In group C, 14 of 16 subjects reported chest pain. The lowest dose resulting in chest pain was lower in group A (0·9 (0·6) mg) than in group B (3·1 (1·5) mg) (p < 0·005) and in group C (6·2 (3·7) mg) (p < 0·005). The maximum tolerable dose was lower in group A (4·7 (2·1) mg) than in group B (9·2 (3·8) mg) (p < 0·05) and in group C (12·0 (4·1) mg) (p < 0·005). Conclusions—Patients with anginalike chest pain and normal coronary angiograms have a low pain threshold and low tolerance to pain induced by adenosine.

Lagerqvist, Bo; Sylven, Christer; Waldenstrom, Anders



Part Two: Infantile Spasms--The New Consensus  

ERIC Educational Resources Information Center

|This article presents the conclusion made by the consensus group regarding infantile spasms. The consensus group concluded that "infantile spasms are a major form of severe epileptic encephalopathy of early childhood that results in neurodevelopmental regression and imposes a significant health burden." The entire group agrees that the best…

Pellock, John M.; O'Hara, Kathryn



Infantile Spasms and Cytomegalovirus Infection: Antiviral and Antiepileptic Treatment  

ERIC Educational Resources Information Center

|From 1 January 1995 to 31 December 2004, 22 patients (13 males, nine females; age range 2-12mo) with infantile spasms and cytomegalovirus (CMV) infection were treated with intravenous ganciclovir (GCV) and antiepileptic drugs. GCV was given for 3 to 12 weeks with a 1-month interval (one, two, or three courses). Epileptic spasms occurred before…

Dunin-Wasowicz, Dorota; Kasprzyk-Obara, Jolanta; Jurkiewicz, Elzbieta; Kapusta, Monika; Milewska-Bobula, Bogumila



Therapeutic Trial of Vigabatrin in Refractory Infantile Spasms  

Microsoft Academic Search

Infantile spasms usually start during the first year of life and constitute one of the most difficult types of epilepsy to treat. They carry a very poor prognosis for both epilepsy and mental development. Seventy children, including 47 infants, with intractable infantile spasms were entered into an open study with vigabatrin as add-on therapy to the usual anticonvulsant treatment. All

Catherine Chiron; Olivier Dulac; Daniel Beaumont; Leonardo Palacios; Nicole Pajot; John Mumford



Infantile Spasms and Cytomegalovirus Infection: Antiviral and Antiepileptic Treatment  

ERIC Educational Resources Information Center

From 1 January 1995 to 31 December 2004, 22 patients (13 males, nine females; age range 2-12mo) with infantile spasms and cytomegalovirus (CMV) infection were treated with intravenous ganciclovir (GCV) and antiepileptic drugs. GCV was given for 3 to 12 weeks with a 1-month interval (one, two, or three courses). Epileptic spasms occurred before…

Dunin-Wasowicz, Dorota; Kasprzyk-Obara, Jolanta; Jurkiewicz, Elzbieta; Kapusta, Monika; Milewska-Bobula, Bogumila



The history of facial palsy and spasm  

PubMed Central

Although Sir Charles Bell was the first to provide the anatomic basis for the condition that bears his name, in recent years researchers have shown that other European physicians provided earlier clinical descriptions of peripheral cranial nerve 7 palsy. In this article, we describe the history of facial distortion by Greek, Roman, and Persian physicians, culminating in Razi's detailed description in al-Hawi. Razi distinguished facial muscle spasm from paralysis, distinguished central from peripheral lesions, gave the earliest description of loss of forehead wrinkling, and gave the earliest known description of bilateral facial palsy. In doing so, he accurately described the clinical hallmarks of a condition that we recognize as Bell palsy.

Sajadi, Mohamad-Reza M.; Tabatabaie, Seyed Mahmoud



Reversible cold-induced abnormalities in myocardial perfusion and function in systemic sclerosis  

SciTech Connect

The effects of peripheral cold exposure on myocardial perfusion and function were studied in 13 patients with scleroderma without clinically evident myocardial disease. Ten patients had at least one transient, cold-induced, myocardial perfusion defect visualized by thallium-201 scintigraphy, and 12 had reversible, cold-induced, segmental left ventricular hypokinesis by two-dimensional echocardiography. The 10 patients with transient perfusion defects all had anatomically corresponding ventricular wall motion abnormalities. No one in either of two control groups (9 normal volunteers and 7 patients with chest pain and normal coronary arteriograms) had cold-induced abnormalities. This study is the first to show the simultaneous occurrence of cold-induced abnormalities in myocardial perfusion and function in patients with scleroderma. The results suggest that cold exposure in such patients may elicit transient reflex coronary vasoconstriction resulting in reversible myocardial ischemia and dysfunction. Chronic recurrent episodes of coronary spasm may lead to focal myocardial fibrosis.

Alexander, E.L.; Firestein, G.S.; Weiss, J.L.; Heuser, R.R.; Leitl, G.; Wagner, H.N. Jr.; Brinker, J.A.; Ciuffo, A.A.; Becker, L.C.



Prolonged left ventricular dysfunction occurs in patients with coronary artery disease after both dobutamine and exercise induced myocardial ischaemia  

Microsoft Academic Search

OBJECTIVETo determine whether pharmacological stress leads to prolonged but reversible left ventricular dysfunction in patients with coronary artery disease, similar to that seen after exercise.DESIGNA randomised crossover study of recovery time of systolic and diastolic left ventricular function after exercise and dobutamine induced ischaemia.SUBJECTS10 patients with stable angina, angiographically proven coronary artery disease, and normal left ventricular function.INTERVENTIONSTreadmill exercise and

E Barnes; C S R Baker; D P Dutka; O Rimoldi; C A Rinaldi; P Nihoyannopoulos; P G Camici; R J C Hall



Emergency Stenting of Unprotected Left Main Coronary Artery after Acute Catheter-Induced Occlusive Dissection  

PubMed Central

Left main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion.

Akgul, Ferit; Batyraliev, Talantbek; Besnili, Fikret; Karben, Zarema



Single photon emission computed tomography with thallium-201 during adenosine-induced coronary hyperemia: Correlation with coronary arteriography, exercise thallium imaging and two-dimensional echocardiography  

SciTech Connect

The feasibility, safety and diagnostic accuracy of single photon emission computed tomography (SPECT) with thallium-201 imaging during adenosine-induced coronary hyperemia were evaluated in 53 patients with and 7 without coronary artery disease proved by coronary angiography. Adenosine was infused intravenously at a dose of 0.14 mg/kg body weight per min for 6 min and thallium was injected at 3 min. Adenosine caused an increase in heart rate (68 +/- 12 at baseline versus 87 +/- 18 beats/min at peak effect, p less than 0.0001) but no change in blood pressure. The sensitivity and specificity were 92% (95% confidence intervals 81% to 98%) and 100% (95% confidence intervals 59% to 100%), respectively; 20 (61%) of 33 patients with multivessel coronary artery disease were also correctly identified. In 30 patients, the predictive accuracy of adenosine thallium imaging was slightly higher than that of exercise SPECT thallium imaging (90% versus 80%, p = NS) (95% confidence intervals 72% to 97% and 61% to 92%, respectively). In 25 patients, two-dimensional echocardiography during adenosine infusion disclosed a new wall motion abnormality in 2 (10%) of 20 patients with coronary artery disease; 80% of these patients had reversible thallium defects (p less than 0.001). Side effects were mild and transient; aminophylline was used in only three patients. Thus, adenosine SPECT thallium imaging provides a high degree of accuracy in the diagnosis of coronary artery disease. The results are comparable with those of exercise SPECT thallium imaging. Most reversible defects in the adenosine study are not associated with any transient wall motion abnormality.

Nguyen, T.; Heo, J.; Ogilby, J.D.; Iskandrian, A.S. (Philadelphia Heart Institute, PA (USA))



Dipyridamole-induced ST segment depression during thallium-201 imaging in patients with coronary artery disease: angiographic and hemodynamic determinants  

SciTech Connect

To examine the angiographic and hemodynamic determinants of dipyridamole-induced ST segment depression in patients with coronary artery disease, 41 patients with angiographically documented coronary disease who underwent dipyridamole-thallium-201 myocardial scintigraphy were studied. Dipyridamole-induced ST depression occurred in 14 (34%) of the 41 patients. Stepwise multivariate logistic regression was performed to compare the predictive value of angiographic findings (good coronary collateral vessels, jeopardized collateral vessels, multivessel disease), hemodynamic changes (changes in heart rate, systolic pressure, diastolic pressure and rate-pressure product), thallium-201 results (perfusion defect, thallium-201 redistribution) and demographic data (age, gender, medications). Only the presence of good coronary collateral vessels (p less than 0.02) and increases in rate-pressure product after dipyridamole infusion (p less than 0.02) were significant multivariate predictors of dipyridamole-induced ST depression. Good collateral vessels were more common in the group with ST depression (11 (79%) of 14) than they were in the group without ST depression (6 (22%) of 27; p less than 0.001). Rate-pressure product increased 2,835 +/- 1,648 beats/ Hg in the group with ST depression compared with 1,179 +/- 1,417 beats/ Hg in patients without ST depression (p less than 0.005). In conclusion, dipyridamole-induced ST segment depression in patients with coronary artery disease appears to be related to 1) the presence of good coronary collateral vessels, which may act by facilitating coronary steal, and 2) increases in rate-pressure product, reflecting increased myocardial oxygen demand. These observations may explain the lack of prognostic value of dipyridamole-induced ST segment depression described in previous reports.

Chambers, C.E.; Brown, K.A.



Role of endothelial cell membrane transport in red wine polyphenols-induced coronary vasorelaxation: involvement of bilitranslocase.  


Red wine polyphenols (RWP) induce nitric oxide (NO) and endothelium-derived hyperpolarization (EDH)-mediated coronary vasodilatation involving the redox-sensitive PI3-kinase/Akt-dependent pathway in the endothelium. However, there is a gap of knowledge in explaining how bioactive polyphenols initialize their signalling pathway in endothelial cells. Here, we investigated the hypothesis that flavonoids act subsequently to their entry into the endothelium via the flavonoid membrane transporter bilitranslocase (TC 2.A.65.1.1). Thus, vascular reactivity studies were performed using isolated porcine coronary artery rings. We separately determined the NO- and EDH-mediated components of the relaxation in the presence of specific inhibitors. In either case, bilitranslocase antibodies significantly reduced the relaxations of coronary artery rings induced by RWP. Furthermore, bilitranslocase antibodies significantly reduced RWP-induced phosphorylation levels of Akt and eNOS, assessed in cultured endothelial cells from porcine coronary arteries by Western blot analysis. The present findings indicate that bilitranslocase-mediated membrane transport substantially contributes to the initial step of RWP-induced coronary vasodilatation. PMID:23963285

Ziberna, Lovro; Kim, Jong-Hun; Auger, Cyril; Passamonti, Sabina; Schini-Kerth, Valérie



Influence of the endothelium, nitric oxide and serotonergic receptors on coronary vasomotor responses evoked by ergonovine in conscious dogs.  


1. The respective contributions of coronary vascular endothelium, nitric oxide (NO) and serotonergic receptors to the effects of ergonovine on large and small coronary arteries were investigated in conscious dogs. 2. In seven dogs with an endothelium intact, ergonovine (30 - 1000 microg, i.v.) induced a biphasic response on large coronary artery with an early and transient vasodilatation (up to +2.9+/-0.5% from 3310+/-160 microm, P<0.01) followed by a sustained vasoconstriction (down to -4.9+/-0.5%, P<0.001) which occurred simultaneously with a sustained increase in coronary blood flow (CBF) (up to +100+/-26% from 28+/-4 ml min(-1), P<0.001). After endothelium removal (balloon angioplasty), the ergonovine-induced vasodilatation was abolished and vasoconstriction potentiated (-6.4+/-0.9% after vs -4.9+/-0.5% before endothelium removal, P<0.01). 3. After blockade of NO synthesis by Nomega-nitro-L-arginine (30 mg kg(-1)) in four other dogs, the early vasodilatation induced by ergonovine was abolished but the delayed vasoconstriction as well as the increase in CBF remained unchanged. 4. Both ketanserin and methiothepin (0.3 mg kg(-1)) abolished the early vasodilatation and reduced the delayed vasoconstriction induced by ergonovine. Ketanserin decreased and methiothepin abolished the reduction in coronary resistance induced by ergonovine. 5. Thus, the complex interactions between vascular endothelium and serotonergic receptors to ergonovine-induced constriction of large coronary arteries might explain the induction of coronary spasms in patients with endothelial dysfunction. PMID:10433513

Karila-Cohen, D; Delpy, E; Dubois-Randé, J L; Puybasset, L; Hittinger, L; Giudicelli, J F; Berdeaux, A



Influence of the endothelium, nitric oxide and serotonergic receptors on coronary vasomotor responses evoked by ergonovine in conscious dogs  

PubMed Central

The respective contributions of coronary vascular endothelium, nitric oxide (NO) and serotonergic receptors to the effects of ergonovine on large and small coronary arteries were investigated in conscious dogs. In seven dogs with an endothelium intact, ergonovine (30–1000??g, i.v.) induced a biphasic response on large coronary artery with an early and transient vasodilatation (up to +2.9±0.5% from 3310±160??m, P<0.01) followed by a sustained vasoconstriction (down to ?4.9±0.5%, P<0.001) which occurred simultaneously with a sustained increase in coronary blood flow (CBF) (up to +100±26% from 28±4?ml?min?1, P<0.001). After endothelium removal (balloon angioplasty), the ergonovine-induced vasodilatation was abolished and vasoconstriction potentiated (?6.4±0.9% after vs ?4.9±0.5% before endothelium removal, P<0.01). After blockade of NO synthesis by N?-nitro-L-arginine (30?mg?kg?1) in four other dogs, the early vasodilatation induced by ergonovine was abolished but the delayed vasoconstriction as well as the increase in CBF remained unchanged. Both ketanserin and methiothepin (0.3?mg?kg?1) abolished the early vasodilatation and reduced the delayed vasoconstriction induced by ergonovine. Ketanserin decreased and methiothepin abolished the reduction in coronary resistance induced by ergonovine. Thus, the complex interactions between vascular endothelium and serotonergic receptors to ergonovine-induced constriction of large coronary arteries might explain the induction of coronary spasms in patients with endothelial dysfunction.

Karila-Cohen, Daniel; Delpy, Eric; Dubois-Rande, Jean-Luc; Puybasset, Louis; Hittinger, Luc; Giudicelli, Jean-Francois; Berdeaux, Alain



Interneuron, interrupted: molecular pathogenesis of ARX mutations and X-linked infantile spasms.  


X-linked Infantile Spasms Syndrome (ISSX) is a catastrophic epilepsy of early childhood with intractable seizures, intellectual disability, and poor prognosis. A spectrum of mutations in the Aristaless-Related Homeobox gene (ARX) has been linked to ISSX, and downstream targets of this interneuron-expressed transcription factor are being defined. Recent advances combining in vitro and in vivo methods have unveiled complex interactions between Arx and its binding partners and their effects on cell migration and maturation that can help explain the diversity of ARX phenotypes. New mutant mouse models of Arx-induced pathology, including a recent human triplet-repeat expansion mutation with a phenotype of infantile spasms and electrographic seizures, provide valuable tools for exploring the pathophysiology of Arx and substrates for testing novel therapies. PMID:22565167

Olivetti, Pedro R; Noebels, Jeffrey L



Diagnostic Value of Nitroglycerin-Induced Headache as a Negative Predictor of Coronary Atherosclerosis  

PubMed Central

The purpose of the present study was to clarify the possible relationship between nitroglycerin (NTG)-induced headache and both vascular functional and organic atherosclerosis. The study included 96 patients with NTG-induced headache (group I: 54.7±9.5 years, 52 males) and 204 patients without headache (group II: 58.1±9.1 years, 127 males) who suffered from new-onset chest pain. Flow-mediated dilation and nitroglycerin-mediated dilation were significantly greater in group I than in group II (8.8±4.1% vs. 7.1±3.5%, p=0.001, and 23.1±7.3% vs. 17.1±11.8%, p<0.001, respectively). The carotid intima-media thickness was significantly smaller in group I than in group II (0.55±0.15 mm vs. 0.67±0.22 mm, p=0.001). Heart-carotid pulse wave velocity was significantly lower in group I than in group II (784.5±160.1 m/s vs. 979.1±215.6 m/s, p=0.003). In the multiple regression analysis, the absence of NTG-induced headache was a predictor of coronary artery disease (CAD) (odds ratio: 17.89, 95% confidence interval: 7.89-40.02, p<0.001). NTG-induced headache developed more frequently in patients with normal coronary arteries or minimal CAD than in patients with obstructive CAD. The presence of NTG-induced headache might be helpful and provide additional information in evaluating patients with chest pain syndrome.

Cho, Sook Hee; Sim, Doo Sun; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee



Pentoxifylline (Trental) does not inhibit dipyridamole-induced coronary hyperemia: Implications for dipyridamole-thallium-201 myocardial imaging  

SciTech Connect

Dipyridamole-thallium-201 imaging is often performed in patients unable to exercise because of peripheral vascular disease. Many of these patients are taking pentoxifylline (Trental), a methylxanthine derivative which may improve intermittent claudication. Whether pentoxifylline inhibits dipyridamole-induced coronary hyperemia like other methylxanthines such as theophylline and should be stopped prior to dipyridamole-thallium-201 imaging is unknown. Therefore, we studied the hyperemic response to dipyridamole in seven open-chest anesthetized dogs after pretreatment with either pentoxifylline (0, 7.5, or 15 mg/kg i.v.) or theophylline (3 mg/kg i.v.). Baseline circumflex coronary blood flows did not differ significantly among treatment groups. Dipyridamole significantly increased coronary blood flow before and after 7.5 or 15 mm/kg i.v. pentoxifylline (p less than 0.002). Neither dose of pentoxifylline significantly decreased the dipyridamole-induced hyperemia, while peak coronary blood flow was significantly lower after theophylline (p less than 0.01). We conclude that pentoxyifylline does not inhibit dipyridamole-induced coronary hyperemia even at high doses.

Brown, K.A.; Slinker, B.K. (Univ. of Vermont College of Medicine, Burlington (USA))



Red wine prevents homocysteine-induced endothelial dysfunction in porcine coronary arteries 1 1 Presented at the 36th Annual Meeting of The Association for Academic Surgery. November 7–9, 2002, Boston, MA  

Microsoft Academic Search

Background. Hyperhomocysteinemia is an independent risk factor of coronary artery disease. Clinical studies have indicated that moderate red wine consumption is associated with a reduction of incidence of coronary artery disease. In this study, we determined the effect of red wine on homocysteine- induced endothelial dysfunction in porcine coronary arteries.Materials and methods. Porcine coronary arteries were dissected from 6 pig

Weiping Fu; Brian S Conklin; Peter H Lin; Alan B Lumsden; Qizhi Yao; Changyi Chen



Angiotensin II type 1 receptor blockade restores angiotensin-(1-7)-induced coronary vasodilation in hypertrophic rat hearts.  


The aim of the present study was to investigate the coronary effects of Ang-(1-7) [angiotensin-(1-7)] in hypertrophic rat hearts. Heart hypertrophy was induced by abdominal aorta CoA (coarctation). Ang-(1-7) and AVE 0991, a non-peptide Mas-receptor agonist, at picomolar concentration, induced a significant vasodilation in hearts from sham-operated rats. These effects were blocked by the Mas receptor antagonist A-779. Pre-treatment with L-NAME (N(G)-nitro-L-arginine methyl ester) or ODQ (1H-[1,2,4]oxadiazolo[4,3-a]quinozalin-1-one) [NOS (NO synthase) and soluble guanylate cyclase inhibitors respectively] also abolished the effect of Ang-(1-7) in control hearts. The coronary vasodilation produced by Ang-(1-7) and AVE 0991 was completely blunted in hypertrophic hearts. Chronic oral administration of losartan in CoA rats restored the coronary vasodilation effect of Ang-(1-7). This effect was blocked by A-779 and AT2 receptor (angiotensin II type 2 receptor) antagonist PD123319. Acute pre-incubation with losartan also restored the Ang-(1-7)-induced, but not BK (bradykinin)-induced, coronary vasodilation in hypertrophic hearts. This effect was inhibited by A-779, PD123319 and L-NAME. Chronic treatment with losartan did not change the protein expression of Mas and AT2 receptor and ACE (angiotensin-converting enzyme) and ACE2 in coronary arteries from CoA rats, but induced a slight increase in AT2 receptor in aorta of these animals. Ang-(1-7)-induced relaxation in aortas from sham-operated rats was absent in aortas from CoA rats. In vitro pre-treatment with losartan restored the Ang-(1-7)-induced relaxation in aortic rings of CoA rats, which was blocked by the Mas antagonist A-779 and L-NAME. These data demonstrate that Mas is strongly involved in coronary vasodilation and that AT1 receptor (angiotensin II type 1 receptor) blockade potentiates the vasodilatory effects of Ang-(1-7) in the coronary beds of pressure-overloaded rat hearts through NO-related AT2- and Mas-receptor-dependent mechanisms. These data suggest the association of Ang-(1-7) and AT1 receptor antagonists as a potential therapeutic avenue for coronary artery diseases. PMID:23718715

Souza, Álvaro P S; Sobrinho, Deny B S; Almeida, Jônathas F Q; Alves, Gisele M M; Macedo, Larissa M; Porto, Juliana E; Vêncio, Eneida F; Colugnati, Diego B; Santos, Robson A S; Ferreira, Anderson J; Mendes, Elizabeth P; Castro, Carlos H



The role of impaired sympathetic nerve function in enhancing coronary vasoconstriction in patients with hypertrophic cardiomyopathy  

PubMed Central

Coronary vasospasm and diminished coronary blood flow reserve have often been reported in patients with hypertrophic cardiomyopathy (HCM). However, the mechanism of coronary spasm in HCM is unknown. Thus, coronary endothelial function and sympathetic nerve function in 11 patients with HCM and 11 control patients matched for age and sex were examined. The diameter of the left anterior descending coronary artery was assessed by quantitative coronary angiography, and the change in coronary blood flow was estimated using an intracoronary Doppler flow wire. To assess myocardial sympathetic nerve function, metaiodobenzylguanidine images – 15 min and 180 min after the injection of 123I-metaiodoben-zylguanidine at a dosage of 111 MBq – were obtained, and the heart to mediastinum (H/M) count ratio and the washout rate (WR) were calculated. The H/M ratio was significantly lower in patients with HCM (2.1±0.3) than in control patients (2.6±0.4) (P<0.01). In addition, the WR was higher in patients with HCM (35±6%) than in control patients (28±3%) (P<0.01). The HCM subjects with coronary spasm had lower H/M ratios and higher WRs than HCM subjects without coronary spasm (P<0.05, respectively). In conclusion, impaired sympathetic nerve function may be associated with coronary vasospasm and diminished coronary blood flow reserve in HCM.

Matsuo, Shinro; Matsumoto, Tetsuya; Nakae, Ichiro; Horie, Minoru



Balloon catheter coronary angioplasty  

SciTech Connect

The author has produced a reference and teaching book on balloon angioplasty. Because it borders in surgery and is performed on an awake patient without circulatory assistance, it is a complex and demanding procedure that requires thorough knowledge before it is attempted. The text is divided into seven sections. The first section describes coronary anatomy and pathophysiology, defines the objectives and mechanisms of the procedure and lists four possible physiologic results. The next section describes equipment in the catheterization laboratory, catheters, guidewires and required personnel. The following section is on the procedure itself and includes a discussion of examination, testing, technique and follow-up. The fourth section details possible complications that can occur during the procedure, such as coronary spasms, occlusion, thrombosis, perforations and ruptures, and also discusses cardiac surgery after failed angioplasty. The fifth section details complex or unusual cases that can occur. The sixth and seventh sections discuss radiation, alternative procedures and the future of angioplasty.

Angelini, P.



Intractable Hemifacial Spasm Treated by Pulsed Radiofrequency Treatment  

PubMed Central

Hemifacial spasm is defined as unilateral, involuntary, irregular twitching of all or parts of the muscles innervated by facial nerves. Here, we present a case of recurrent hemifacial spasm after microvascular decompression (MVD) treated with pulsed radiofrequency (PRF) treatment with good results. A 35-year-old woman suffered from recurrent hemifacial spasm after MVD that was refractory to medical treatment and botulinum toxin injections. We attempted a left facial nerve block twice. Then, we applied PRF at a maximum temperature of 42? for 120 sec. Some response was observed, so we applied PRF two additional times. The frequency of twitch decreased from 3-4 Hz to < 0.5 Hz, and subjective severity on a visual analogue scale also decreased from 10/10 to 2-3/10. PRF treatment might be an effective medical treatment for refractory hemifacial spasm and has fewer complications and is less invasive compared with those of surgery.

Park, Hae Lang; Lim, Seung Mo; Kim, Tae Hwa; Kang, Kyung Ho; Kang, Hyun; Jung, Yong Hun; Baek, Chong Wha; Woo, Young Cheol; Kim, Jin Yun; Koo, Gill Hoi



Intractable hemifacial spasm treated by pulsed radiofrequency treatment.  


Hemifacial spasm is defined as unilateral, involuntary, irregular twitching of all or parts of the muscles innervated by facial nerves. Here, we present a case of recurrent hemifacial spasm after microvascular decompression (MVD) treated with pulsed radiofrequency (PRF) treatment with good results. A 35-year-old woman suffered from recurrent hemifacial spasm after MVD that was refractory to medical treatment and botulinum toxin injections. We attempted a left facial nerve block twice. Then, we applied PRF at a maximum temperature of 42? for 120 sec. Some response was observed, so we applied PRF two additional times. The frequency of twitch decreased from 3-4 Hz to < 0.5 Hz, and subjective severity on a visual analogue scale also decreased from 10/10 to 2-3/10. PRF treatment might be an effective medical treatment for refractory hemifacial spasm and has fewer complications and is less invasive compared with those of surgery. PMID:23342210

Park, Hae Lang; Lim, Seung Mo; Kim, Tae Hwa; Kang, Kyung Ho; Kang, Hyun; Jung, Yong Hun; Baek, Chong Wha; Woo, Young Cheol; Kim, Jin Yun; Koo, Gill Hoi; Shin, Hwa Yong



Laryngeal spasm after general anaesthesia due to Ascaris lumbricoides.  


Postoperative upper airway obstruction during recovery from general anaesthesia may have several causes. This is a report of a young girl who developed laryngeal spasm as a result of an ectopic roundworm Ascaris lumbricoides. PMID:23679043

Finsnes, K D



Surgical outcomes for intractable epilepsy in children with epileptic spasms.  


Epileptic spasms, or seizures marked by flexor, extensor, or flexor-extensor spasms, are not always responsive to medical management. The purpose of our study was to evaluate the outcome of epilepsy surgery in children with medically intractable epileptic spasms. We identified 11 children with epileptic spasms who underwent lesionectomy (36%), lobectomy (27%), multi-lobectomy (9%), hemispherectomy (18%), or corpus callosotomy (9%). At the time of surgery, 6 children had developed other concurrent seizure type(s), including simple partial (9%), complex partial (27%), partial undifferentiated (9%), primary generalized tonic clonic (9%), tonic (9%), atonic (27%), and myoclonic (9%) seizures. Six children (55%) were seizure free at last follow-up from initial surgery. Predictors of favorable outcome included lack of focal slowing and the presence of less than 2 interictal epileptiform abnormalities on postoperative electroencephalogram (P = .035 and .035, respectively). Favorable outcome was significantly associated with parent/caregiver report of improved postoperative developmental outcomes (P = .026). PMID:22123426

Moseley, Brian D; Nickels, Katherine; Wirrell, Elaine C



Incidence and Main Determinants of Contrast-Induced Nephropathy following Coronary Angiography or Subsequent Balloon Angioplasty  

PubMed Central

Background/Aims Patient assessment by imaging studies using contrast media is currently replacing open procedures, especially in high-risk patients. However, the use of such contrast media might result in acute events and injuries after the procedure. In the present study, we first determined the incidence of contrast-induced nephropathy (CIN) in a sample of Iranian patients who candidated for coronary angiography and/or angioplasty, and then assessed major risk factors predicting the appearance of CIN following these procedures. Methods Two hundred and fifty consecutive, eligible patients scheduled for coronary angiography and/or angioplasty at the Afshar Hospital in Yazd between January 2009 and August 2010 were considered for enrollment. Renal function was measured at baseline and 48 h after the intervention, and CIN was defined by an increase in creatinine of >0.5 mg/dl or 25% of the initial value. The predictive role of potential risk factors was determined in a multivariate model adjusted for comorbidities, preexisting renal impairment, and angiographic data. Results CIN following coronary angiography or angioplasty appeared in 12.8% of the cases. A myocardial infarction before the procedure (OR = 2.121, p = 0.036) and a prior history of hypertension (OR = 2.789, p = 0.025) predicted the appearance of acute renal failure following angiography or subsequent angioplasty. A low estimated glomerular filtration rate at baseline slightly predicted CIN after these interventions. Conclusion Transient acute renal dysfunction occurred in 12.8% of the patients within 48 h after angiography or subsequent angioplasty and could be predicted by a myocardial infarction before the procedure or by a prior history of systolic hypertension.

Nough, Hossein; Eghbal, Fatemeh; Soltani, Mohammadhossein; Nejafi, Farzaneh; Falahzadeh, Hossein; Fazel, Habib; Sheikhvatan, Mehrdad



Is a Metallic Microcoil Really a Permanent Embolic Agent for the Management of Distal Guidewire-Induced Coronary Artery Perforation?  

PubMed Central

Coronary artery perforation (CAP) after percutaneous coronary intervention is a rare, but serious complication. It can cause cardiac tamponade, acute myocardial infarction or death. The treatments of CAP involve prolonged balloon inflation, emergent surgery, coil embolization, and implantation of covered stent. We have successfully performed the emergent microcoil embolization in a patient with uncontrolled Ellis grade 3 guidewire-induced CAP resulting in delayed cardiac tamponade. Contrasting our usual expectation, the 1-year follow-up angiography showed a patent flow at the embolized site.

Kim, Jae Hyun; Kim, Young Jin; Park, Sun Man; Park, Kyoung-Ha; Choi, Young-Jin



Exercise-induced ST-segment depression in inferior leads during treadmill exercise testing and coronary artery disease  

Microsoft Academic Search

The exercise electrocardiogram is a commonly used non-invasive and inexpensive method for detection of electrocardiogram (ECG) changes secondary to myocardial ischemia. Reversible ST-segment depression is the characteristic finding associated with exercise-induced, demand-driven ischemia in patients with significant coronary obstruction but no flow limitation at rest. The exercise-induced ST-segment depression in inferior leads has been questioned and it has been reported

Salvatore Patanè; Filippo Marte; Giuseppe Dattilo; Rosario Grassi; Francesco Patanè



Cardiac diastolic dysfunction in conscious dogs with heart failure induced by chronic coronary microembolization.  


Left ventricular (LV) diastolic dysfunction is a fundamental impairment in congestive heart failure (CHF). This study examined LV diastolic function in the canine model of CHF induced by chronic coronary embolization (CCE). Dogs were implanted with coronary catheters (both left anterior descending and circumflex arteries) for CCE and instrumented for measurement of LV pressure and dimension. Heart failure was elicited by daily intracoronary injections of microspheres (1.2 million, 90- to 120-microm diameter) for 24 +/- 4 days, resulting in significant depression of cardiac systolic function. After CCE, LV maximum negative change of pressure with time (dP/dt(min)) decreased by 25 +/- 2% (P < 0.05) and LV isovolumic relaxation constant and duration increased by 19 +/- 5% and 25 +/- 6%, respectively (both P < 0.05), indicating an impairment of LV active relaxation, which was cardiac preload independent. LV passive viscoelastic properties were evaluated from the LV end-diastolic pressure (EDP)-volume (EDV) relationship (EDP = be(alpha*EDV)) during brief inferior vena caval occlusion and acute volume loading, while the chamber stiffness coefficient (alpha) increased by 62 +/- 10% (P < 0.05) and the stiffness constant (k) increased by 66 +/- 13% after CCE. The regional myocardial diastolic stiffness in LV anterior and posterior walls was increased by 70 +/- 25% and 63 +/- 24% (both P < 0.05), respectively, after CCE, associated with marked fibrosis, increase in collagen I and III, and enhancement of plasminogen activator inhibitor-1 (PAI-1) protein expression. Thus along with depressed LV systolic function there is significant impairment of LV diastolic relaxation and increase in chamber stiffness, with development of myocardial fibrosis and activation of PAI-1, in the canine model of CHF induced by CCE. PMID:16877566

Gill, Robert M; Jones, Bonita D; Corbly, Angela K; Wang, Juan; Braz, Julian C; Sandusky, George E; Wang, Jie; Shen, Weiqun



Prevention of subsequent exercise-induced periinfarct ischemia by emergency coronary angioplasty in acute myocardial infarction: comparison with intracoronary streptokinase  

SciTech Connect

To compare the efficacy of emergency percutaneous transluminal coronary angioplasty and intracoronary streptokinase in preventing exercise-induced periinfarct ischemia, 28 patients presenting within 12 hours of the onset of symptoms of acute myocardial infarction were prospectively randomized. Of these, 14 patients were treated with emergency angioplasty and 14 patients received intracoronary streptokinase. Recatheterization and submaximal exercise thallium-201 single photon emission computed tomography were performed before hospital discharge. Periinfarct ischemia was defined as a reversible thallium defect adjacent to a fixed defect assessed qualitatively. Successful reperfusion was achieved in 86% of patients treated with emergency angioplasty and 86% of patients treated with intracoronary streptokinase (p = NS). Residual stenosis of the infarct-related coronary artery shown at predischarge angiography was 43.8 +/- 31.4% for the angioplasty group and 75.0 +/- 15.6% for the streptokinase group (p less than 0.05). Of the angioplasty group, 9% developed exercise-induced periinfarct ischemia compared with 60% of the streptokinase group (p less than 0.05). Thus, patients with acute myocardial infarction treated with emergency angioplasty had significantly less severe residual coronary stenosis and exercise-induced periinfarct ischemia than did those treated with intracoronary streptokinase. These results suggest further application of coronary angioplasty in the management of acute myocardial infarction.

Fung, A.Y.; Lai, P.; Juni, J.E.; Bourdillon, P.D.; Walton, J.A. Jr.; Laufer, N.; Buda, A.J.; Pitt, B.; O'Neill, W.W.



Effects of rolipram on U46619-induced contraction and cyclic nucleotide content in the porcine coronary artery.  


The effects of various selective phosphodiesterase (PDE) inhibitors on muscle contractility and cyclic nucleotide content in the porcine coronary artery were investigated. Various selective PDE inhibitors, vinpocetine (type 1), erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA, type 2), milrinone (type 3), rolipram (type 4), Ro20-1724 (type 4), and zaprinast (type 5), inhibited U46619-induced contractions in a concentration-dependent manner. The rank order of potency for the porcine coronary artery was rolipram > Ro20-1724 >milrinone > vinpocetine > zaprinast > EHNA, which was different from that of both the porcine carotid artery and aorta. Rolipram inhibited the U46619-induced muscle tension with a decreased [Ca(2+)](i) level, but inhibited the high K(+)-induced contraction without a change in [Ca(2+)](i) level. Rolipram increased cAMP but not cGMP content. Iberiotoxin restored the inhibition of muscle tension and the [Ca(2+)](i) levels induced by rolipram. U46619 and caffeine induced a transient increase in the [Ca(2+)](i) levels in a Ca(2+)-free solution, but rolipram only inhibited the U46619-induced Ca(2+) transient. In conclusion, rolipram is the most potent inhibitor in the porcine coronary artery, but not in the carotid artery and aorta. Moreover it is suggested that the mechanism by which rolipram causes relaxation is due to a decrease in the [Ca(2+)](i) levels and of the Ca(2+) sensitivity of the contractile elements to cAMP. PMID:20383031

Kaneda, Takeharu; Kubota, Takashi; Fujimoto, Kenji; Urakawa, Norimoto; Nakajyo, Shinjiro; Shimizu, Kazumasa



Isointegral Analysis of Body Surface Electrocardiographic Mapping for Assessing Exercise-Induced Changes in Repolarization Properties in Patients with Coronary Artery Disease  

Microsoft Academic Search

To assess the exercise-induced changes in repolarization properties in patients with coronary artery disease, we analyzed body surface ECG mapping. The patients studied had a normal resting 12-lead ECG and were divided into 2 groups: group A ( n = 15; coronary artery narrowing (-), exercise thallium defect (-), ST depression ? 0.1 mV (-)) and group B (n =

Gias Uddin Ahmmed; Hiroyuki Miyakoda; Chiaki Shigemasa



Efficacy of Short-Term High-Dose Atorvastatin for Prevention of Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography  

Microsoft Academic Search

Contrast-induced nephropathy (CIN) is associated with increased morbidity, extended hospital stay, and higher costs. We compared an atorvastatin plus N-acetylcysteine (NAC) regimen with NAC alone in patients undergoing coronary angiography. A total of 130 patients (mean age 54 ± 10; 77 men) undergoing coronary angiography were studied. Seven CIN cases occurred in the NAC group and 2 in the atorvastatin

Hakan Özhan; Ismail Erden; Serkan Ordu; Mesut Aydin; Onur Caglar; Cengiz Basar; Subhan Yalcin; Recai Alemdar



Dipyridamole-Induced Angina Pectoris During Sestamibi Stress Test in Patients with Significant Coronary Artery Disease: Clinical, Angiographic, and Nuclear Determinants  

Microsoft Academic Search

Intravenous dipyridamole induces angina pectoris (AP) in some patients with significant coronary artery disease (CAD). The aim of this prospective study was to identify the angiographic, nuclear, and clinical determinants. The authors examined 50 patients consecutively with significant CAD on coronary angiography. All antiischemic medica tions were stopped twenty-four hours (nitrates only 6 hours) before injection of dipyri damole (0.84

M. Rosseel; P. Dendale; C. De Sadeleer; D. Schoors; P. Block; P. R. Franken



Exercise and diet-induced weight loss attenuates oxidative stress related-coronary vasoconstriction in obese adolescents.  


Obesity is a disease of oxidative stress (OS). Acute hyperoxia (breathing 100 % O(2)) can evoke coronary vasoconstriction by the oxidative quenching of nitric oxide (NO). To examine if weight loss would alter the hyperoxia-related coronary constriction seen in obese adolescents, we measured the coronary blood flow velocity (CBV) response to hyperoxia using transthoracic Doppler echocardiography before and after a 4-week diet and exercise regimen in 6 obese male adolescents (age 13-17 years, BMI 36.5 ± 2.3 kg/m(2)). Six controls of similar age and BMI were also studied. The intervention group lost 9 ± 1 % body weight, which was associated with a reduced resting heart rate (HR), reduced diastolic blood pressure (BP), and reduced RPP (all P < 0.05). Before weight loss, hyperoxia reduced CBV by 33 ± 3 %. After weight loss, CBV only fell by 15 ± 3 % (P < 0.05). In the control group, CBV responses to hyperoxia were unchanged during the two trials. Thus weight loss: (1) reduces HR, BP, and RPP; and (2) attenuates the OS-related coronary constrictor response seen in obese adolescents. We postulate that: (1) the high RPP before weight loss led to higher myocardial O(2) consumption, higher coronary flow and greater NO production, and in turn a large constrictor response to hyperoxia; and (2) weight loss decreased myocardial oxygen demand and NO levels. Under these circumstances, hyperoxia-induced vasoconstriction was attenuated. PMID:22814577

Gao, Zhaohui; Novick, Marsha; Muller, Matthew D; Williams, Ronald J; Spilk, Samson; Leuenberger, Urs A; Sinoway, Lawrence I



Ostreolysin induces sustained contraction of porcine coronary arteries and endothelial dysfunction in middle- and large-sized vessels.  


Ostreolysin (Oly), a cytolytic and cardiotoxic protein from the oyster mushroom (Pleurotus ostreatus), is lethal for mice with an LD(50) of 1170 microg/kg following intravenous application. Its cardiotoxicity is associated with hyperkalemia, which is probably a consequence of potassium released from the lysed cells. Moreover, sub-micromolar concentrations of Oly induce a concentration-dependent increase in rat aortic ring tension, suggesting that ischaemia, and consequent hypoxic injury of cardiomyocytes, could also derive from vasospasm induced by this toxic protein. The purpose of the present study was to demonstrate histopathological lesions caused by Oly after parenteral application to rats, and to define the mechanisms of Oly-induced vasoconstriction using inhibitors verapamil, lanthanum chloride, and selective endothelin receptor antagonist TBC3214, which have different molecular targets, in vitro on porcine coronary artery rings. We found that Oly causes endothelial injury with perivascular oedema in the heart and lungs, as well as myocardial haemorrhages in rats. Treatment of porcine coronary artery rings with Oly causes concentration-dependent vasoconstriction and prevents endothelium-mediated relaxation. Using TBC3214 as a selective blocker of the endothelin A receptor, we showed that vasoconstriction induced by Oly was independent of endothelin release and its effects. Verapamil (1 microM) greatly reduced Oly-evoked contractions of porcine coronary artery rings, while lanthanum abolished them completely. These results provide evidence that the contraction of coronary arteries by Oly is due mainly to the increased influx of Ca(2+) from the extracellular space through voltage-dependent L-type Ca(2+) channels and cation non-selective channels. Experiments suggest that Oly damages endothelial cells both in vitro and in vivo, and probably exhibits direct contractile effects on coronary smooth muscle cells. PMID:19524606

Juntes, Polona; Rebolj, Katja; Sepci?, Kristina; Macek, Peter; Zuzek, Monika Cecilija; Cestnik, Vojteh; Frangez, Robert



The sulphydryl containing ACE inhibitor Zofenoprilat protects coronary endothelium from Doxorubicin-induced apoptosis.  


Pediatric and adult cancer patients, following the use of the antitumor drug Doxorubicin develop cardiotoxicity. Pharmacological protection of microvascular endothelium might produce a double benefit: (i) reduction of myocardial toxicity (the primary target of Doxorubicin action) and (ii) maintenance of the vascular functionality for the adequate delivery of chemotherapeutics to tumor cells. This study was aimed to evaluate the mechanisms responsible of the protective effects of the angiotensin converting enzyme inhibitor (ACEI) Zofenoprilat against the toxic effects exerted by Doxorubicin on coronary microvascular endothelium. We found that exposure of endothelial cells to Doxorubicin (0.1-1?M range) impaired cell survival by promoting their apoptosis. ERK1/2 related p53 activation, but not reactive oxygen species, was responsible for Doxorubicin induced caspase-3 cleavage. P53 mediated-apoptosis and impairment of survival were reverted by treatment with Zofenoprilat. The previously described PI-3K/eNOS/endogenous fibroblast growth factor signaling was not involved in the protective effect, which, instead, could be ascribed to cystathionine gamma lyase dependent availability of H2S from Zofenoprilat. Furthermore, considering the tumor environment, the treatment of endothelial/tumor co-cultures with Zofenoprilat did not affect the antitumor efficacy of Doxorubicin. In conclusion the ACEI Zofenoprilat exerts a protective effect on Doxorubicin induced endothelial damage, without affecting its antitumor efficacy. Thus, sulfhydryl containing ACEI may be a useful therapy for Doxorubicin-induced cardiotoxicity. PMID:23965518

Monti, Martina; Terzuoli, Erika; Ziche, Marina; Morbidelli, Lucia



[Coronary microvascular dysfunction. An update].  


Several studies in the last years have shown that a dysfunction of coronary microcirculation may be responsible for abnormalities in coronary blood flow and some clinical pictures. Coronary microvascular dysfunction, in absence of other coronary artery abnormalities, can cause anginal symptoms, resulting in a condition named microvascular angina (MVA). MVA can occur in a chronic form, predominantly related to effort (stable MVA), more frequently referred as cardiac syndrome X, or in an acute form, most frequently ensuing at rest, which simulates an acute coronary syndrome (unstable MVA). The main abnormalities characterizing these two forms of MVA consist of an impaired vasodilation and an increased vasoconstriction of small resistive coronary arteries, respectively. The mechanisms responsible for stable MVA are still unclear, but seem to include, together with the known traditional cardiovascular risk factors, an abnormally increased cardiac adrenergic activity. The prognosis of stable MVA is good, but some patients have progressive worsening of symptoms. Clinical outcome of patients with unstable MVA is substantially unknown, as there are no specific studies about this population. Treatment of stable MVA includes traditional anti-ischemic drugs as first step; in case of persisting symptoms several other drugs have been proposed, including xanthine derivatives, ACE-inhibitors, statins and, in women, estrogens. Severe forms of intense constriction (or spasm) of small coronary arteries may cause transmural myocardial ischemia, as the microvascular form of variant angina and the tako-tsubo syndrome. PMID:21947187

Lamendola, Priscilla; Di Franco, Antonino; Tarzia, Pierpaolo; Milo, Maria; Laurito, Marianna; Lanza, Gaetano A



False positive ST-segment depression during exercise in subjects with short PR segment and angiographically normal coronaries: Correlation with exercise-induced ST depression in subjects with normal PR and normal coronaries  

Microsoft Academic Search

The aim of this study was to investigate exercise-induced ST-segment depression in subjects with a 120-ms or shorter PR segment and normal coronary arteries. A population of 86 individuals who demonstrated ST-segment depression of 1.5 mm or more on treadmill testing and had a subsequent normal coronary arteriography was classified into two groups. Group A (n = 71) comprised those

Michael M Myrianthefs; Evagoras P Nicolaides; Damianos Pitiris; Evros I Demetriades; Costakis M Zambartas



Surgery for symptomatic infant-onset epileptic encephalopathy with and without infantile spasms.  


Children undergoing surgery with infant-onset epilepsy were classified into those with medically refractory infantile spasms (IS), successfully treated IS, and no IS history, and the groups were compared for pre- and postsurgery clinical and Vineland Adaptive Behavior Scale (VABS) developmental quotients (DQ). Children without an IS history were older at surgery and had longer epilepsy durations than those with IS despite similar substrates, surgeries, and seizure frequencies. In all groups, better postsurgery VABS-DQ scores were associated with early surgical intervention indicating that infant-onset epilepsy patients with or without IS are at risk for seizure-induced encephalopathy. PMID:15728309

Jonas, R; Asarnow, R F; LoPresti, C; Yudovin, S; Koh, S; Wu, J Y; Sankar, R; Shields, W D; Vinters, H V; Mathern, G W



Infantile Spasms: A Critical Review of Emerging Animal Models  

PubMed Central

Infantile spasms is a developmental epilepsy syndrome with unique clinical and EEG features, a specific pattern of pharmacological responsiveness, and poor outcome in terms of cognition and epilepsy. Despite the devastating nature of infantile spasms, little is known about its pathogenesis. Until recently, there has been no animal model available to investigate the pathophysiology of the syndrome or to generate and test novel therapies. Now, several promising animal models have emerged, spanning the etiological spectrum from genetic causes (e.g., Down syndrome or Aristaless-related homeobox [ARX] mutation) to acquired causes (e.g., endogenous and exogenous toxins or stress hormones with convulsant activity or blockade of neural activity). These new models are discussed in this review, with emphasis on the insights each can provide for understanding, treating, and preventing infantile spasms.

Stafstrom, Carl E



Clinical profile and treatment of infantile spasms using vigabatrin and ACTH - a developing country perspective  

Microsoft Academic Search

BACKGROUND: Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of patients with infantile spasms from Pakistan. METHODS: All patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from

Shahnaz Ibrahim; Shamshad Gulab; Sidra Ishaque; Taimur Saleem



Discharge planning for the child with infantile spasms.  


Infantile spasms is a type of seizure disorder usually occurring within the first 24 months of life. The standard treatment is intramuscular injections of repository corticotropin (HP ACTHAR gel). The child with infantile spasms is at risk for developmental delay, even if the seizures are controlled. The parents' grief reaction to this prognosis may affect their ability to learn and implement the treatment plan. Discharge planning for children and families is extensive and must begin at the time of the child's admission to the hospital. PMID:1697884

Kongelbeck, S R



Phosphodiesterase 5 inhibition-induced coronary vasodilation is reduced after myocardial infarction.  


The balance between the production and removal of cGMP in coronary vascular smooth muscle is of critical importance in determining coronary vasomotor tone and thus in the regulation of coronary blood flow. cGMP production by soluble guanylyl cyclase is activated by nitric oxide (NO), whereas cGMP breakdown occurs through phosphodiesterase 5 (PDE5). We hypothesized that myocardial infarction (MI) alters the balance between the production and removal of cGMP in the coronary vasculature and thereby alters the control of coronary vasomotor tone. Chronically instrumented swine with and without a 2-wk-old MI were exercised on a treadmill in the absence and presence of the PDE5 inhibitor EMD-360527 (300 ?g·kg(-1)·min(-1) iv). Inhibition of PDE5 produced coronary resistance vessel dilation, which was more pronounced at rest than during exercise in normal swine. PDE5 gene expression was markedly reduced in coronary resistance vessels isolated from the remote myocardium of MI swine, which was accompanied by a similarly marked attenuation of coronary vasodilation by PDE5 inhibition in MI swine. The coronary vasoconstriction produced by inhibition of NO synthesis with N(?)-nitro-L-arginine (20 mg/kg iv) was only slightly smaller in swine with MI. Interestingly, inhibition of NO synthesis reduced the vasodilator response to subsequent PDE5 inhibition in normal swine but not in MI swine. Conversely, PDE5 inhibition enhanced the coronary vasoconstriction produced by NO synthesis inhibition in normal swine but not in MI swine, suggesting that downregulation of PDE5 mitigated the loss of NO vasodilator influence. In conclusion, the expression and vasoconstrictor influence of PDE5 are markedly attenuated in coronary resistance vessels in the remote myocardium after MI, which appears to serve as a compensatory mechanism to mitigate the loss of NO vasodilator influence. PMID:23504180

Merkus, Daphne; Visser, Marleen; Houweling, Birgit; Zhou, Zhichao; Nelson, Jessica; Duncker, Dirk J



Coronary hemodynamics in the transplanted human heart  

Microsoft Academic Search

The basal features of the coronary circulation, including coronary reserve, were assessed in 12 nonrejecting heart transplant recipients and compared to similar data obtained in 10 innervated subjects. Coronary sinus blood flow (CSBF) was determined by thermodilution, and coronary reserve was measured as the increment in flow after maximal coronary vasodilatation induced by 10 mg intracoronary papaverine. Heart rate and

Carles Crexells; Josep Roca; Mónica Masotti; Antoni Oriol



Hostility and its association with behaviorally induced and somatic coronary risk indicators in finnish adolescents and young adults  

Microsoft Academic Search

The association of hostility to behaviorally induced (i.e. smoking behavior, alcohol consumption and physical activity) and somatic coronary risk indicators (i.e. LDL- and HDL-cholesterol, systolic and diastolic blood pressure and obesity) was studied in a randomly selected representative sample of healthy adolescents and young adults (n = 1609). The question was whether the association, previously found between hostility and CHD

Katri Räikkönen; Liisa Keltikangas-Järvinen



Chlamydia pneumoniae infection is associated with coronary artery disease but not implicated in inducing plaque instability  

Microsoft Academic Search

Background: Many authors have shown an association between Chlamydia pneumoniae (C. pneumoniae) infection and coronary artery disease. However, whether C. pneumoniae infection plays an important role in triggering an acute coronary event remains to be elucidated. Methods: Sixty-four consecutive patients with unstable angina (group A), 56 consecutive patients with stable exertional angina (group B) and 74 control subjects (group C)

Silvio Romano; Maria Penco; Simona Fratini; Marisa Di Pietro; Rosa Sessa; Massimo Del Piano; Francesco Fedele; Armando Dagianti



Effect of Homocysteine-Induced Oxidative Stress on Endothelial Function in Coronary Slow-Flow  

Microsoft Academic Search

Background and Objective: Coronary slow-flow (CSF) phenomenon is characterized by delayed opacification of vessels in a normal coronary angiogram, but its etiopathogenesis remains unclear. Plasma homocysteine (Hcy) level can severely disturb vascular endothelial function and may play a role in the pathogenesis of CSF. In our study, endothelial function in patients with CSF and their relationship with Hcy and oxidative

Halil Tanriverdi; Harun Evrengul; Yasar Enli; Omur Kuru; Deniz Seleci; Seyhan Tanriverdi; Nurullah Tuzun; H. Asuman Kaftan; Nevzat Karabulut



Lipopolysaccharide induces H1 receptor expression and enhances histamine responsiveness in human coronary artery endothelial cells  

PubMed Central

Histamine is a well-recognized modulator of vascular inflammation. We have shown that histamine, acting via H1 receptors (H1R), synergizes lipopolysaccharide (LPS)-induced production of prostaglandin I2 (PGI2), PGE2 and interleukin-6 (IL-6) by endothelial cells. The synergy between histamine and LPS was partly attributed to histamine -induced expression of Toll-like receptor 4 (TLR4). In this study, we examined whether LPS stimulates the H1R expression in human coronary artery endothelial cells (HCAEC) with resultant enhancement of histamine responsiveness. Incubation of HCAEC with LPS (10–1000 ng/ml) resulted in two-fold to fourfold increases in H1R mRNA expression in a time-dependent and concentration-dependent fashion. In contrast, LPS treatment did not affect H2R mRNA expression. The LPS-induced H1R mRNA expression peaked by 4 hr after LPS treatment and remained elevated above the basal level for 20–24 hr. Flow cytometric and Western blot analyses revealed increased expression of H1R protein in LPS-treated cells. The specific binding of [3H]pyrilamine to H1R in membrane proteins from LPS-treated HCAEC was threefold higher than the untreated cells. The LPS-induced H1R expression was mediated through TLR4 as gene silencing by TLR4-siRNA and treatment with a TLR4 antagonist inhibited the LPS effect. When HCAEC were pre-treated with LPS for 24 hr, washed and challenged with histamine, 17-, 10- and 15-fold increases in PGI2, PGE2 and IL-6 production, respectively, were noted. Histamine-induced enhancement of the synthesis of PGI2, PGE2 and IL-6 by LPS-primed HCAEC was completely blocked by an H1R antagonist. The results demonstrate that LPS, through TLR4 activation, up-regulates the expression and function of H1R and amplifies histamine-induced inflammatory responses in HCAEC.

Raveendran, Vineesh V; Tan, Xiaoyu; Sweeney, Matthew E; Levant, Beth; Slusser, Joyce; Stechschulte, Daniel J; Dileepan, Kottarappat N



2-Chlorohexadecanal and 2-chlorohexadecanoic acid induce COX-2 expression in human coronary artery endothelial cells  

PubMed Central

2-Chlorohexadecanal (2-ClHDA), a 16-carbon chain chlorinated fatty aldehyde that is produced by reactive chlorinating species attack of plasmalogens, is elevated in atherosclerotic plaques, infarcted myocardium, and activated leukocytes. We tested the hypothesis that 2-ClHDA and its metabolites, 2-chlorohexadecanoic acid (2-ClHA) and 2-chlorohexadecanol (2-ClHOH), induce COX-2 expression in human coronary artery endothelial cells (HCAEC). COX-2 protein expression increased in response to 2-ClHDA treatments at 8 and 20 h. 2-ClHA also increased COX-2 expression following an 8 h treatment. Quantitative PCR showed that 2-ClHDA treatment increased COX-2 mRNA over 8 h, while 2-ClHA treatment led to a modest increase by 1 h and those levels remained constant over 8 h. 2-ClHDA led to a significant increase in 6-keto-PGF1? release (a measure of PGI2 release) by HCAEC. These data suggest that 2-ClHDA and its metabolite 2-ClHA, which are produced during leukocyte activation, may alter vascular endothelial cell function by upregulation of COX-2 expression.

Messner, Maria C.; Albert, Carolyn J.; Ford, David A.



Prolonged left ventricular dysfunction occurs in patients with coronary artery disease after both dobutamine and exercise induced myocardial ischaemia  

PubMed Central

OBJECTIVE—To determine whether pharmacological stress leads to prolonged but reversible left ventricular dysfunction in patients with coronary artery disease, similar to that seen after exercise.?DESIGN—A randomised crossover study of recovery time of systolic and diastolic left ventricular function after exercise and dobutamine induced ischaemia.?SUBJECTS—10 patients with stable angina, angiographically proven coronary artery disease, and normal left ventricular function.?INTERVENTIONS—Treadmill exercise and dobutamine stress were performed on different days. Quantitative assessment of systolic and diastolic left ventricular function was performed using transthoracic echocardiography at baseline and at regular intervals after each test.?RESULTS—Both forms of stress led to prolonged but reversible systolic and diastolic dysfunction. There was no difference in the maximum double product (p = 0.53) or ST depression (p = 0.63) with either form of stress. After exercise, ejection fraction was reduced at 15 and 30 minutes compared with baseline (mean (SEM), ?5.6 (1.5)%, p < 0.05; and ?6.1 (2.2)%, p < 0.01), and at 30 and 45 minutes after dobutamine (?10.8 (1.8)% and ?5.5 (1.8)%, both p < 0.01). Regional analysis showed a reduction in the worst affected segment 15 and 30 minutes after exercise (?27.9 (7.2)% and ?28.6 (5.7)%, both p < 0.01), and at 30 minutes after dobutamine (?32 (5.3)%, p < 0.01). The isovolumic relaxation period was prolonged 45 minutes after each form of stress (p < 0.05).?CONCLUSIONS—In patients with coronary artery disease, dobutamine induced ischaemia results in prolonged reversible left ventricular dysfunction, presumed to be myocardial stunning, similar to that seen after exercise. Dobutamine induced ischaemia could therefore be used to study the pathophysiology of this phenomenon further in patients with coronary artery disease.???Keywords: myocardial stunning; echocardiography; exercise; dobutamine

Barnes, E; Baker, C; Dutka, D; Rimoldi, O; Rinaldi, C; Nihoyannopoulos, P; Camici, P; Hall, R



Detection of high-burden coronary artery disease by exercise-induced changes of the E/E' ratio.  


To investigate whether exercise-induced changes of the E/E' average ratio can detect high-burden coronary artery disease (CAD) in patients with chest pain and normal left ventricular (LV) systolic function. The study population consisted of 359 patients admitted for chest pain (59.8 ± 9.8 years, 75% male). Patients underwent exercise echocardiography, scintigraphy and coronary angiography. The average of the lateral and septal ratios of early diastolic transmitral velocity to early diastolic tissue velocity (E/E') at baseline and immediately after exercise was calculated. Exercise induced wall motion abnormalities were also calculated. Coronary angiography showed flow limiting CAD in 238 patients (66%). The exercise-induced changes of E/E' average ratio had a sensitivity of 87.3% and a specificity of 75.2% for detection of flow limiting CAD, whereas myocardial scintigraphy showed 79.2% sensitivity and 80.1% specificity and exercise induced wall motion abnormalities had a sensitivity of 74.3% and a specificity of 66.9%. Likelihood ratio chi square showed an incremental value of the exercise-induced changes of E/E' average ratio over regional perfusion technique (from 121.37 to 194.15, P < 0.001) and over wall motion abnormalities (from 57.03 to 146.50, P < 0.001). The exercise-induced change of the E/E' average ratio detects flow limiting CAD in patients with chest pain and normal LV systolic function showing an incremental value over regional perfusion technique and wall motion abnormalities. PMID:21394613

Tsougos, Elias; Paraskevaidis, Ioannis; Dagres, Nikolaos; Varounis, Christos; Panou, Fotios; Karatzas, Dimitrios; Trapali, Xenia; Iliodromitis, Efstathios; Kremastinos, Dimitrios T



Hemimasticatory Spasm Associated With Localized Scleroderma and Facial Hemiatrophy  

Microsoft Academic Search

Patient: A 37-year-old woman had a 3-year history of involuntary spasms of the right masseter muscle in as- sociation with localized scleroderma and facial hemiat- rophy. Electrophysiological studies revealed a normal blink reflex. However, the masseter reflex and silent pe- riod were absent on the affected side. Distal latency and compound muscle action potential of the masseter nerve were normal.

Ho Jin Kim; Beom S. Jeon; Kwang-Woo Lee



Polygraphic Study during Whole Night Sleep in Infantile Spasms  

Microsoft Academic Search

The whole night EEG were polygraphically recorded and analyzed in 9 patients with infantile spasms prior to ACTH therapy. The subjects were divided into two groups, favorable and unfavorable, depending upon the response to the ACTH therapy. (1) Among the unfavorable group, the deep sleep stage was not observed; while the light sleep stage tended to dominate. (2) REM sleep

Yukio Fukuyama; Atsuko Shionaga; Yoko Iida



Part One: Infantile Spasms--The New Consensus  

ERIC Educational Resources Information Center

Infantile spasms (IS, West syndrome) represent a difficult to treat and sometimes not immediately recognized form of epilepsy which is relatively rare. West Syndrome or IS is one of the most recognized types of epileptic encephalopathy, a form of epilepsy usually associated with developmental regression and delay, frequently difficult to treat and…

Pellock, John



Periprocedural Hemoglobin Drop and Contrast-Induced Nephropathy in Percutaneous Coronary Intervention Patients  

PubMed Central

Background and Objectives The development of contrast-induced nephropathy (CIN) is associated with an increased risk of death and late cardiovascular events after percutaneous coronary intervention (PCI). The relationship between CIN and hemoglobin drop has been controversial. The aim of this study was to evaluate the clinical usefulness of periprocedural hemoglobin drop as a nontraditional risk factor for CIN. Subjects and Methods Five-hundred thirty-seven patients who underwent PCI were divided into 2 groups: Group I (486 patients: patients who did not develop CIN) and Group II (51 patients: patients who developed CIN). All patients were administered iodixanol as contrast media during coronary angiography. CIN is defined as a rise in serum creatinine of ?25% or ?0.5 mg/dL above the baseline value within 48 hours after contrast administration. Results Baseline clinical and cardiovascular risk factors were not significantly different between the two groups, except for low abdominal circumference (Group I : Group II=87.9±9.0 cm : 81.2±15.1 cm, p=0.024), body weight (Group I : Group II=63.5±10.6 kg : 59.7±9.2 kg, p=0.008), body mass index (BMI) (Group I : Group II=24.4±3.4 kg/m2 : 23.4±2.8 kg/m2, p=0.032), pre-PCI hemoglobin (Group I : Group II=13.2±2.0 g/dL : 12.3±2.0 g/dL, p=0.003), and post-PCI hemoglobin (Group I : Group II=12.4±1.9 g/dL : 11.5±1.8 g/dL, p=0.001). Multiple logistic regression analysis showed that a periprocedural drop in hemoglobin (>1 g/dL) was an independent predictor of CIN, like other known risk factors. Conclusion A periprocedural drop in hemoglobin of more than 1 g/dL is another important independent predictor for CIN, even in patients administered the lowest nephrotoxic contrast agent, iodixanol, during PCI.

Lee, Kang Hyu; Kang, Kyung Pyo; Kim, Huy Jung; Lee, Sun Hwa; Rhee, Kyoung-Suk; Chae, Jei Keon; Kim, Won Ho; Ko, Jae Ki



Hydrogen peroxide-induced vascular relaxation in porcine coronary arteries is mediated by Ca 2+ -activated K + channels  

Microsoft Academic Search

Summary  Hydrogen peroxide (H2O2) elicited concentration-dependent relaxation of endothelium-denuded rings of porcine coronary arteries. The relaxation induced\\u000a by the H2O2 was markedly attenuated by 10?M 1H-[1,2,4]oxadiazolo [4,3,a]quinoxalin-1-one (ODQ), an inhibitor of soluble guanylate cyclase,\\u000a or by 100nM charybdotoxin, an inhibitor of large-conductance Ca2+-activated K+ (KCa) channels. A combination of the ODQ and charybdotoxin abolished the H2O2-induced relaxation. Pretreatment with 25 ?M

Yasunobu Hayabuchi; Yutaka Nakaya; Suguru Matsuoka; Yasuhiro Kuroda



Successful treatment of distal coronary guidewire-induced perforation with balloon catheter delivery of intracoronary thrombin.  


Distal coronary artery perforation with a coronary guidewire is a relatively rare but potentially fatal complication during PTCA. Historically, these types of perforations have been easy to control with reversal of heparin anticoagulation combined with prolonged distal balloon inflation. In the modern era, with widespread use of potent glycoprotein IIb/IIIa inhibitors, this type of distal wire perforation has become more difficult to manage and potentially lethal. In this article, we report two cases of guidewire-related distal coronary artery perforation, successfully treated using a new technique using localized, distal intracoronary thrombin injection. During prolonged low-pressure balloon inflation, a small dose of thrombin was injected just proximal to the wire perforation site via the lumen of a coronary balloon catheter. This approach appears to be a relatively rapid and effective way to control this troublesome complication. PMID:12594705

Fischell, Tim A; Korban, Elie H; Lauer, Michael A



Prevention of Reocclusion following Tissue-Type Plasminogen Activator-Induced Thrombolysis by the RGD-Containing Peptide, Echistatin, in a Canine Model of Coronary Thrombosis  

Microsoft Academic Search

We evaluated the effect of the RGD-containing peptide, echistatin, on thrombolysis time and acute reocclusion in a canine model of coronary thrombosis\\/thrombolysis. Occlusive thrombus formation was induced by electrical injury, via a stimulating electrode, to the endothelial surface of the circumflex coronary artery in the open-chest, anesthetized dog in the presence of a critical stenosis. Fifteen minutes after occlusive thrombus

Marie A. Holahan; Michael J. Mellott; Victor M. Garsky; Ronald J. Shebuski



Vasodilator pre-treatment of human radial arteries; comparison of effects of phenoxybenzamine vs papaverine on norepinephrine-induced contraction in vitro  

Microsoft Academic Search

Aims The radial artery, increasingly used for coronary artery bypass grafting (CABG), has a potential for spasm which may increase peri-operative risk. Increased alpha- adrenoceptor activation is a key candidate for the spasm. We studied the effects of vasoconstriction in a radial artery, which had undergone brief exposure to the alpha- adrenoceptor antagonist phenoxybenzamine vs the opioid derivative papaverine. Methods

W. E. Harrison; A. J. Mellor; J. Clark; D. R. J. Singer



Possible role of nitric oxide and arachidonic acid pathways in hypoxia-induced contraction of rabbit coronary artery rings.  


In isolated coronary arteries, hypoxia induces an increase in tone by releasing an unidentified endothelium-derived contracting factor (EDCF). Isometric force was measured in an isolated rabbit coronary artery ring at 37 degrees C in control and high K+ (40 mM) pre-contracted conditions. Hypoxia (15 mmHg pO2) induced by equilibrating the perfusate with nitrogen. Hypoxia did not affect the resting tone but induced an endothelium-dependent contraction on pre-contracted rings. Inhibitors of nitric oxide (NO) were tested, L-NAME (10(-4) M) totally and L-NMMA (10(-4) M) partially convert the hypoxic contraction to an hypoxic relaxation. The addition of L-arginine (10(-4) or 10(-3) M) did not restore the response. Methylene blue (10( -5) M) and ODQ (1 H-[1,2,4] oxadiazolo-[4,3-a] quinoxalin-1-one, 10(-5) M), both inhibitors of guanylate cyclase, also changed the hypoxic contraction into a hypoxic relaxation. Catalase (1200 U/ml), which decomposes hydrogen peroxide (H2O2), and superoxide dismutase (150 U/ml, SOD), a free radical scavenger, did not change the hypoxic response but quinacrine (50 microM), an inhibitor of phospholipase A2, significantly decreased it. Inhibitors of arachidonic acid metabolism (indomethacin, diethylcarbamazine, miconazole) however did not affect the hypoxic response. We conclude that in K+ pre-contracted rabbit coronary artery rings, hypoxia induces a contraction which is nitric oxide and arachidonic acid dependent. PMID:11471068

Barbé, C; De Crescenzo, V; Diemont, F; Bonnet, P



Can continuous venovenous hemofiltration prevent contrast-agent induced nephropathy in patients with advanced chronic kidney disease after coronary angiography?  


To determine whether contrast induced nephropathy (CIN) post coronary angio-graphy procedure can be prevented in chronic kidney disease (CKD) patients by continuous venovenous hemofiltration (CVVH), we evaluated 98 CKD patients [52 (53.1%) were males, the mean age was 60.7 ± 11.0 years] who underwent coronary angiography from January 2004 to December 2006. Serum creatinine (Cr) before the procedure was 411 ± 79.9 ?mol/L and crea-tinine clearance (Cr Cl) was 18.04 ± 4.26 mL/min. All patients underwent post procedure CVVH for 21.34 ± 2.12 hours. The mean time interval between the procedure and the start of CVVH was 44.3 ± 18.8 min. The mean serum Cr at discharge was 403 ± 88.4 ?mol/L (Cr Cl 18.5 ± 4.61 mL/min) and was 423 ± 88.9 ?mol/L (Cr Cl17.6 ± 4.27 mL/min) 15 days after the procedure. One patient (1.02%) developed worsening of renal functions that required repeated CVVH during hospitalization and ended up on regular hemodialysis. There was no in-hospital mortality. We conclude that CVVH is effective in preventing CIN after coronary angiography in CKD patients. PMID:21196613

Ghani, Amal Abdel; Hussain, Naser; Al Helal, Bassam



Influence of right ventricular site of stimulation and infarct location on the inducibility of ventricular tachycardia in patients with coronary artery disease  

Microsoft Academic Search

No prior studies have evaluated the relationship between the site of right ventricular stimulation, the site of prior infarction, and the inducibility of ventricular tachycardia (VT). This study was performed to determine if the location of pathologic Q waves influences the inducibility of VT at various right ventricular sites in patients with coronary artery disease (CAD) and a history of

Mark Harvey; Rajiva Goyal; Bradley P Knight; K. Ching Man; S. Adam Strickberger; Fred Morady



Quercetin and its principal metabolites, but not myricetin, oppose lipopolysaccharide-induced hyporesponsiveness of the porcine isolated coronary artery  

PubMed Central

BACKGROUND AND PURPOSE Quercetin is anti-inflammatory in macrophages by inhibiting lipopolysaccharide (LPS)-mediated increases in cytokine and nitric oxide production but there is little information regarding the corresponding effect on the vasculature. We have examined the effect of quercetin, and its principal human metabolites, on inflammatory changes in the porcine isolated coronary artery. EXPERIMENTAL APPROACH Porcine coronary artery segments were incubated overnight at 37°C in modified Krebs-Henseleit solution with or without 1 µg·mL?1 LPS. Some segments were also co-incubated with quercetin-related flavonoids or Bay 11-7082, an inhibitor of NF?B. Changes in isometric tension of segments to vasoconstrictor and vasodilator agents were recorded. Nitrite content of the incubation solution was estimated using the Griess reaction, while inducible nitric oxide synthase was identified immunohistochemically. KEY RESULTS Lipopolysaccharide reduced, by 35–50%, maximal contractions to KCl and U46619, thromboxane A2 receptor agonist, and impaired endothelium-dependent relaxations to substance P. Nitrite content of the incubation medium increased 3- to 10-fold following exposure to LPS and inducible nitric oxide synthase was detected in the adventitia. Quercetin (0.1–10 µM) opposed LPS-induced changes in vascular responses, nitrite production and expression of inducible nitric oxide synthase. Similarly, 10 µM Bay 11-7082, 10 µM quercetin 3?-sulphate and 10 µM quercetin 3-glucuronide prevented LPS-induced changes, while myricetin (10 µM) was inactive. Myricetin (10 µM) prevented quercetin-induced modulation of LPS-mediated nitrite production. CONCLUSION AND IMPLICATIONS Quercetin, quercetin 3?-suphate and quercetin 3-glucuronide, exerted anti-inflammatory effects on the vasculature, possibly through a mechanism involving inhibition of NF?B. Myricetin-induced antagonism of the effect of anti-inflammatory action of quercetin merits further investigation.

Al-Shalmani, Salmin; Suri, Sunita; Hughes, David A; Kroon, Paul A; Needs, Paul W; Taylor, Moira A; Tribolo, Sandra; Wilson, Vincent G



Pallister-Killian syndrome: an unusual cause of epileptic spasms.  


Pallister-Killian syndrome (PKS) is a rare, sporadic, genetic disorder characterized by dysmorphic features, learning disability, and epilepsy. It is caused by a mosaic supernumerary isochromosome 12p (i[12p]). The i(12p) is rarely found in peripheral blood but it is present in skin fibroblasts. Recognition is essential for cytogenetic diagnosis. We describe a male aged 2 years 6 months and a female aged 11 years with PKS and epileptic spasms (ES). This type of seizure is not unusual in patients with brain malformations and with severe developmental delay, but it is sometimes difficult to recognize without video-electroencephalogram studies and could be mistaken for other types of seizure or behavioural manifestations. In these two patients with PKS, spasms had late onset, persisted beyond infancy, and were drug resistant. Clinicians should be aware of this possibility in PKS, which appears to be a rare cause of ES. PMID:16225743

Sánchez-Carpintero, Rocio; McLellan, Ailsa; Parmeggiani, Lucio; Cockwell, Annette E; Ellis, Richard J; Cross, J Helen; Eckhardt, Susan; Guerrini, Renzo



[Tetrazepam in the treatment of painful muscle spasms].  


The aim of the study was to examine myorelaxant and analgetic effects of tetrazepam using double-blind controlled random tests. The study comprised two groups of patients with 30 subjects in each with reflex muscle spasms in the lumbar and cervical spine. One group was treated with a nonsteroid analgetic and the another one with the combination of tetrazepam and a nonsteroid analgetic. The treatment lasted 15 days and the assessment using the standardized, graded scale was performed 0, 7 and 15 days after the onset of the treatment. More hematologic and biochemical parameters were analysed both at the beginning and completion of the treatment. The results of the study have shown that the combination of nonsteroid analgetics and tetrazepam achieved better and faster effects on pain and muscle spasms compared to nonsteroid analgetics with no significant side effects. PMID:1686339

Jovici?, A; Ivanisevi?, V


Muscle spasms associated with Sudeck's atrophy after injury.  

PubMed Central

Four patients developed abnormal involuntary movements of a limb after injury. All subsequently developed sympathetic algodystrophy with Sudeck's atrophy and then abnormal muscle spasms or jerks of the affected limb, lasting years. Sympathetic block in three patients did not relieve the abnormal movements. Two patients obtained partial recovery spontaneously, but the other two required surgery for relief. The pathophysiology of this condition remains to be determined but the evidence suggests that it is a distinct, disabling clinical syndrome. Images FIG 1 FIG 3

Marsden, C D; Obeso, J A; Traub, M M; Rothwell, J C; Kranz, H; La Cruz, F



Treatment of infantile spasms: emerging insights from clinical and basic science perspectives.  


Infantile spasms is an epileptic encephalopathy of early infancy with specific clinical and electroencephalographic (EEG) features, limited treatment options, and a poor prognosis. Efforts to develop improved treatment options have been hindered by the lack of experimental models in which to test prospective therapies. The neuropeptide adrenocorticotropic hormone (ACTH) is effective in many cases of infantile spasms, although its mechanism(s) of action is unknown. This review describes the emerging candidate mechanisms that can underlie the therapeutic effects of ACTH in infantile spasms. These mechanisms can ultimately help to improve understanding and treatment of the disease. An overview of current treatments of infantile spasms, novel conceptual and experimental approaches to infantile spasms treatment, and a perspective on remaining clinical challenges and current research questions are presented here. This summary derives from a meeting of specialists in infantile spasms clinical care and research held in New York City on June 14, 2010. PMID:21719797

Stafstrom, Carl E; Arnason, Barry G W; Baram, Tallie Z; Catania, Anna; Cortez, Miguel A; Glauser, Tracy A; Pranzatelli, Michael R; Riikonen, Raili; Rogawski, Michael A; Shinnar, Shlomo; Swann, John W



Tonic spasms are a common clinical manifestation in patients with neuromyelitis optica.  


Tonic spasms have been most commonly associated with multiple sclerosis. To date, few reports of series of patients with neuromyelitis optica and tonic spasms have been published. Methods: We analyzed the characteristics and frequency of tonic spasms in 19 subjects with neuromyelitis optica. Data was collected using a semi-structured questionnaire for tonic spasms, by both retrospectively reviewing medical records and performing clinical assessment. Results: All patients except one developed this symptom. The main triggering factors were sudden movements and emotional factors. Spasms were commonly associated to sensory disturbances and worsened during the acute phases of the disease. Carbamazepine was most commonly used to treat the symptom and patients showed good response to the drug. Conclusions: Tonic spasms are a common clinical manifestation in patients with neuromyelitis optica. PMID:23539090

Abaroa, Luz; Rodríguez-Quiroga, Sergio A; Melamud, Luciana; Arakaki, Tomoko; Garretto, Nelida S; Villa, Andres M



Altered coronary flow properties in diffuse coronary artery ectasia  

Microsoft Academic Search

Objectives The purpose of this study was to investigate coronary blood flow properties in patients with diffuse coronary artery ectasia (CAE) associated with exercise-induced myocardial ischemia.Methods Seventeen patients with diffuse CAE and without coexisting coronary artery stenosis were enrolled in the study (CAE group). CAE was defined as luminal dilatation 1.5 to 2 times that of the adjacent normal coronary

Ömer Akyürek; Berkten Berkalp; Tamer Say?n; Deniz Kumbasar; Celal Kervanc?o?lu; Dervi? Oral



Corticosteroids for the treatment of infantile spasms: a systematic review.  


Adrenocorticotropic hormone (ACTH) and corticosteroids are the usual first-line treatment options for infantile spasms. Despite significant differences, these agents are often lumped together in this context. There is a need to systematically explore the efficacy of corticosteroids in the treatment of infantile spasms, especially in comparison to ACTH. This review identified and analyzed corticosteroid clinical trials and summarized their short-term efficacy and tolerability. Primary outcome was cessation of spasms and abolition of hypsarrhythmia on prolonged video electroencephalographic monitoring. Eight corticosteroid clinical trials were found with only 2 fulfilling the criteria for adequate design. The weighted-mean efficacy of corticosteroids to achieve primary outcome was 31% for these 2 methodologically adequate studies. Including reanalyzed data from 3 other studies, the corticosteroid efficacy was found to be 42%. On the basis of the available evidence, the efficacy of high-dose corticosteroids is similar to low-dose ACTH and inferior to high-dose ACTH, the current standard treatment. PMID:22859699

Arya, Ravindra; Shinnar, Shlomo; Glauser, Tracy A



Keyhole microsurgery for trigeminal neuralgia, hemifacial spasm and glossopharyngeal neuralgia.  


The aim of the study was to describe and evaluate the efficacy of the keyhole microsurgery to manage patients with trigeminal neuralgia (TN), hemifacial spasm (HFS) and glossopharyngeal neuralgia (GPN). Two hundred and seven patients underwent microvascular decompression (MVD) and neurotomy via retrosigmoid keyhole approach in our department clinic: MVD for trigeminal neuralgia 169 cases, hemifacial spasm 31 cases, glossopharyngeal neuralgia 4 cases and neurotomy for glossopharyngeal neuralgia 3 cases. There was no serious complication such as deaths or infarction in the cerebellum or the brainstem. Complete and partial symptoms relief was obtained in 160 (94.7%) cases and failure 9 (5.3%) cases with MVD for trigeminal neuralgia, postoperatively. Meanwhile, complications occurred in one case with cerebellar hematoma only. The postoperative results of MVD for hemifacial spasm with symptoms relief was noted in 29 (93.5%) cases and failure 2 (6.5%) cases. Postoperative complications occurred in one case with moderate hearing loss, another three cases complained of transient facial paralysis. Symptoms relief achieved in all 7 (100%) cases undergone MVD or neurotomy for glosspharyngeal neuralgia. Postoperative complications occurred in one case with moderate vocal paralysis. We think that microsurgery via retrosigmoid keyhole approach is safe and effective for CPA hyperactive cranial nerve dysfunction syndromes. PMID:19536556

Ma, Zhaoxin; Li, Ming; Cao, Yi; Chen, Xuhui



Voltage- and time-dependent inhibitory effects on rat aortic and porcine coronary artery contraction induced by propafenone and quinidine.  

PubMed Central

1. Class I antiarrhythmic drugs (e.g. Na+ channel blockers) such as propafenone and quinidine also inhibit voltage-gated Ca2+ and K+ channels. In the present paper the voltage- and time-dependent inhibitory effects of propafenone and quinidine were studied on depolarization-induced vascular contractions and 45Ca2+ uptake in isolated endothelium denuded rat aorta and pig left descending coronary artery. 2. Quinidine and propafenone (10(-7) M -5 x 10(-5) M) produced a concentration-dependent relaxation of the contractions induced by 80 mM KCl. Propafenone was significantly more potent (P < 0.05) than quinidine in both rat aorta and pig coronary arteries but both drugs more potent (P < 0.05) in relaxing rat aorta than pig coronary arteries. In rat aortic rings, the relaxant effects of propafenone were unaffected by pretreatment with the Na+ channel blocker, tetrodotoxin. 3. The degree of inhibition produced after prolonged exposure (40 min) to propafenone and quinidine differed as the time of depolarization with 80 mM KCl was increased. Quinidine (3 x 10(-6) M, 10(-5) M and 3 x 10(-5) M) not only produced an inhibition at the very early stage of contraction, but also a time-dependent inhibition was observed. In contrast, propafenone (10(-6) M, 3 x 10(-6) M and 10(-5) M) produced a more marked concentration-dependent early block but only a mild time-dependent inhibition.(ABSTRACT TRUNCATED AT 250 WORDS)

Perez-Vizcaino, F; Fernandez del Pozo, B; Zaragoza, F; Tamargo, J



[Muscle spasms in patients with amyotrophic lateral sclerosis (clinico-electromyographnic analysis)].  


The diagnostic importance and electromyographic characteristics of the muscular spasms were studied in patients with lateral amyotrophic sclerosis at various stages of the disease. It has been shown that the muscular spasms are a typical symptom of this disease, and may be an early manifestation of the latter. The clinical and electromyographic characteristics of the spasms depend on the depth of the pathological process. Of importance in the origin of the muscular spasms in the lateral amyotrophic sclerosis is involvement of many levels of the cortico-muscular path, however, distrubances of the intraspinal mechanisms are, probably, the leading cause. PMID:465160

Khondkarian, O A; Zavalishin, I A; Novikova, V P



Local adenoviral-mediated inducible nitric oxide synthase gene transfer inhibits neointimal formation in the porcine coronary stented model.  


In this study the effect of local adenoviral-mediated delivery of inducible nitric oxide synthase on restenosis was evaluated in a porcine coronary stented model. Local gene transfer of recombinant adenoviral vectors that encode human inducible nitric oxide synthase (AdiNOS) was tested. Control vector (AdNull) lacked a recombinant transgene. Endoluminal delivery of 1.0 x 10(11) adenoviral particles was accomplished in 45 s using the Infiltrator catheter (Interventional Technologies, San Diego, CA). Coronary stents were deployed, oversized by a ratio of 1.2:1, in the treated segments immediately after gene transfer. Fourteen animals were sacrificed at day 28 to evaluate the effects of iNOS gene transfer on morphometric indices, and 4 animals were sacrificed at day 4 for detection of human iNOS expression by RT-PCR. iNOS mRNA was detected in six of eight iNOS-transferred arteries, whereas no expression of human iNOS was detected in the nontarget arteries. Morphometric analysis showed that iNOS transfer significantly reduced neointimal formation (3.41 +/- 1.12 mm(2) vs 2.14 +/- 0.68 mm(2), P < 0.05). We concluded that efficient intramural adenovirus-mediated iNOS transfer can be achieved by using Infiltrator catheters. iNOS gene transfer significantly reduces neointimal hyperplasia following stent injury. PMID:12718902

Wang, Kai; Kessler, Paul D; Zhou, Zhongmin; Penn, Marc S; Forudi, Farhad; Zhou, Xiaorong; Tarakji, Khaldoun; Kibbe, Melina; Kovesdi, Imre; Brough, Douglas E; Topol, Eric J; Lincoff, A Michael



Reoxygenation-induced relaxation of coronary arteries. A novel endothelium-dependent mechanism.  


Coronary artery contractility is well known to be modulated by oxygen partial pressure. Both smooth muscle and the endothelium contribute to coronary artery oxygen sensitivity. Mechanisms underlying endothelium-dependent effects of oxygen include the sensitivity of the nitric oxide/endothelium-derived relaxing factor (EDRF), hydrogen peroxide, and eicosanoid pathways. In the present study, we characterize a novel endothelium-dependent component of porcine coronary artery oxygen sensitivity that is independent of these known pathways. Porcine coronary arteries were stimulated with either KCl or U46619. Hypoxia elicited a transient increase in force that was much greater in endothelium-intact arteries. This effect was abolished by nitric oxide/EDRF pathway inhibitors NG-monomethyl-L-arginine and N-nitro-L-arginine. In the steady state, hypoxia reduced isometric force to a similar degree in both intact and denuded arteries. Reoxygenation elicited a rapid and transient relaxation only in intact arteries. In contrast, this endothelium-dependent relaxation was not inhibited by nitric oxide/EDRF pathway inhibitors nor inhibitors of other potential oxygen-sensitive pathways, such as indomethacin, aminotriazole, superoxide dismutase, catalase, propranolol, or ouabain. The reoxygenation relaxation was, however, sensitive to very low levels of oxygen and was inhibited by cyanide and rotenone, suggesting an involvement of mitochondrial metabolism. Interestingly, the relaxation response to reoxygenation, similar to that for substance P, could be restored in denuded arteries by coupling with an endothelium-intact donor artery. This "sandwich" experiment suggests that the endothelium dependence is mediated by a transmissible factor. Our results indicate that a novel class of endothelium-dependent factors may contribute to coronary artery responses to changes in oxygen partial pressure. PMID:8156634

Close, L A; Bowman, P S; Paul, R J



Mechanism of nitroglycerin-induced coronary dilatation: lack of relation to intracoronary thromboxane concentrations.  


Intracoronary nitroglycerin (NTG) increases coronary blood flow and NTG inhibits thromboxane (Tx) A2 production and release. However, whether an alteration in TxA2 is the mechanism by which NTG increases coronary blood flow is not known. Coronary sinus (CS) blood flow (BF) (by thermodilution) and the concentration of TxB2 (the stable metabolite of TxA2) in CS blood were measured in 23 patients (16 men and 7 women, aged 26 to 65 years) with coronary artery disease before, during and after injection of normal saline solution (n = 5, control subjects) or NTG, 100 micrograms (n = 18), into the left coronary artery. In the 5 control subjects, saline solution caused no change in CSBF or the concentration of TxB2 in CS blood. Ten of the 18 patients to whom NTG was given had received no cyclooxygenase inhibitors for 10 days. In these patients, NTG caused a marked increase in CSBF (from 112 +/- 64 to 152 +/- 70 ml/min, p less than 0.01) but no consistent change in the concentration of TxB2 in CS blood (141 +/- 132 to 160 +/- 155 pg/ml, difference not significant [NS]). The remaining 8 patients to whom NTG was given received aspirin before the study. In these patients, NTG caused a marked increase in CSBF (from 111 +/- 39 to 180 +/- 63 ml/min, p less than 0.01), even though the concentration of TxB2 in CS blood (8 +/- 10 to 6 +/- 6 pg/ml, NS) was lower (p less than 0.05) than that in control subjects and patients not receiving aspirin.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6437206

Rehr, R B; Jackson, J A; Winniford, M D; Campbell, W B; Hillis, L D



Inhibition of hypoxia-induced relaxation of rabbit isolated coronary arteries by NG-monomethyl-L-arginine but not glibenclamide.  

PubMed Central

1. The effects of NG-monomethyl-L-arginine, tetrodotoxin and glibenclamide on hypoxia-induced coronary artery relaxation, induced by bubbling Krebs solution with 95% N2 and 5% CO2 instead of 95% O2 and 5% CO2, were assessed by measuring the changes in isometric tension in isolated epicardial coronary artery rings of the rabbit. In addition, the effects of glibenclamide on the relaxation induced by adenosine were investigated. 2. Hypoxia caused a transient relaxation of 38 +/- 3% (P < 0.01) and 17 +/- 2% (P < 0.01) in endothelium-intact or -denuded arteries respectively. NG-monomethyl-L-arginine (30 and 100 microM) inhibited the relaxation in endothelium-intact rings to 31 +/- 2% (P < 0.05) and 16 +/- 2% (P < 0.01) respectively and slightly but significantly attenuated the relaxation in endothelium-denuded rings to 15 +/- 1% and 13 +/- 1% (P < 0.05) respectively. 3. Glibenclamide, a potassium channel inhibitor, did not significantly after the hypoxia-induced relaxation. 4. Incubation with tetrodotoxin (3 and 10 microM) for 30 min reduced the relaxation to 31 +/- 3% (P < 0.05) and 14 +/- 2% (P < 0.01), and 14 +/- 2% (P < 0.05) and 11 +/- 1% (P < 0.05) in endothelium-intact and -denuded rings respectively. However, indomethacin (10 microM), atropine (1 microM), propranolol (10 microM) and phentolamine (10 microM) did not significantly affect the relaxation.(ABSTRACT TRUNCATED AT 250 WORDS)

Jiang, C.; Collins, P.



Ischemia induced by coronary steal through a patent mammary artery side branch: a role for embolization.  


Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting. The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing. Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients. PMID:23809629

Moreno, Nuno; da Silva Castro, Alexandra; Pereira, Adriana; Silva, João Carlos; Almeida, Pedro Bernardo; Andrade, Aurora; Maciel, Maria Júlia; Pinto, Paula



Assessment of exercise-induced alterations in body composition of patients with coronary heart disease  

Microsoft Academic Search

Summary  The porpose of this study was to determine the effects of exercise habituation on body composition and anthropometric characteristics in cardiac patients. The subjects, comprising 20 patients with coronary heart disease, aged 43–69, participated in our supervised exercise programme for 38.0 (SD 12.5) weeks while in hospital. The intensity of most exercise was set at the lactate threshold. Analyses of

Kiyoji Tanaka; Teruo Hiyama; Yutaka Watanabe; Katsumi Asano; Masaki Takeda; Yohko Hayakawa; Fumio Nakadomo



Vasoconstriction induced by ouabain in the canine coronary artery: Contribution of adrenergic and nonadrenergic responses  

Microsoft Academic Search

Ouabain, when applied to rings of the left ciroumfiex coronary artery of the dog (which contains both alpha1-adrenoceptors leading to contraction and beta1-adrenoceptors leading to relaxation) caused an initial contraction which peaked within 15 minutes and a later secondary increase in tension which peaked within 60 minutes. These contractions were prevented by Ca2+ removal or by verapamil. Adrenergic denervation with

J. P. Cooke; J. T. Shepherd; P. M. Vanhoutte



Effect of coronary bypass surgery on anaerobic myocardial lactate metabolism during pacing-induced angina pectoris.  


Myocardial lactate metabolism was studied by coronary sinus catheterization in nine patients before and 8-12 months after coronary bypass surgery. Measurements were performed at rest and during atrial pacing increased to a heart rate which produced strong chest pain. The estimation of myocardial lactate extraction and release was facilitated by a constant rate infusion of 14C lactate and coronary sinus blood flow (CSBF) was measured by thermodilution. Pre-operatively strong chest pain could be elicited in all patients and isotope data indicated a significant myocardial lactate release in all of them, although the net a-cs difference was negative in only half of them. After bypass surgery the maximum tolerable heart rate was increased by 23 beats min-1 and chest pain both at heart rate 110 beats min-1 and at the highest heart rate achieved was reduced or absent in eight of the nine patients. The increase in chest pain during pacing was quantitatively related to the increase in myocardial lactate release, and the correlation between these two variables followed the same course after the operation as it did before. It is concluded that the improvement in chest pain limited cardiac performance after bypass surgery is well correlated with the improvement in myocardial aerobic metabolism. PMID:1769187

Kaijser, L; Gunnes, S; Berglund, B



Erythropoietin to augment myocardial salvage induced by coronary thrombolysis in patients with ST segment elevation acute myocardial infarction.  


To determine whether the administration of erythropoietin (EPO) early after the onset of ischemia could enhance the preservation of jeopardized myocardium by reperfusion, 236 patients admitted <6 hours after the onset of chest pain indicative of acute coronary syndromes confirmed to be ST-segment elevation acute myocardial infarctions who were treated with tenecteplase to induce coronary thrombolysis were studied. Patients were randomized to standard care or standard care plus the administration of a single dose of EPO 30,000 IU intravenously immediately before the onset of treatment with tenecteplase. The primary end point was enzymatically estimated infarct size. The results indicated that infarct size index was virtually identical in the 2 groups, with a mean +/- SE of 13.2 +/- 0.1 creatine kinase-MB gram equivalents in controls and 12.4 +/- 0.9 creatine kinase-MB gram equivalents in patients treated with EPO. In conclusion, although the early administration of EPO was apparently safe, it did not enhance the preservation of jeopardized ischemic myocardium. PMID:19801020

Binbrek, Azan S; Rao, Nayan S; Al Khaja, Najib; Assaqqaf, Jamal; Sobel, Burton E



Botulinum toxin treatment of cranial-cervical dystonia, spasmodic dysphonia, other focal dystonias and hemifacial spasm  

Microsoft Academic Search

In the past five years, 477 patients with various focal dystonias and hemifacial spasm received 3,806 injections of botulinum A toxin for relief of involuntary spasms. A definite improvement with a global rating greater than or equal to 2 on a 0-4 scale, was obtained in all 13 patients with spasmodic dysphonia, 94% of 70 patients with blepharospasm, 92% of

J Jankovic; K Schwartz; D T Donovan



Histopathology of cortex and white matter in pediatric epileptic spasms: Comparison with those of partial seizures  

Microsoft Academic Search

Epileptic spasms in older children have increasingly been recognized as a distinct seizure type and subset of these patients are considered for surgical resection. This study compares histopathology and magnetic resonance imaging (MRI), especially focusing the difference between the cortical grey matter and the subcortical white matter to understand the extensive epileptic brain in patients with epileptic spasms. We examined

Yukiko Inage; William C. Halliday; Cristina Go; Ayako Ochi; Tomoyuki Akiyama; Mari Akiyama; Elysa Widjaja; Hiroshi Otsubo


Microscopic Cortical Dysplasia in Infantile Spasms: Evolution of White Matter Abnormalities  

Microsoft Academic Search

PURPOSE: To determine whether microscopic cortical lamination defects in patients with infantile spasms, not initially identifiable on MR, may be inferred from evolving changes in the adjacent white matter. METHODS: Three infants between 3 and 6 months of age presented with infantile spasms. Based on negative metabolic assessment and normal MR findings, they were classified as cryptogenic. Despite therapy the

Raman Sankar; John G. Curran; John W. Kevill; Pertti J. Rintahaka; D. Alan Shewmon; Harry V. Vinters


Use of the modified Atkins diet in infantile spasms refractory to first-line treatment  

Microsoft Academic Search

This prospective, open label, uncontrolled study was performed to evaluate the efficacy and tolerability of the modified Atkins diet in children with refractory infantile spasms. Fifteen consecutive children aged six months to three years having daily infantile spasms in clusters with electroencephalographic evidence of hypsarrhythmia despite treatment with hormonal treatment (oral corticosteroids\\/adrenocorticotrophic hormone) and\\/or vigabatrin, and at least one additional

Suvasini Sharma; Naveen Sankhyan; Sheffali Gulati; Anuja Agarwala


Neurodevelopmental and Epilepsy Outcomes in a North American Cohort of Patients With Infantile Spasms  

Microsoft Academic Search

Studies have suggested disparate variables affecting long-term outcomes in patients with infantile spasms. Using a retrospective chart review, the authors identified 109 patients who had follow-up data for at least 1 year since the onset of spasms. Patient and treatment variables were recorded, in addition to neurodevelopmental and seizure outcomes. Etiology was strongly associated with motor and cognitive status but

Arthur Partikian; Wendy G. Mitchell



Diffuse esophageal spasm in children referred for manometry.  


Diffuse esophageal spasm (DES) causes chest pain and/or dysphagia in adults. We reviewed charts of 278 subjects 0 to 18 years of age after esophageal manometry to describe the frequency and characteristics of DES in children. Patient diagnoses included normal motility (61%), nonspecific esophageal motility disorder (20%), DES (13%, n=36), and achalasia (4%). Of patients with DES, the most common chief complaint was food refusal in subjects younger than 5 years (14/24, 58%) and chest pain in subjects older than 5 years (4/12, 33%). Comorbid medical conditions, often multiple, existed in 33 subjects. DES should be considered when young children present with food refusal. PMID:23114472

Rosen, John M; Lavenbarg, Teri; Cocjin, Jose; Hyman, Paul E



Induced ischemia detected by dobutamine stress echocardiography in coronary heart disease patients after myocardial re-vascularization. Experience in a District General Hospital.  


Most episodes of myocardial ischemia in patients with known coronary artery disease (CHD) are asymptomatic. Silent myocardial ischemia (SMI) is an important predictor of adverse outcome in patients with proven coronary artery disease. beta-blockers are effective in suppressing ischemia, and improve clinical outcome in patients with coronary artery disease. At present, it is common practice to stop treatment with beta-blockers in clinically asymptomatic patients after coronary artery bypass graft (CABG) and/or myocardial re-vascularization (PTCA/Stent), although the possible presence of SMI/inducible ischemia after myocardial re-vascularization is not known. We examined 56 asymptomatic CHD patients after coronary artery bypass graft (n=36), percutaneous coronary angioplasty PTCA/stent (n=15), or both (n=5); therapy with beta-blockers was stopped in all of them after myocardial revascularization. All these patients underwent a dobutamine stress echocardiography test (DSE test). The DSE test was proposed to these asymptomatic CHD patients to investigate the possible presence of SMI/inducible ischemia after myocardial re-vascularization. All patients had history of myocardial infarction or evidence of mildly impaired left ventricular function at rest as assessed by cardiac catheterization. Abnormal DSE studies occurred in eight of the 56 patients (14%; 95% C.I.: 6-26%). Therapeutic approaches specifically targeted at reducing total ischaemic burden include pharmacologic therapy and myocardial revascularization. On the basis of these data, it can be concluded that asymptomatic CHD patients after myocardial re-vascularization must be re-evaluated to rule out SMI/inducible ischemia that can be treated (e.g. with beta-blockers) reducing cardiovascular morbidity and mortality. PMID:12007683

De Lorenzo, Ferruccio; Saba, Neelam; Dancy, Mark; Kakkar, Vijay Vir; Kadziola, Zbigniew; Xiao, Han B



Sustained retention of tetradecylthioacetic acid after local delivery reduces angioplasty-induced coronary stenosis in the minipig  

Microsoft Academic Search

Objective: The sulfur containing tetradecylthioacetic acid (TTA) has a profound effect on lipid metabolism and may also exert antioxidant and anti-inflammatory actions and thereby counteract coronary stenosis after angioplasty balloon injury. This study examined the possible modulatory effects of TTA, delivered locally, on coronary stenosis in minipigs and the underlying mechanisms of action. Methods: Coronary balloon angioplasty injury using an

Reidar J. Pettersen; Ziad A. Muna; Karel K. J. Kuiper; Einar Svendsen; Fredrik Muller; Pal Aukrust; Rolf K. Berge; Jan Erik Nordrehaug


The current evaluation and treatment of infantile spasms among members of the Child Neurology Society.  


The optimal evaluation and treatment of children with infantile spasms is unknown. To aid in the development of a standardized approach to infantile spasms, members of the Child Neurology Society were surveyed to determine common practice. The survey had 222 responders with a responder rate of 18.5%. We found that the diagnostic evaluation and the use of first-line treatments varied among responders. For example, although adrenocorticotropic hormone continues to be the most commonly used first-line treatment for infantile spasms not due to tuberous sclerosis, some clinicians use corticosteroids, vigabatrin, and topiramate as first-line treatments for this group. Seventy percent of our responders reported seeing fewer than 10 new-onset cases of infantile spasms per year. Thus, future clinical trials will require multicenter collaboration. An important first step in such collaboration is to standardize the evaluation and treatment of infantile spasms within and between participating centers. PMID:22914371

Mytinger, John R; Joshi, Sucheta



Endothelin but Not Angiotensin II May Mediate Hypertension-Induced Coronary Vascular Calcification in Chronic Kidney Disease  

PubMed Central

To understand the relationship between putative neurohormonal factors operative in hypertension and coronary artery calcification (CAC), the relevant cellular actions of angiotensin (Ang II) and endothelin-1 (ET-1) are reviewed. There is compelling evidence to implicate ET-1 in CAC. ET-1 increases phosphate transport with a 42 to 73% increase in Vmax. Increased cellular phosphate may induce CAC through increased Ca x phosphate product, transformation of vascular smooth muscle cells into a bone-producing phenotype or cell apoptosis that releases procalcific substances. ET-1 is increased in several models of vascular calcification. ET-1 inhibits inhibitors of calcification, matrix Gla and osteoprotegerin, while enhancing pro-calcific factors such as BMP-2 and osteopontin. In contrast, Ang II inhibits phosphate transport decreasing Vmax by 38% and increases matrix Gla. Ang II also stimulates bone resorption. Vascular calcification is reduced by ET-1 A receptor antagonists and to a greater extent than angiotensin receptor blockade although both agents reduce blood pressure.

Rabkin, Simon W.



Yohimbine and rauwolscine inhibit 5-hydroxytryptamine-induced contraction of large coronary arteries of calf through blockade of 5 HT 2 receptors  

Microsoft Academic Search

5-Hydroxytryptamine (5 HT)-induced contractions were investigated on cocaine-treated strips of bovine large coronary arteries.1.The a2-adrenoceptor blockers rauwolscine and yohimbine antagonized competitively 5 HT-induced contractions. The estimated equilibrium dissociation constantsKB (-log mol\\/l) were 7.1 for rauwolscine and 7.3 for yohimbine. The affinity of yohimbine for the receptors mediating the response to 5HT appears to be 10 times higher than for postsynaptic

A. J. Kaumann



Quantitative analysis of exercise-induced enhancement of early- and late-systolic retrograde coronary blood flow  

PubMed Central

Coronary blood flow (CBF) is reduced and transiently reversed during systole via cardiac contraction. Cardiac contractility, coronary tone, and arterial pressure each influence systolic CBF (CBFSYS), particularly by modulating the retrograde component of CBFSYS. The effect of concurrent changes in these factors on CBFSYS during dynamic exercise has not been examined. Using chronically instrumented swine, we hypothesized that dynamic exercise enhances retrograde CBFSYS. Phasic CBF was examined at rest and during treadmill exercise [2–5 miles/h (mph)]. Absolute values of mean CBF over the cardiac cycle (CBFCYCLE) as well as mean CBF in diastole (CBFDIAS) and mean CBFSYS were increased by exercise, while relative CBFDIAS and CBFSYS expressed as percentage of mean CBFCYCLE were principally unchanged. Early retrograde CBFSYS was present at rest and increased in magnitude (?33 ± 4 ml/min) and as a percent of CBFCYCLE (?0.6 ± 0.1%) at 5 mph. This reversal was transient, comprising 3.7 ± 0.3% of cardiac cycle duration at 5 mph. Our results also reveal that moderately intense exercise (>3 mph) induced a second CBF reversal in late systole before aortic valve closure. At 5 mph, late retrograde CBFSYS amounted to ?53 ± 11 ml/min (?3.1 ± 0.7% of CBFCYCLE) while occupying 11.1 ± 0.3% of cardiac cycle duration. Wave-intensity analysis revealed that the second flow reversal coincided with an enhanced aortic forward-going decompression wave (vs. rest). Therefore, our data demonstrate a predictable increase in early-systolic CBF reversal during exercise and additionally that exercise induces a late-systolic CBF reversal related to the hemodynamic effects of left ventricular relaxation that is not predictable using current models of phasic CBF.

van Houwelingen, Marc J.; Merkus, Daphne; Duncker, Dirk J.; Laughlin, M. Harold



Quantitative analysis of exercise-induced enhancement of early- and late-systolic retrograde coronary blood flow.  


Coronary blood flow (CBF) is reduced and transiently reversed during systole via cardiac contraction. Cardiac contractility, coronary tone, and arterial pressure each influence systolic CBF (CBF(SYS)), particularly by modulating the retrograde component of CBF(SYS). The effect of concurrent changes in these factors on CBF(SYS) during dynamic exercise has not been examined. Using chronically instrumented swine, we hypothesized that dynamic exercise enhances retrograde CBF(SYS). Phasic CBF was examined at rest and during treadmill exercise [2-5 miles/h (mph)]. Absolute values of mean CBF over the cardiac cycle (CBF(CYCLE)) as well as mean CBF in diastole (CBF(DIAS)) and mean CBF(SYS) were increased by exercise, while relative CBF(DIAS) and CBF(SYS) expressed as percentage of mean CBF(CYCLE) were principally unchanged. Early retrograde CBF(SYS) was present at rest and increased in magnitude (-33 +/- 4 ml/min) and as a percent of CBF(CYCLE) (-0.6 +/- 0.1%) at 5 mph. This reversal was transient, comprising 3.7 +/- 0.3% of cardiac cycle duration at 5 mph. Our results also reveal that moderately intense exercise (>3 mph) induced a second CBF reversal in late systole before aortic valve closure. At 5 mph, late retrograde CBF(SYS) amounted to -53 +/- 11 ml/min (-3.1 +/- 0.7% of CBF(CYCLE)) while occupying 11.1 +/- 0.3% of cardiac cycle duration. Wave-intensity analysis revealed that the second flow reversal coincided with an enhanced aortic forward-going decompression wave (vs. rest). Therefore, our data demonstrate a predictable increase in early-systolic CBF reversal during exercise and additionally that exercise induces a late-systolic CBF reversal related to the hemodynamic effects of left ventricular relaxation that is not predictable using current models of phasic CBF. PMID:20007853

Bender, Shawn B; van Houwelingen, Marc J; Merkus, Daphne; Duncker, Dirk J; Laughlin, M Harold



Infantile spasms: a U.S. consensus report.  


The diagnosis, evaluation, and management of infantile spasms (IS) continue to pose significant challenges to the treating physician. Although an evidence-based practice guideline with full literature review was published in 2004, diversity in IS evaluation and treatment remains and highlights the need for further consensus to optimize outcomes in IS. For this purpose, a working group committed to the diagnosis, treatment, and establishment of a continuum of care for patients with IS and their families—the Infantile Spasms Working Group (ISWG)—was convened. The ISWG participated in a workshop for which the key objectives were to review the state of our understanding of IS, assess the scientific evidence regarding efficacy of currently available therapeutic options, and arrive at a consensus on protocols for diagnostic workup and management of IS that can serve as a guide to help specialists and general pediatricians optimally manage infants with IS. The overall goal of the workshop was to improve IS outcomes by assisting treating physicians with early recognition and diagnosis of IS, initiation of short duration therapy with a first-line treatment, timely electroencephalography (EEG) evaluation of treatment to evaluate effectiveness, and, if indicated, prompt treatment modification. Differences of opinion among ISWG members occurred in areas where data were lacking; however, this article represents a consensus of the U.S. approach to the diagnostic evaluation and treatment of IS. PMID:20608959

Pellock, John M; Hrachovy, Richard; Shinnar, Shlomo; Baram, Tallie Z; Bettis, David; Dlugos, Dennis J; Gaillard, William D; Gibson, Patricia A; Holmes, Gregory L; Nordl, Douglas R; O'Dell, Christine; Shields, W Donald; Trevathan, Edwin; Wheless, James W



Quality-of-care indicators for infantile spasms.  


We developed a comprehensive set of quality-of-care indicators for the management of children with infantile spasms in the United States, encompassing evaluation, diagnosis, treatment, and prevention and management of side effects and comorbidities. The indicators were developed using the RAND/UCLA Modified Delphi Method. After a focused review of the literature and guidelines by the study team, an expert panel (nominated by leaders of Child Neurology Society, American Epilepsy Society, and National Institute for Neurologic Disorders) rated the draft indicators anonymously, met face-to-face to discuss each indicator, and rerated the revised indicators on validity, feasibility, and importance. The panel recommended 21 indicators, of which 8 were identified as most likely to have a large positive impact on improving quality of life and/or health outcomes for children with infantile spasms. The proposed indicators can be used to assess and document variations and gaps in quality-of-care and inform future research and quality improvement interventions. PMID:22566712

Wang, C Jason; Jonas, Rinat; Fu, Chong Min; Ng, Chun Y; Douglass, Laurie



Motoneuron excitability and muscle spasms are regulated by 5-HT2B and 5-HT2C receptor activity.  


Immediately after spinal cord injury (SCI), a devastating paralysis results from the loss of brain stem and cortical innervation of spinal neurons that control movement, including a loss of serotonergic (5-HT) innervation of motoneurons. Over time, motoneurons recover from denervation and function autonomously, exhibiting large persistent calcium currents (Ca PICs) that both help with functional recovery and contribute to uncontrolled muscle spasms. Here we systematically evaluated which 5-HT receptor subtypes influence PICs and spasms after injury. Spasms were quantified by recording the long-lasting reflexes (LLRs) on ventral roots in response to dorsal root stimulation, in the chronic spinal rat, in vitro. Ca PICs were quantified by intracellular recording in synaptically isolated motoneurons. Application of agonists selective to 5-HT(2B) and 5-HT(2C) receptors (including BW723C86) significantly increased the LLRs and associated Ca PICs, whereas application of agonists to 5-HT(1), 5-HT(2A), 5-HT(3), or 5-HT(4/5/6/7) receptors (e.g., 8-OH-DPAT) did not. The 5-HT(2) receptor agonist-induced increases in LLRs were dose dependent, with doses for 50% effects (EC(50)) highly correlated with published doses for agonist receptor binding (K(i)) at 5-HT(2B) and 5-HT(2C) receptors. Application of selective antagonists to 5-HT(2B) (e.g., RS127445) and 5-HT(2C) (SB242084) receptors inhibited the agonist-induced increase in LLR. However, antagonists that are known to specifically be neutral antagonists at 5-HT(2B/C) receptors (e.g., RS127445) had no effect when given by themselves, indicating that these receptors were not activated by residual 5-HT in the spinal cord. In contrast, inverse agonists (such as SB206553) that block constitutive activity at 5-HT(2B) or 5-HT(2C) receptors markedly reduced the LLRs, indicating the presence of constitutive activity in these receptors. 5-HT(2B) or 5-HT(2C) receptors were confirmed to be on motoneurons by immunolabeling. In summary, 5-HT(2B) and 5-HT(2C) receptors on motoneurons become constitutively active after injury and ultimately contribute to recovery of motoneuron function and emergence of spasms. PMID:20980537

Murray, Katherine C; Stephens, Marilee J; Ballou, Edmund W; Heckman, Charles J; Bennett, David J



The relationship between hyperuricemia and the risk of contrast-induced acute kidney injury after percutaneous coronary intervention in patients with relatively normal serum creatinine  

PubMed Central

OBJECTIVES: Hyperuricemia is a risk factor for contrast-induced acute kidney injury in patients with chronic kidney disease. This study evaluated the value of hyperuricemia for predicting the risk of contrast-induced acute kidney injury in patients with relatively normal serum creatinine who were undergoing percutaneous coronary interventions. METHODS AND RESULTS: A total of 788 patients with relatively normal baseline serum creatinine (<1.5 mg/dL) undergoing percutaneous coronary intervention were prospectively enrolled and divided into a hyperuricemic group (n?=?211) and a normouricemic group (n?=?577). Hyperuricemia is defined as a serum uric acid level>7 mg/dL in males and >6 mg/dL in females. The incidence of contrast-induced acute kidney injury was significantly higher in the hyperuricemic group than in the normouricemic group (8.1% vs. 1.4%, p<0.001). In-hospital mortality and the need for renal replacement therapy were significantly higher in the hyperuricemic group. According to a multivariate analysis (adjusting for potential confounding factors) the odds ratio for contrast-induced acute kidney injury in the hyperuricemic group was 5.38 (95% confidence interval, 1.99-14.58; p?=?0.001) compared with the normouricemic group. The other risk factors for contrast-induced acute kidney injury included age >75 years, emergent percutaneous coronary intervention, diuretic usage and the need for an intra-aortic balloon pump. CONCLUSION: Hyperuricemia was significantly associated with the risk of contrast-induced acute kidney injury in patients with relatively normal serum creatinine after percutaneous coronary interventions. This observation will help to generate hypotheses for further prospective trials examining the effect of uric acid-lowering therapies for preventing contrast-induced acute kidney injury.

Liu, Yong; Tan, Ning; Chen, Jiyan; Zhou, Yingling; Chen, Liling; Chen, Shiqun; Chen, Zhujun; Li, Liwen



YouTube videos as a teaching tool and patient resource for infantile spasms.  


The purpose of this study was to assess YouTube videos for their efficacy as a patient resource for infantile spasms. Videos were searched using the terms infantile spasm, spasm, epileptic spasm, and West syndrome. The top 25 videos under each term were selected according to set criteria. Technical quality, diagnosis of infantile spasms, and suitability as a teaching resource were assessed by 2 neurologists using the Medical Video Rating Scale. There were 5858 videos found. Of the 100 top videos, 46% did not meet selection criteria. Mean rating for technical quality was 4.0 of 5 for rater 1 and 3.9 of 5 for rater 2. Raters found 60% and 64% of videos to accurately portray infantile spasms, respectively, with significant agreement (Cohen ? coefficient = 0.75, P < .001). Ten videos were considered excellent examples (grading of 5 of 5) by at least 1 rater. YouTube may be used as an excellent patient resource for infantile spasms if guided search practices are followed. PMID:21551373

Fat, Mary Jane Lim; Doja, Asif; Barrowman, Nick; Sell, Erick



Histopathology of cortex and white matter in pediatric epileptic spasms: comparison with those of partial seizures.  


Epileptic spasms in older children have increasingly been recognized as a distinct seizure type and subset of these patients are considered for surgical resection. This study compares histopathology and magnetic resonance imaging (MRI), especially focusing the difference between the cortical grey matter and the subcortical white matter to understand the extensive epileptic brain in patients with epileptic spasms. We examined 22 patients consisting of 11 patients with epileptic spasms and 11 with partial seizures. Scalp video electroencephalography (EEG) showed interictal generalized epileptiform discharges (9 patients with epileptic spasms vs. 1 with partial seizures) and ictal generalized epileptiform discharges (10 vs. 3). We found MRI abnormalities in a single lobe (6 vs. 7) and multiple lobes (2 vs. 1). Surgical resections were performed across multiple lobes (9 vs. 2), comparing within a single lobe (2 vs. 9), (p<0.001). Histopathology showed abnormal cortical organizations as FCD (2 vs. 5) and microdysgenesis (4 vs. 4), normal (4 vs. 1). Two patients with epileptic spasms showed hyaline proteoplasmic astrocytopathy. There were heterotopic neurons (10 vs. 10), cluster of oligodendroglia (8 vs. 7), balloon cells (2 vs. 5) and blurred myelination (1 vs. 4), in the white matter. Seizure-free outcomes were seen in seven patients with epileptic spasms (64%) and four with partial seizures (36%). The multilobar epileptogenic zones existed in patients with epileptic spasms, compared with the focal epileptogenic zone in patients with partial seizures. There was no difference of MRI and histopathology findings in cortex and subcortical white matter between two groups. PMID:21493023

Inage, Yukiko; Halliday, William C; Go, Cristina; Ochi, Ayako; Akiyama, Tomoyuki; Akiyama, Mari; Widjaja, Elysa; Otsubo, Hiroshi



Reproducibility of coronary haemodynamics and cardiac metabolism during pacing-induced angina pectoris.  


The reproducibility of coronary sinus blood flow (CSBF) (thermodilution technique) and myocardial metabolism (exchange of oxygen, lactate, free fatty acids, glucose, citrate, glutamate and alanine) during two identical pacing periods separated by 45 min were studied in eight patients with chronic coronary artery disease. The mean of the individual difference (delta-values) between values during the first (T1) and second (T2) test, at corresponding times (rest, pacing and after 3-5 min of recovery), were calculated and expressed as a percentage of the resting level of each parameter in order to assess their reproducibility. All patients experienced angina pectoris during both pacing sessions, and pacetime to onset of symptoms did not differ between the tests. Group values for haemodynamics and exchange of metabolites were acceptably reproducible throughout the period under study. Mean delta-values of CSBF ranged from 10% to 16% and myocardial oxygen uptake from 14% to 22% in relation to the resting levels. In contrast, mean delta-values of metabolites ranged from 5% to 136% in relation to the respective A-V differences during the study. The greatest variation occurred during pacing and of all the metabolites lactate exchange varied most. A spontaneous variation in the degree of ischaemia during repeat stress tests might be the major reason for the metabolite variability. Changes in CSBF, however, tended to correlate inversely to the delta-aortocoronary sinus differences of substrates during pacing. Precision of chemical analysis and blood sampling technique were of minor importance for the variability. Since lactate exchange varied most, the study suggests that additional measurements should be made of more metabolites when assessing the efficacy of therapy by means of myocardial metabolism. PMID:4042575

Bagger, J P; Nielsen, T T; Thomassen, A



Does a selective adenosine A1 receptor agonist protect against exercise induced ischaemia in patients with coronary artery disease?  

PubMed Central

Background: The “warm up” effect in angina may represent ischaemic preconditioning, which is mediated by adenosine A1 receptors in most models. Objective: To investigate the effect of a selective A1 agonist, GR79236 (GlaxoSmithKline), on exercise induced angina and ischaemic left ventricular dysfunction in patients with coronary artery disease. Design: A double blind crossover study. Patients: 25 patients with multivessel coronary artery disease. Interventions: On mornings one week apart, patients received intravenous GR79236 10 ?g/kg or placebo, and then carried out two supine bicycle exercise tests separated by 30 minutes. Equilibrium radionuclide angiography was done before and during exercise. Results: The onset of chest pain or 1 mm ST depression was delayed and occurred at a higher rate–pressure product during the second exercise test following either placebo or GR79236. Compared with placebo, GR79236 did not affect these indices during equivalent tests. GR79236 reduced resting global ejection fraction from (mean (SD)) 63 (7)% to 61 (5)% (p < 0.05) by a selective reduction in the regional ejection fraction of “ischaemic” left ventricular sectors (those where the ejection fraction fell during the first exercise test following placebo). Ischaemic sectors showed increased function during the second test following placebo (72 (21)% v 66 (20)%; p = 0.0001), or during the first test following GR79236 (69 (21)% v 66 (20)%; p = 0.0001). Sequential exercise further increased the function of ischaemic sectors even after drug administration. Conclusions: GR79236 failed to mimic the warm up effect, and warm up occurred even in the presence of this agent. This suggests that ischaemic preconditioning is not an important component of this type of protection. The complex actions of the drug on regional left ventricular function at rest and during exercise suggest several competing A1 mediated actions.

Kelion, A D; Webb, T P; Gardner, M A; Ormerod, O J M; Shepherd, G L; Banning, A P



Relationship between regional myocardial blood flow and thallium-201 distribution in the presence of coronary artery stenosis and dipyridamole-induced vasodilation  

SciTech Connect

This study assesses the relationship between the distribution of thallium-201 and myocardial blood flow during coronary vasodilation induced by intravenous dipyridamole in canine models of partial and complete coronary artery stenosis. 10 dogs were chronically instrumented with catheters in the left atrium and aorta and with a balloon occluder and electromagnetic flow probe on the proximal left circumflex coronary artery. Regional myocardial blood flow was measured during control conditions with radioisotope-labeled microspheres, and the phasic reactive hyperemic response to a 20-s transient occlusion was then recorded. Dipyridamole was then infused intravenously until phasic coronary blood flow increased to match peak hyperemic values. The left circumflex coronary artery was either partially occluded to reduce phasic blood flow to control values (group 1) or it was completely occluded (group 2), and thallium-201 and a second microsphere label were injected. 5 min later, the animals were sacrificed, the left ventricle was sectioned into 1-2-g samples, and thallium-201 activity and regional myocardial blood flow were measured. Curvilinear regression analyses between thallium-201 localization and myocardial blood flow during dipyridamole infusion demonstrated a slightly better fit to a second- as compared with a first-order model, indicating a slight roll-off of thallium activity as myocardial blood flow increases. During the dipyridamole infusion, the increases in phasic blood flow, the distributions of regional myocardial blood flow, and the relationships between thallium-201 localization and regional blood flow were comparable to values previously observed in exercising dogs with similar occlusions. These data provide basic validation that supports the use of intravenous dipyridamole and thallium-201 as an alternative to exercise stress and thallium-201 for evaluating the effects of coronary occlusive lesions on the distribution of regional myocardial blood flow.

Mays, A.E. Jr.; Cobb, F.R.



Effects of a phorbol ester on acetylcholine-induced Ca2+ mobilization and contraction in the porcine coronary artery.  

PubMed Central

1. The effects of 12-O-tetradecanoylphorbol-13-acetate (TPA), an activator of protein kinase C, have been investigated on intact and chemically skinned muscle strips of the porcine coronary artery. 2. In the presence or absence of extracellular Ca2+, TPA (0.1-1 nM) slightly enhanced the amplitude of ACh (10 microM)-induced contractions but at 100 nM, inhibited the contractions by approximately 50%. 3. ACh (10 microM) reduced the amount of [32P]phosphatidylinositol 4,5-bisphosphate (PIP2) and increased the amount of [32P]phosphatidic acid (PA) in the presence or absence of Ca2+. TPA (over 1 nM) dose-dependently inhibited the hydrolysis of PIP2 induced by ACh. 4. ACh (over 0.1 microM) dose-dependently increased the intensity of fura-2 fluorescence in dispersed single-cell suspensions. TPA (over 1 nM) dose-dependently inhibited the increase of the Ca2+ transient evoked by ACh, but it did not modify the ionomycin-induced Ca2+ transient or the resting fluorescence. These inhibitory effects of TPA occurred over a similar dose range to that which inhibited ACh-induced PIP2 break-down. 5. When the relationship between ACh-induced contraction amplitude and Ca2+ transient was observed in the presence or absence of 10 nM-TPA, TPA greatly reduced the Ca2+ transient but did not modify the amplitude of contraction. 6. In saponin-treated skinned muscle strips, TPA (10 nM) or 1,2-diolein (50 micrograms/ml) with phosphatidylserine (PS; 50 micrograms/ml) increased the amplitude of contraction evoked by various concentrations of Ca2+ (0.1-1.0 microM) without any change in the maximum amplitude of the Ca2+-induced contraction. 7. TPA (10 nM) with PS (50 micrograms/ml) increased the amplitude of contraction evoked by 10 microM-inositol 1,4,5-trisphosphate in chemically skinned muscle strips. 8. It is concluded that TPA inhibits the ACh-induced [Ca2+]i increase by inhibiting the hydrolysis of PIP2, but that it enhances the Ca2+ sensitivity of the contractile proteins. These results indicate that ACh-induced contractions are controlled by negative feed-back regulation of PIP2 hydrolysis together with a positive feed-back regulation of the Ca2+ sensitivity of the contractile proteins. This may depend on the on-going level of protein kinase C activation.

Itoh, T; Kubota, Y; Kuriyama, H



Near-infrared spectroscopy study of tourniquet-induced forearm ischemia in patients with coronary artery disease  

NASA Astrophysics Data System (ADS)

Near-Infrared Spectroscopy (NIRS) can be employed to monitor local changes in haemodynamics and oxygenation of human tissues. A preliminary study has been performed in order to evaluate the NIRS transmittance response to induced forearm ischaemia in patients with coronary artery disease (CAD). The population consists in 40 patients with cardiovascular risk factors and angiographically documented CAD, compared to a group of 13 normal subjects. By inflating and subsequently deflating a cuff placed around the patient arm, an ischaemia has been induced and released, and the patients have been observed until recovery of the basal conditions. A custom NIRS spectrometer has been used to collect the backscattered light intensities from the patient forearm throughout the ischaemic and the recovery phase. The time dependence of the near-infrared transmittance on the control group is consistent with the available literature. On the contrary, the magnitude and dynamics of the NIRS signal on the CAD patients show deviations from the documented normal behavior, which can be tentatively attributed to abnormal vessel stiffness. These preliminary results, while validating the performance of the IRIS spectrometer, are strongly conducive towards the applicability of the NIRS technique to ischaemia analysis and to the endothelial dysfunction characterization in CAD patients with cardiovascular risk factors.

Giardini, Mario E.; Guizzetti, Giovanni G.; Bavera, Matteo; Lago, Paolo; Corti, Mario; Falcone, Colomba; Pastore, Federico



Mechanism of 5-hydroxytryptamine-induced coronary vasodilation assessed by direct detection of nitric oxide production in guinea-pig isolated heart.  

PubMed Central

1. We assessed whether a submaximal concentration (1 microM) of 5-hydroxytryptamine (5-HT) releases nitric oxide (NO) from the coronary endothelium in guinea-pig perfused heart (n = 5 or 6/group) by direct detection of NO in coronary effluent, and determined whether this accounts for the associated coronary dilation. We also tested whether saponin is a selective and specific tool for examining the role of this mechanism in mediating agonist-induced coronary dilatation. 2. Continuous 5 min perfusion with 5-HT, or acetylcholine (ACh; 1 microM), substance P (1 nM) or sodium nitroprusside (SNP; 1 microM) increased coronary flow from baseline by 3.6 +/- 0.2, 3.4 +/- 0.2, 1.8 +/- 0.1 and 4.1 +/- 0.2 ml min-1 g-1, respectively (all P < 0.05). Coronary effluent NO content, detected by chemiluminescence, was correspondingly increased from baseline by 715 +/- 85, 920 +/- 136, 1019 +/- 58 and 2333 +/- 114 pmol min-1 g-1, respectively (all P < 0.05). 3. Continuous perfusion for 30 min with NG-nitro-L-arginine methyl ester (L-NAME) 100 microM reduced basal coronary effluent NO content by 370 +/- 32 pmol min-1 g-1 and coronary flow by 7.5 +/- 0.5 ml min-1 g-1 (both P < 0.05). Saponin (three cycles of 2 min of 30 micrograms ml-1 saponin perfusion interrupted by 2 min control perfusion) reduced basal coronary NO content by a similar amount (307 +/- 22 pmol min-1 g-1) but reduced basal coronary flow by only 0.6 +/- 0.2 ml min-1 g-1 (P < 0.05 versus the effect of L-NAME). 4. The increases in coronary flow in response to (5-HT), ACh and substance P were reduced (all P < 0.05) by 100 microM L-NAME to 1.2 +/- 0.3, 1.2 +/- 0.4 and 0.3 +/- 0.3 ml min-1 g-1, respectively. However, the flow increase in response to SNP was not reduced; it was in fact increased slightly to 4.8 +/- 0.4 ml min-1 g-1 (P < 0.05). 5. Similarly, after treatment with saponin, the increases in coronary flow in response to 5-HT, ACh and substance P were reduced to 2.1 +/- 0.3, 1.3 +/- 0.3 and 0.4 +/- 0.2 ml min-1 g-1, respectively (all P < 0.05). Again, the response to SNP was increased slightly to 4.6 +/- 0.5 ml min-1 g-1 (P < 0.05). 6. L-NAME and saponin also inhibited 5-HT, ACh and substance P-induced NO release (P < 0.05), without affecting equivalent responses to SNP. 7. For substance P, the change in coronary flow (delta CF) correlated with log10 delta NO in the presence and absence of saponin and L-NAME; delta CF = 1.2(log delta NO) 1.9; r = 0.92; P < 0.05. For 5-HT the relationship was delta CF = 2.2(log delta NO-2.7; r = 0.79; P < 0.05, indicating that 5-HT causes a disproportionately greater increase in coronary flow per release of NO. This was taken to indicate that 5-HT relaxes coronary vasculature in part by releasing NO, but in part by additional mechanisms. ACh resembled 5-HT in this respect. 8. Saponin had no effect on cardiac systolic or diastolic contractile function assessed by the construction of Starling curves with an isochoric intraventricular balloon. 9. In conclusion, despite its minimal effect on basal coronary flow, saponin is an effective tool for revealing endothelium-dependent actions of coronary vasodilator substances and has selectivity in that it does not impair endothelium-independent vasodilatation or cardiac contractile function. 5-HT dilates guinea-pig coronary arteries largely by the release of NO from the coronary endothelium.

Ellwood, A. J.; Curtis, M. J.



Coronary microembolization  

Microsoft Academic Search

Atherosclerotic plaque rupture is the key event in the pathogenesis of acute coronary syndromes\\u000a and it also occurs during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic\\u000a occlusion of the epicardial coronary artery with subsequent impending myocardial infarction, but may in milder forms result\\u000a in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation.

Andreas Skyschally; Kirsten Leineweber; Petra Gres; Michael Haude; Raimund Erbel; Gerd Heusch



Recurrent acute coronary events in a young adult.  


Acute myocardial infarction (MI) in young adults is rare. Clinicopathological conditions such as nephrotic syndrome, antiphospholipid syndrome, spontaneous coronary artery spasms or embolism can be attributed to such events. In this case report, we present a 30-year-old male who had his first MI at the age of 20 years. He received percutaneous intervention as initial treatment. Despite aggressive risk factor management, he continued to have acute coronary events and was later diagnosed with antiphospholipid syndrome (APS). At the same time, he was diagnosed with severe chronic thromboembolic pulmonary hypertension and severe tricuspid regurgitation. He underwent pulmonary endartererectomy, tricuspid annuloplasty and radial artery bypass graft to the first obtuse marginal artery. Warfarin therapy was initiated upon the diagnosis of APS. Despite being therapeutic on warfarin and aggressive risk factor management, he had yet another MI. Coronary angiogram at this time showed fresh occlusion of the right coronary artery at the mid-segment, and the patient received two overlapping stents that achieved a good effect. This case emphasizes the importance of awareness, early recognition and aggressive management of patients with APS presenting chest pain or acute coronary events. Despite appropriate treatment, such as risk factor management and percutaneous interventions, recurrence of an acute coronary event is high. The presentation of younger patients with recurrent coronary events but no significant risk factors of atherosclerosis should evoke the suspicion of APS-related coronary artery disease, and all risk factors should be aggressively managed. PMID:22932774

Thapamagar, Suman B; Aung, Thein T; Mascarenhas, Daniel



A Case of Acute Myocardial Infarction With ST-Segment Elevation in a Lead Augmented Right Vector Caused by a Left Main Coronary Artery Vasospasm  

PubMed Central

Diagnosing and selecting an appropriate treatment strategy for left main coronary artery (LMCA) obstruction is very important. Although this disease is not frequently encountered, it can cause severe hemodynamic deterioration resulting in a less favorable prognosis without a suitable management approach. Another aspect of LMCA that we must not overlook is coronary artery spasm, which can be an infrequent but important cause of acute coronary syndrome. Although it is rare, LMCA can cause critical complications. In this study, we report the case of a 35-year-old female who was admitted to the hospital with a diagnosis of acute myocardial infarction with ST-segment elevation in the aVR lead caused by a left main coronary spasm that was examined on intravascular ultrasound.

Jung, Kyong Yeun



Differential role of endothelial versus neuronal nitric oxide synthase in the regulation of coronary blood flow during pacing-induced increases in cardiac workload.  


Endothelial nitric oxide synthase (eNOS) was assumed to be the only source of nitric oxide (NO) involved in the regulation of human coronary blood flow (CBF). However, our recent first-in-human study using the neuronal NOS (nNOS)-selective inhibitor S-methyl-L-thiocitrulline (SMTC) showed that nNOS-derived NO also plays a role. In this study, we investigated the relative contribution of nNOS and eNOS to the CBF response to a pacing-induced increase in cardiac workload. Incremental right atrial pacing was undertaken in patients with angiographically normal coronary arteries during intracoronary infusion of saline vehicle and then either SMTC or N(G)-monomethyl-l-arginine (l-NMMA; which inhibits both eNOS and nNOS). Intracoronary SMTC (0.625 ?mol/min) and l-NMMA (25 ?mol/min) reduced basal CBF to a similar extent (-19.2 ± 3.2% and 25.0 ± 2.7%, respectively; n = 10 per group). Pacing-induced increases in CBF were significantly blunted by l-NMMA (maximum CBF: 83.5 ± 14.2 ml/min during saline vs. 61.6 ± 9.5 ml/min during l-NMMA; P < 0.01). By contrast, intracoronary SMTC had no effect on the maximum CBF during pacing (98.5 ± 12.9 ml/min during saline vs. 102.1 ± 16.6 ml/min during SMTC; P = not significant). l-NMMA also blunted the pacing-induced increase in coronary artery diameter (P < 0.001 vs. saline), whereas SMTC had no effect. Our results confirm a role of nNOS in the regulation of basal CBF in humans but show that coronary vasodilation in response to a pacing-induced increase in cardiac workload is exclusively mediated by eNOS-derived NO. PMID:23479261

Shabeeh, Husain; Melikian, Narbeh; Dworakowski, Rafal; Casadei, Barbara; Chowienczyk, Phil; Shah, Ajay M



Low-fat diet and regular, supervised physical exercise in patients with symptomatic coronary artery disease: reduction of stress-induced myocardial ischemia  

Microsoft Academic Search

The effects of physical exercise and normalization of serum lipoproteins on stress-induced myocardial ischemia were studied in 18 patients with coronary artery disease, stable angina pectoris, and mild hypercholesterolemia (total serum cholesterol 242 +\\/- 32 mg\\/dl). These patients underwent a combined regimen of low-fat\\/low-cholesterol diet and regular, supervised physical exercise at high intensity for 12 months. At 1 year serum

G. Schuler; G. Schlierf; A. Wirth; H. P. Mautner; H. Scheurlen; M. Thumm; H. Roth; F. Schwarz; M. Kohlmeier; H. C. Mehmel



Cranial dystonia, blepharospasm and hemifacial spasm: clinical features and treatment, including the use of botulinum toxin.  

PubMed Central

Blepharospasm, the most frequent feature of cranial dystonia, and hemifacial spasm are two involuntary movement disorders that affect facial muscles. The cause of blepharospasm and other forms of cranial dystonia is not known. Hemifacial spasm is usually due to compression of the seventh cranial nerve at its exit from the brain stem. Cranial dystonia may result in severe disability. Hemifacial spasm tends to be much less disabling but may cause considerable distress and embarrassment. Patients affected with these disorders are often mistakenly considered to have psychiatric problems. Although the two disorders are quite distinct pathophysiologically, therapy with botulinum toxin has proven very effective in both. We review the clinical features, proposed pathophysiologic features, differential diagnosis and treatment, including the use of botulinum toxin, of cranial dystonia and hemifacial spasm. Images Fig. 2 Fig. 3

Kraft, S P; Lang, A E



Long-term treatment with eicosapentaenoic acid improves exercise-induced vasodilation in patients with coronary artery disease.  


We have previously shown that long-term treatment with eicosapentaenoic acid (EPA) improves endothelium-dependent vasodilation of the atherosclerotic arteries in both animals and humans. The aim of the present study was to examine whether EPA treatment also improves metabolic vasodilation evoked by exercise in patients with coronary artery disease (CAD). Forearm blood flow (FBF) was measured by strain gauge plethysmography in 10 patients with stable CAD, before and 3 months after oral treatment with EPA (1,800 mg/kg). FBF was measured at rest and during intra-arterial infusion of acetylcholine or sodium nitroprusside, before and after intra-arterial infusion of NG-monomethyl-L-arginine (L-NMMA, an inhibitor of nitric oxide (NO) synthesis). A rhythmic handgrip exercise was also performed for 3 min before and after L-NMMA, and FBF was measured for 3 min just after the handgrip exercise. These protocols were repeated after the long-term treatment with EPA for 3 months. The long-term treatment with EPA significantly improved the FBF responses to acetylcholine (p < 0.01), which was significantly reduced by acute administration of L-NMMA (p < 0.01). By contrast, the EPA treatment did not affect the endothelium-independent responses to sodium nitroprusside. Metabolic increases in FBF caused by the handgrip exercise were not significantly decreased by L-NMMA before the EPA treatment. The EPA treatment significantly augmented the exercise-induced increases in FBF (p < 0.05) and L-NMMA acutely abolished this augmentation (p < 0.01). These results indicate that long-term treatment with EPA improves both endothelium-dependent and exercise-induced forearm vasodilations in patients with CAD and that NO is substantially involved in the EPA-induced improvement of the FBF responses in patients with CAD. PMID:12484504

Tagawa, Tatsuya; Hirooka, Yoshitaka; Shimokawa, Hiroaki; Hironaga, Kiyoshi; Sakai, Koji; Oyama, Jun-ichi; Takeshita, Akira



Clinical study on treatment of post-apoplectic limb spasm by puncturing acupoints of Governor Vessel  

Microsoft Academic Search

Objective: To investigate the clinical significance of treating post-apoplectic limb spasm by puncturing the acupoints of\\u000a Governor Vessel as a main therapy. Methods: Twentynine patients with post-apoplectic limb spasm were treated by puncturing\\u000a the acupoints of Governor Vessel plus the acupoints adjacent to joints, together with another 29 patients treated by conventional\\u000a acupoints for comparison of the curative effects. Results:

Zhang Wen-dong; Chen Xing-sheng; Han Wei; Chen Hao; Yu Hong-wu; Zhou Ting



Prinzmetal's angina with documented coronary artery spasm. Treatment and follow-up  

Microsoft Academic Search

Eighteen patients with Prinzmetal's angina were studied angiographically and 17 were followed for an average of 27 months. The were 12 men and six women, with a mean age of 46.3 years. The mean duration of symptoms before clinical diagnosis was 4.1 weeks. Four had had a previous myocardial infarction. Six patients had spontaneous cardiac arrests within 48 hours of

V F Huckell; P R McLaughlin; J E Morch; E D Wigle; A G Adelman



A novel, innovative ovine model of chronic ischemic cardiomyopathy induced by multiple coronary ligations.  


Heart failure is one of the fastest-growing epidemics worldwide in health care today. Although a wide variety of animal models exist to create chronic heart failure, there are few truly successful, reproducible models with ischemic dilation and mitral regurgitation. Six healthy sheep (36 ± 5 kg) underwent multiple, strategic coronary artery ligations on the left ventricle (LV). Six to eight ligations were performed transmurally on three of four segments of the LV: anterior, lateral, and posterior. Side branches of the left anterior descending and circumflex arteries were ligated to create multiple, patchy areas of myocardial infarction. Cardiac global and regional systolic function was assessed by echocardiography and cardiac magnetic resonance imaging (MRI). The extent, the characteristics, and the location of the myocardial infarction were qualitatively and quantitatively assessed by late gadolinium enhancement imaging. The overall mortality rate was 16.7% (1/6 animals). Animals who survived showed a significantly reduced ejection fraction (mean 60 ± 5% to 28 ± 7%; P < 0.05); additionally, two out of the remaining five (40%) animals developed mild to moderate mitral regurgitation quantified by cardiac MRI. Furthermore, each animal developed clinical signs of heart failure (tachycardia, dyspnea, and tachypnea) consistent with global, dilated cardiomyopathy noted on MRI. Creating and reproducing a model of global, ischemic cardiomyopathy with functional mitral regurgitation is an arduous task. We have developed a promising model of ischemic heart failure using multiple ligations, which mimics the sequelae of human cardiomyopathy. Our proposed model is highly effective, reproducible, and may be used for experimental research on heart failure (cardiac assist devices, heart transplant, etc.). PMID:21137156

Schmitto, Jan D; Mokashi, Suyog A; Lee, Lawrence S; Laurence, Rita; Schotola, Hanna; Coelho-Filho, Otavio; Rajab, Taufiek K; Kwong, Raymond; Bolman, R Morton; Quintel, Michael; Cohn, Lawrence H; Chen, Frederick Y



Non-convulsive status epilepticus and audiogenic seizures complicating a patient with asymmetrical epileptic spasms.  


A female infant suffered from epilepsy since the neonatal period, which evolved into West syndrome at the age of 2 months. Spasms in series and hypsarrhythmia disappeared after treatment with high-dose phenobarbital; however, single spasms persisted with right-sided predominance, and polyspike activity in the left parieto-temporal areas preceded or coincided with these spasms. Magnetic resonance imaging revealed a small calcification in the right occipital area, and positron emission tomography showed hypometabolism over the right hemisphere. Widespread epileptic discharges gradually increased on electroencephalography (EEG) during sleep thereafter. The patient presented with daytime unresponsiveness at 1 year and 6 months, when diffuse, irregular spike and wave activity characterized the waking EEG. Spasms or brief tonic seizures with right-sided predominance were provoked by auditory stimuli during this period, particularly by her mother's voice, with ictal EEG of right posterior predominant fast activity and subsequent desynchronization. The administration of clobazam resulted in the marked improvement of EEG findings and transient disappearance of spasms. Presumably, certain patients with asymmetrical epileptic spasms may be regarded as a unique type of localization-related epilepsy, and can show an unusual course of evolution in comparison to other cases of epilepsy that evolve after West syndrome. PMID:19735986

Saito, Yoshiaki; Sugai, Kenji; Nakagawa, Eiji; Sakuma, Hiroshi; Komaki, Hirofumi; Sasaki, Masayuki; Hoshino, Kyoko



Cortical contribution to scalp EEG gamma rhythms associated with epileptic spasms.  


The cortical contribution for the generation of gamma rhythms detected from scalp ictal EEG was studied in unique cases of epileptic spasms and a review of the related literature was conducted. Ictal scalp gamma rhythms were investigated through time-frequency analysis in two cases with a combination of focal seizures and spasms and another case with spasms associated with cortical dysplasia. In the two patients with combined seizures, the scalp distribution of ictal gamma rhythms was related to that of focal seizure activity. In the third patient, an asymmetric distribution of the ictal scalp gamma rhythms was transiently revealed in correspondence to the dysplasic cortex during hormonal treatment. Therefore, the dominant region of scalp gamma rhythms may correspond to the epileptogenic cortical area. The current findings have reinforced the possibility of the cortical generation of ictal scalp gamma rhythms associated with spasms. The detection of high frequencies through scalp EEG is a technical challenge, however, and the clinical significance of scalp gamma rhythms may not be the same as that of invasively recorded high frequencies. Further studies on the pathophysiological mechanisms related to the generation of spasms involving high frequencies are necessary in the future, and the development of animal models of spasms will play an important role in this regard. PMID:23410838

Kobayashi, Katsuhiro; Miya, Kazushi; Akiyama, Tomoyuki; Endoh, Fumika; Oka, Makio; Yoshinaga, Harumi; Ohtsuka, Yoko



Antiarrhythmic effects of flecainide against canine ventricular arrhythmias induced by two-stage coronary ligation and halothane-epinephrine.  


We studied the electrophysiologic effects of flecainide on noninfarcted and infarcted dog hearts and in dogs anesthetized with halothane and administered intravenous epinephrine. Flecainide demonstrated no effect on atrial conduction times, but significantly (p less than 0.05) increased ventricular conduction times in noninfarcted, infarcted, and halothane-epinephrine-exposed dog hearts. Atrial and ventricular effective refractory periods (ERPs) were significantly (p less than 0.05) increased by flecainide. The increase in ERP was more pronounced in infarcted than in noninfarcted dog hearts. Flecainide significantly (p less than 0.05) decreased the echo zone for two or more repetitive ventricular responses in infarcted dog hearts and eliminated all ventricular arrhythmias observed at 48 h after coronary artery ligation. The dose of epinephrine required to induce ventricular arrhythmias in dogs anesthetized with halothane was significantly increased (p less than 0.05) by flecainide. Acute intravenous administration of flecainide to dogs with infarcted hearts produced sinus arrest, transient third-degree heart block, inability to pace, right bundle branch block, and torsade des pointes. Our results provide evidence that flecainide produces its antiarrhythmic effects by increased ventricular ERP and ventricular conduction time. Caution is advised when administering flecainide to patients with previous history of myocardial infarction. PMID:2581074

Dobmeyer, D; Muir, W W; Schaal, S F


Risk score for the prediction of contrast-induced nephropathy in elderly patients undergoing percutaneous coronary intervention.  


We developed a risk score for contrast-induced nephropathy (CIN) in elderly patients (n = 668) before percutaneous coronary intervention (PCI). Another 277 elderly patients were studied for validation. Based on the odds ratio, risk factors were assigned a weighted integer; the sum of the integers was the risk score. Among the 668 elderly patients, 105 (15.7%) experienced CIN. There were 9 risk factors for CIN (with weighted integer): estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) (4), diabetes (3), left ventricular ejection fraction <45% (3), hypotension (2), age >70 years (2), myocardial infarction (2), emergency PCI (2), anemia (2), and contrast agent volume >200 mL (2). The incidence of CIN was 3.4%, 11.9%, 36.9%, and 69.8% in the low-risk (?4), moderate risk (5-8), high-risk (9-12), and very-high-risk groups (?13). The model demonstrated good discriminative power in the validation population (c statistic = 0.79). This score can be used to plan preventative measures. PMID:23196639

Fu, Naikuan; Li, Ximing; Yang, Shicheng; Chen, Yongli; Li, Qiong; Jin, Dongxia; Cong, Hongliang



Reduction of Flow and Eddy Currents Induced Image Artifacts in Coronary Magnetic Resonance Angiography (MRA) Using a Linear-Centric-Encoding (LCE) SSFP Sequence  

PubMed Central

Coronary magnetic resonance angiography (MRA) acquired using steady-state free precession (SSFP) sequences tend to suffer from image artifacts caused by local magnetic field inhomogeneities. Flow and gradient switching induced eddy currents are important sources of such phase errors, especially under off-resonant condition. In this study, we propose to reduce these image artifacts by using a linear-centric-encoding (LCE) scheme in the phase-encoding (PE) direction. Abrupt change of the gradients including magnitude as well as polarity between consecutive radio-frequency (RF) cycles is minimized using the LCE scheme. Results from numeric simulations and phantom study demonstrated that signal oscillation can be markedly reduced using LCE as compared to conventional alternating-centric-encoding (ACE) scheme. Image quality of coronary arteries was improved at both 1.5 T and 3.0 T using LCE compared to those acquired with ACE PE scheme (1.5 T: ACE / LCE = 2.2 ± 0.8 / 3.0 ± 0.6, p = 0.02; 3.0 T: ACE / LCE = 2.1 ± 1.1 / 3.0 ± 0.8, p = 0.01). In conclusion, flow and eddy currents induced imaging artifacts in coronary MRA using SSFP sequence can be markedly reduced with LCE acquisition of PE lines.

Bi, Xiaoming; Park, Jaeseok; Deshpande, Vibhas; Simonetti, Orlando; Laub, Gerhard; Li, Debiao



Tachycardia-Induced Subendocardial Necrosis in Acutely Instrumented Dogs with Fixed Coronary Stenosis  

Microsoft Academic Search

It has been speculated but never proven that tachycardia- induced ischemia per se may lead to myocardial infarction. In 17 anesthetized dogs, the proximal left anterior de- scending (LAD) artery was cannulated and perfused via bypass from the left subclavian artery. Distal LAD pres- sure was reduced by a screw clamp to cause $20% de- crease in wall thickening during



Adrenergic receptors modulate motoneuron excitability, sensory synaptic transmission and muscle spasms after chronic spinal cord injury.  


The brain stem provides most of the noradrenaline (NA) present in the spinal cord, which functions to both increase spinal motoneuron excitability and inhibit sensory afferent transmission to motoneurons (excitatory postsynaptic potentials; EPSPs). NA increases motoneuron excitability by facilitating calcium-mediated persistent inward currents (Ca PICs) that are crucial for sustained motoneuron firing. Spinal cord transection eliminates most NA and accordingly causes an immediate loss of PICs and emergence of exaggerated EPSPs. However, with time PICs recover, and thus the exaggerated EPSPs can then readily trigger these PICs, which in turn produce muscle spasms. Here we examined the contribution of adrenergic receptors to spasms in chronic spinal rats. Selective activation of the ?(1A) adrenergic receptor with the agonists methoxamine or A61603 facilitated Ca PIC and spasm activity, recorded both in vivo and in vitro. In contrast, the ?(2) receptor agonists clonidine and UK14303 did not facilitate Ca PICs, but did decrease the EPSPs that trigger spasms. Moreover, in the absence of agonists, spasms recorded in vivo were inhibited by the ?(1) receptor antagonists WB4010, prazosin, and REC15/2739, and increased by the ?(2) receptor antagonist RX821001, suggesting that both adrenergic receptors were endogenously active. In contrast, spasm activity recorded in the isolated in vitro cord was inhibited only by the ?(1) antagonists that block constitutive receptor activity (activity in the absence of NA; inverse agonists, WB4010 and prazosin) and not by the neutral antagonist REC15/2739, which only blocks conventional NA-mediated receptor activity. RX821001 had no effect in vitro even though it is an ?(2) receptor inverse agonist. Our results suggest that after chronic spinal cord injury Ca PICs and spasms are facilitated, in part, by constitutive activity in ?(1) adrenergic receptors. Additionally, peripherally derived NA (or similar ligand) activates both ?(1) and ?(2) adrenergic receptors, controlling PICs and EPSPs, respectively. PMID:21047936

Rank, M M; Murray, K C; Stephens, M J; D'Amico, J; Gorassini, M A; Bennett, D J



Combined use of hydration and alprostadil for preventing contrast-induced nephropathy following percutaneous coronary intervention in elderly patients  

PubMed Central

Contrast-induced nephropathy (CIN) is a complex syndrome of acute kidney injury that follows exposure to intravascular contrast media. Although a series of preventive measures have been developed, CIN remains a major challenge encountered in elderly patients by interventional cardiologists. No data are currently available concerning the potential effects of the combined use of hydration and alprostadil in the prevention of CIN following percutaneous coronary intervention (PCI) in elderly patients. Therefore, the aim of the present study was to investigate the ability of a combination of hydration and alprostadil to prevent CIN following PCI in elderly patients. From June 1, 2010 to January 31, 2012, 85 elderly patients undergoing PCI were included in the present study. The included patients were randomly allocated into three groups: the control (22 cases), hydration (28 cases) and hydration + alprostadil (35 cases) group. Serum creatinine (SCr) levels were measured prior to PCI and then daily for 3 days following PCI. Creatinine clearance (Ccr) was also calculated. Following investigation of the incidence of CIN, a significant decline in Ccr was observed in the control group but not in the hydration + alprostadil group after PCI. The reduction in the level of Ccr from baseline in the hydration + alprostadil group was the smallest among the three groups. Moreover, the highest incidence of CIN was in the control group (6 cases, 27.27%), followed by the hydration group (3 cases, 10.71%) and the hydration + alprostadil group (1 case, 2.86%). Therefore, the combined use of hydration and alprostadil significantly reduces the incidence of CIN in elderly patients undergoing PCI. Hydration and alprostadil are suggested to act synergistically to protect renal function. In conclusion, the combined use of hydration and alprostadil is more effective in the prevention of CIN in elderly patients undergoing PCI compared with hydration alone.




Use of the modified Atkins diet in infantile spasms refractory to first-line treatment.  


This prospective, open label, uncontrolled study was performed to evaluate the efficacy and tolerability of the modified Atkins diet in children with refractory infantile spasms. Fifteen consecutive children aged six months to three years having daily infantile spasms in clusters with electroencephalographic evidence of hypsarrhythmia despite treatment with hormonal treatment (oral corticosteroids/adrenocorticotrophic hormone) and/or vigabatrin, and at least one additional anti-epileptic drug were enrolled. Children with known or suspected inborn errors of metabolism or systemic illnesses were excluded. Carbohydrate intake was restricted to ten grams/day. Among these 12 boys and three girls (median age-24 months), 13 had symptomatic etiology. After three months of diet, six children were spasm free. The time to spasm freedom after diet initiation ranged from two days to two months. The most frequent adverse effect observed was constipation. The modified Atkins diet was found to be effective and well tolerated in children with refractory infantile spasms ( identifier: NCT01006811). PMID:21920781

Sharma, Suvasini; Sankhyan, Naveen; Gulati, Sheffali; Agarwala, Anuja



Magnetoencephalography reveals a unique neurophysiological profile of focal-onset epileptic spasms.  


Epilepsy is defined as a disorder of the brain characterized by an enduring predisposition to experience epileptic seizures and the neurobiological, cognitive, psychological, and social difficulties relating to the condition. An epileptic spasm (ES) is a type of seizure characterized by clusters of short contractions involving axial muscles and proximal segments. However, the precise mechanism of ESs remains unknown. Despite the potential of magnetoencephalography (MEG) as a tool for investigating the neurophysiological mechanism of ESs, it has been difficult to use this methodology due to magnetic artifacts attributable to patient movement. We report on an 8-year-old girl suffering from intractable epileptic spasms from the age of 7 months. She was diagnosed with possible Aicardi syndrome [corrected] (AGS), characterized by the triad of callosal agenesis, infantile spasms, and chorioretinal lacunae. She is now intellectually delayed and suffers from intractable ES. We used both MEG and electroencephalography to investigate her epilepsy. The recording captured two series of spasm clusters. Spikes were clearly identified with MEG in about four-fifths of all spasms but were identified poorly or not at all in the remainder. MEG findings support previous studies that used intracranial electrodes to analyze patients with ESs and that showed variability in ES-associated spikes in terms of manner of cortical involvement and magnitude. Given the limitations of intracranial electrodes, such as sampling restrictions and invasiveness, MEG may be a helpful tool for non-invasively investigating the unique pathophysiological profile of focal-onset ESs. PMID:23343709

Kakisaka, Yosuke; Gupta, Ajay; Enatsu, Rei; Wang, Zhong I; Alexopoulos, Andreas V; Mosher, John C; Dubarry, Anne-Sophie; Hino-Fukuyo, Naomi; Burgess, Richard C



Coronary CTA  

Microsoft Academic Search

This article will first compare the various cardiac imaging studies commonly prescribed and will discuss basic technical aspects of coronary computed tomography angiography (CCTA). CCTA represents one of the most valuable diagnostic studies available in the fight against coronary artery disease (CAD) because early diagnosis is imperative for early intervention. Advances in temporal and spatial resolution enable identification of CAD

Jody W. Baker



Sequential thallium-201 myocardial perfusion studies after successful percutaneous transluminal coronary artery angioplasty: delayed resolution of exercise-induced scintigraphic abnormalities  

SciTech Connect

To characterize the sequential changes of myocardial perfusion scintigraphy in patients with coronary artery disease (CAD) after complete revascularization, 43 patients underwent exercise thallium-201 (/sup 201/Tl) myocardial perfusion scintigraphy before and at 9 +/- 5 days, 3.3 +/- 0.6, and 6.8 +/- 1.2 months after percutaneous transluminal coronary angioplasty (PTCA). Only patients with single-vessel CAD, without previous myocardial infarction, and without evidence of restenosis at 6 to 9 months after PTCA were included. Perfusion scans were analyzed blindly with the use of a new quantitative method to define regional myocardial perfusion in the topographic distribution of each coronary artery, which was shown to be reproducible (r = .94 or higher and SEE of 7% or less, between repeated measures by one and two operators). At 4 to 18 days after PTCA, the mean treadmill walking time increased by 123 +/- 42 sec, mean exercise-induced ST segment depression decreased by 0.6 +/- 0.3 mm, group maximal heart rate increased by 20 +/- 9 beats/min, and group systolic blood pressure at peak exercise increased by 24 +/- 10 mm Hg, compared with pre-PTCA values (p less than .001). However, no group differences were noted in these variables between the three post-PTCA stages. Myocardial perfusion in the distribution of the affected (dilated) coronary artery, on the other hand, improved progressively. In the 45 degree left anterior oblique view for instance, myocardial perfusion increased at 9 days after PTCA (from 68 +/- 24% before PTCA to 91 +/- 9%, p less than .001) and at 3.3 months after PTCA (101 +/- 8%, p less than .05 vs 9 days after PTCA), but no further significant changes were seen at 6.8 months after PTCA (102 +/- 8%). Similar changes were noted in the other two views. No relationship between minor complications during PTCA and delayed improvement on the /sup 201/Tl was observed.

Manyari, D.E.; Knudtson, M.; Kloiber, R.; Roth, D.



Microvascular decompression for hemifacial spasm: focus on late reoperation.  


The objective of this study is to investigate late repeat microvascular decompression (MVD) with persistent or recurrent hemifacial spasm (HFS) and to compare the clinical characteristics, intraoperative findings, complications, and outcomes with first MVD. We analyzed MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000 and December 31, 2007. Thirty-three patients who underwent late redo MVDs were classified as group I and 243 patients who underwent their first MVD as group II. Clinical data were collected to analyze the difference between the two groups. The mean follow-up period was 54.48 months (range, 9-102 months). There is no significant difference in preoperative clinical characteristics (gender, age, side of MVD, botox usage, facial weakness) between the two groups. In present study, we found a vein as the offending vessel in significantly more number of patients who underwent repeat MVD as compared to first MVD (P?=?0.02). The lateral spread response disappeared in 66% of patients during repeat MVDs, which is not different from those undergoing their first MVD. No difference in the relief rate was found during the immediate postoperative, discharge, or follow-up stages between repeat and first MVD. Moreover, no difference was found in the incidence of complications between repeat MVD and first MVD. Late repeat MVD for HFS is an effective and safe procedure. No specific preoperative clinical characteristics were identified in patients with repeat MVD. Intraoperative monitoring with lateral spread response (LSR) is an effective tool to evaluate adequate decompression. In patients with persistent LSR at the end of the procedure, facial nerve compression from a vein should be examined. We believe that it is important to undergo a repeat MVD for failed HFS relief irrespective of the timing of the operation. PMID:23749049

Wang, Xuhui; Thirumala, Parthasarathy D; Shah, Aalap; Gardner, Paul; Habeych, Miguel; Crammond, Donald; Balzer, Jeffrey; Burkhart, Lois; Horowitz, Michael



The contrast medium volume to estimated glomerular filtration rate ratio as a predictor of contrast-induced nephropathy after primary percutaneous coronary intervention  

Microsoft Academic Search

Background  Contrast-induced nephropathy (CIN) is a serious complication in percutaneous coronary intervention (PCI) patients, which may\\u000a be related to the contrast dose used during cardiac catheterization.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We prospectively investigated 277 consecutive consenting patients with acute ST-segment elevation myocardial infarction (STEMI)\\u000a who were given primary PCI, and we calculated their ratio of volume of contrast media to estimated glomerular filtration rate\\u000a (V\\/eGFR).

Yong Liu; Ning Tan; Ying-Ling Zhou; Peng-Cheng He; Jian-Fang Luo; Ji-Yan Chen


An easy method for the intraluminal administration of peppermint oil before colonoscopy and its effectiveness in reducing colonic spasm  

Microsoft Academic Search

Background: Systemic administration of a cholinergic blocking agent or glucagon is used to reduce spasms, but it is inconvenient and sometimes causes side effects. This study is an evaluation of the intracolonic administration of peppermint oil during colonoscopy for the control of colonic spasm. Methods: Each patient in the treated group (n = 409) was given approximately 200 mL of

Takayuki Asao; Erito Mochiki; Hideki Suzuki; Jun-ichi Nakamura; Isao Hirayama; Nobuhiro Morinaga; Hisanori Shoji; Yoshinori Shitara; Hiroyuki Kuwano



Jaw closing spasm--a form of focal dystonia? An electrophysiological study.  

PubMed Central

The case of a 36 year old man suffering from unilateral right jaw closing spasms over two years is reported. Permanent spasm with trismus severely impeding mouth-opening was combined with paroxysms triggered by various sensory stimuli. The diagnosis of temporo-mandibular joint syndrome was considered but treatment failed to improve the symptoms. Neurological investigation two years after onset of the spasms showed by electrophysiological studies excessive co-contraction of the antagonistic jaw-closers, mainly the right masseter during attempts at jaw opening and absence of the silent period in the right masseter and anterior temporalis following jaw tap and trigeminal exteroceptive stimulation. Jaw dystonia was therefore considered and Botulinum A toxin was injected into the right masseter and temporalis which dramatically improved the patient's condition.

Lagueny, A; Deliac, M M; Julien, J; Demotes-Mainard, J; Ferrer, X



Pharmacological relaxation of the saphenous vein during harvesting for coronary artery bypass grafting.  


Spasm of the saphenous vein frequently occurs during harvesting from the leg and high-pressure distension is required to restore an adequate diameter for grafting. Forceful distention has been shown to damage the intima and media and may predispose to subsequent occlusion of the vein graft. Various pharmacologic vasodilators are capable of relaxing veins; in this study, we carried out a systematic investigation to determine the appropriate agents and concentrations for use during vein graft operations. In organ baths, human saphenous vein segments were contracted with potassium or a thromboxane mimetic, and vasodilator agents were then applied. Glyceryl trinitrate, 7.2 micrograms/mL, or papaverine hydrochloride, 11.9 micrograms/mL, caused 80% to 100% relaxation of contraction induced by potassium or thromboxane. Verapamil, 15.5 micrograms/mL, relaxed the potassium contraction by 100% and the thromboxane contraction by 75%. Comparison of the time course of action showed that glyceryl trinitrate had a rapid onset and a short duration of maximal action, whereas verapamil (like papaverine) had delayed onset and a long duration. A mixture of glyceryl trinitrate and verapamil combined rapid onset with long duration of action. We now use a mixture of glyceryl trinitrate and verapamil (pH 7.4) topically and intraluminally during harvesting of the saphenous vein to provide a relaxed conduit for coronary artery bypass grafting. PMID:8494433

He, G W; Rosenfeldt, F L; Angus, J A



Single coronary artery with prepulmonic coursing left main coronary artery manifesting as prinzmetal's angina.  


We report the case of a 32-year-old man who presented at the emergency department with severe chest pressure, left arm pain, and dizziness. These symptoms were described as intermittent, occurring after exercise and at rest. He had undergone several stress tests during the past 8 years, but no objective evidence of ischemia was produced. His history of hyperlipidemia and increasing frequency of symptoms prompted us to perform coronary angiography, which showed a single coronary artery with an ostium at the right sinus of Valsalva. The vessel had an initial, mixed common trunk that gave rise to both the right coronary artery proper and to the left coronary artery. The left main trunk followed a prepulmonic course. The anatomic features were eventually confirmed by computed tomographic angiography. The left main stem had a fixed 50% to 60% area narrowing, at baseline study. A treadmill stress myocardial perfusion study showed no evidence of ischemia. The patient was referred to a 2nd facility, where intravascular ultrasonography, at baseline, revealed 63% left main narrowing without evidence of atherosclerosis. Acetylcholine provocation demonstrated worsening of the stenosis to about 80%, with reproduction of angina and ST-segment depression, which indicated that medical management of spasm might provide symptomatic relief. PMID:18172528

Sanford, Garrett B; Molavi, Behzad; Sinha, Anjan K; Garza, Luis; Angelini, Paolo



Efficacy of thiocolchicoside in Indian patients suffering from low back pain associated with muscle spasm.  


Low back pain (LBP), a high prevalent condition among middle aged population, is usually associated with 'muscle spasm' that is responsible for giving rise to pain as well as its persistence. Muscle spasm is an involuntary, painful contraction of muscles that interferes with the function and cause of muscular disorder. Therefore centrally acting skeletal muscle relaxants, also called lissive drugs, are commonly used for its treatment. Sometimes these are combined with NSAIDs. The use of centrally acting skeletal muscle relaxants, though efficacious, is associated with frequent development of dose-related adverse drug reactions like sedation, impairment of voluntary motor functions and ataxia. So there is an urgent need for newer better drugs for treatment of conditions associated with muscle spasm. The objective of this study was to assess the efficacy and safety of oral thiocolchicoside (TC), a natural glycoside as compared to an adrenergic alpha 2 agonist tizanidine (TZ) in the Indian patients with LBP accompanied by muscle spasm. In this randomised, non-cross over clinical study, 60 adult Indians aged between 18 and 65 years with clinical diagnosis of muscle spasm associated with low back pain were enrolled. Patients satisfying the inclusion and exclusion criteria were either treated with TC and TZ for one week duration. Visual analogue scale (VAS) for pain at rest and VAS for tiredness, drowsiness, dizziness and alertness was used as the self-rated primary efficacy and safety variable. Pain was also assessed by mobility assessment; muscle spasm assessment and analgesic consumption. Data obtained from 58 patients (those who completed the study) indicated that in this one week study both TC and TZ provided sustained symptoms relief compared with the baseline. There was statistically significant reduction in severity of symptoms from day 0 to day 7 in both the groups. Patients were followed up on 3rd and 7th day and severity score of various parameters was recorded. There was significant difference among the treatment groups in favour of TC than TZ in efficacy parameters thus showing TC is at slightly better effective than TZ and in case of safety, TC scores significantly better over TZ in the patients with accompanying muscle spasm. These findings confirm that TC is a preferred option for the LBP with muscle spasms. PMID:18839644

Soonawalla, Darius F; Joshi, Niteen



Teaching NeuroImages: Concurrent hemifacial spasm and trigeminal neuralgia due to vertebrobasilar dolichoectasia.  


A 64-year-old man reported a 2-week worsening of a 2-year history of paroxysmal, lancinating right facial pain and spasms. Head CT demonstrated a tortuous and ectatic vertebral-basilar system. MRI confirmed a dolichoectatic basilar artery that distorted the right trigeminal (figure 1) and facial nerve roots (figure 2). He failed conservative medical management including carbamazepine, oxcarbazepine, and levetiracetam. He underwent Gamma Knife radiosurgery with few months of pain relief and was offered botulinum neurotoxin injection for spasms. PMID:23960199

Lakhan, Shaheen E



Use of fillers as adjunct therapy for the treatment of lower face hemifacial spasm.  


The treatment of hemifacial spasm with periorbital injections of higher doses of botulinum toxin can create disfiguring and undesirable weakness in the lower face during active facial movements. The use of asymmetric hyaluronidate filler injections to the lower face provides a refinement allowing for a lowered neurotoxin dose. The filler creates a ballasting effect and involuntary facial movement. The conventional filler effect also further reduces asymmetric nasolabial folds and marionette lines. Fifteen of 18 patients with lower facial spasms found the filler toxin combination an improvement over neurotoxin alone. PMID:23559346

Borodic, Gary E


Increase of Circulating Endothelial Progenitor Cells in Patients with Coronary Artery Disease After Exercise-Induced Ischemia  

Microsoft Academic Search

Objectives—The concept of neovascularization in response to tissue ischemia has been extended by the finding of postnatal vasculogenesis initiated by endothelial progenitor cells (EPCs). The aim of this study was to analyze whether a maximal stress test in patients with coronary artery disease (CAD) increases the number of circulating EPCs. Methods and Results—Blood concentration of EPCs was analyzed by FACS

Volker Adams; Karsten Lenk; Axel Linke; Dominik Lenz; Sandra Erbs; Markus Sandri; Attila Tarnok; Stephan Gielen; Frank Emmrich; Gerhard Schuler; Rainer Hambrecht



Increase of Circulating Endothelial Progenitor Cells in Patients with Coronary Artery Disease After Exercise-Induced Ischemia  

Microsoft Academic Search

Objectives—The concept of neovascularization in response to tissue ischemia has been extended by the finding of postnatal vasculogenesis initiated by endothelial progenitor cells (EPCs). The aim of this study was to analyze whether a maximal stress test in patients with coronary artery disease (CAD) increases the number of circulating EPCs. Methods and Results—Blood concentration of EPCs was analyzed by FACS

Volker Adams; Karsten Lenk; Axel Linke; Dominik Lenz; Sandra Erbs; Markus Sandri; Attila Tarnok; Stephan Gielen; Frank Emmrich; Gerhard Schuler; Rainer Hambrecht



Established risk factors for coronary heart disease are unrelated to androgen-induced baldness in female-to-male transsexuals  

Microsoft Academic Search

A high scalp sensitivity to androgens is part of the pathophysiology of male-pattern baldness (MPB). Androgens affect established risk factors for coronary heart disease (CHD), and a supposedly heightened impact on these risk factors is hypothesized to explain the epidemio- logical association between MPB and CHD. In this retrospective, observational study we studied 81 female- to-male transsexual (FM) subjects, mean

E J Giltay; A R Sarabdjitsingh; L J G Gooren



Arachidonic Acid-Induced Dilation in Human Coronary Arterioles: Convergence of Signaling Mechanisms on Endothelial TRPV4-Mediated Ca2+ Entry  

PubMed Central

Background Arachidonic acid (AA) and/or its enzymatic metabolites are important lipid mediators contributing to endothelium?derived hyperpolarizing factor (EDHF)–mediated dilation in multiple vascular beds, including human coronary arterioles (HCAs). However, the mechanisms of action of these lipid mediators in endothelial cells (ECs) remain incompletely defined. In this study, we investigated the role of the transient receptor potential vanilloid 4 (TRPV4) channel in AA?induced endothelial Ca2+ response and dilation of HCAs. Methods and Results AA induced concentration?dependent dilation in isolated HCAs. The dilation was largely abolished by the TRPV4 antagonist RN?1734 and by inhibition of endothelial Ca2+?activated K+ channels. In native and TRPV4?overexpressing human coronary artery ECs (HCAECs), AA increased intracellular Ca2+ concentration ([Ca2+]i), which was mediated by TRPV4?dependent Ca2+ entry. The AA?induced [Ca2+]i increase was inhibited by cytochrome P450 (CYP) inhibitors. Surprisingly, the CYP metabolites of AA, epoxyeicosatrienoic acids (EETs), were much less potent activators of TRPV4, and CYP inhibitors did not affect EET production in HCAECs. Apart from its effect on [Ca2+]i, AA induced endothelial hyperpolarization, and this effect was required for Ca2+ entry through TRPV4. AA?induced and TRPV4?mediated Ca2+ entry was also inhibited by the protein kinase A inhibitor PKI. TRPV4 exhibited a basal level of phosphorylation, which was inhibited by PKI. Patch?clamp studies indicated that AA activated TRPV4 single?channel currents in cell?attached and inside?out patches of HCAECs. Conclusions AA dilates HCAs through a novel mechanism involving endothelial TRPV4 channel?dependent Ca2+ entry that requires endothelial hyperpolarization, PKA?mediated basal phosphorylation of TRPV4, and direct activation of TRPV4 channels by AA.

Zheng, Xiaodong; Zinkevich, Natalya S.; Gebremedhin, Debebe; Gauthier, Kathryn M.; Nishijima, Yoshinori; Fang, Juan; Wilcox, David A.; Campbell, William B.; Gutterman, David D.; Zhang, David X.



Coronary Calcium Scan  


... the NHLBI on Twitter. What Is a Coronary Calcium Scan? A coronary calcium scan is a test ... you have calcifications in your coronary arteries. Coronary Calcium Scan Figure A shows the position of the ...


Coronary arteries  

Microsoft Academic Search

.   Coronary angiography (CA) is presently considered the gold standard for the assessment of the coronary arteries. However,\\u000a the presence of ionizing radiation, its invasiveness and the small associated risk of morbidity prompted long ago the development\\u000a of more patient-friendly imaging modalities. A promising technique, magnetic resonance imaging (MRI), has been regarded as\\u000a the major modality in the coming decade.

P. A. Wielopolski; R. J. M. van Geuns; P. J. de Feyter; M. Oudkerk



Coronary aneurysms.  


Coronary aneurysms represent anomalies identified in 0.15-4.9% of patients undergoing coronary angiography. At present there is no uniform definition of this pathology. According to current definitions, the term "aneurysm" refers to both diffuse over 150% dilation of the largest diameter of a coronary artery, and limited spherical or saccular dilation. Aneurysms are observed most commonly in the right coronary artery, and least frequently in the left main coronary artery. It has been demonstrated that atherosclerosis is the main cause of these anomalies in adults, and Kawasaki disease in children and adolescents. However, regardless of the pathogenesis of the aneurysm, pathology of the media of the blood vessel plays a major role in its formation. The most prevalent consequence of aneurysms in the coronary arteries is formation of a thrombus with distal embolization, vasospasm or vessel disruption at the site of wall injury. Therefore, therapeutic management in this anomaly involves both the prevention of thromboembolic complications and percutaneous or surgical closure of the aneurysm entry. PMID:19202953

Gziut, Aneta I; Gil, Robert J



Infantile spasms in a child with brain tumor: Seizure-free outcome after resection  

Microsoft Academic Search

A 17-month-old child had typical infantile spasms (IS) in association with a frontal lobe tumor. EEG showed hypsarrthmia, and typical IS were documented by video-EEG monitoring (no focal features were identified). Seizures ceased after surgical removal of the tumor, a ganglioglioma. We investigated the role of surgery in infants with West syndrome (WS) and lesions of various types.

Prakash Kotagal; Bruce H. Cohen; Joseph F. Hahn



Clinical and Electroencephalographic Features of Infantile Spasms Associated with Malformations of Cortical Development  

Microsoft Academic Search

The aim of this study was to reveal the clinical and encephalographic (EEG) features of infantile spasms (IS) with malformations of cortical development (MCDs). The clinical features, EEG findings, neuroimaging studies and outcomes of various therapeutic modalities for 27 patients with IS and MCDs were reviewed. Background activities of EEG on the MCDs, i.e. asymmetric hypsarrhythmia, localized persistent polymorphic slowing,

Hoon Chul Kang; Yong Soon Hwang; Jung Chae Park; Woo Ho Cho; Soung Hee Kim; Heung Dong Kim; Sang Keun Park



Infantile Spasms as an Adverse Outcome of Neonatal Cortical Sinovenous Thrombosis  

Microsoft Academic Search

Cerebral sinovenous thrombosis is a rare but potentially serious condition often occurring in children with nonspecific presenting features. Much remains to be learned about the long-term outcome of infants with cerebral sinovenous thrombosis. We report a series of four patients taken from a prospective database of neonates with sinovenous thrombosis who subsequently developed infantile spasms, three with hypsarrythmia on electroencephalography

Teesta B. Soman; Mahendranath Moharir; Gabrielle deVeber; Shelly Weiss



Massive expansion of SCA2 with autonomic dysfunction, retinitis pigmentosa, and infantile spasms  

PubMed Central

Objective: To provide clinical data on a cohort of 6 patients with massive expansion (>200 CAG repeats) of spinocerebellar ataxia type 2 (SCA2) and investigate possible pathways of pathogenesis using bioinformatics analysis of ATXN2 networks. Methods: We present data on 6 patients with massive expansion of SCA2 who presented in infancy with variable combinations of hypotonia, global developmental delay, infantile spasms, and retinitis pigmentosa. ATXN2 is known to interact with a network of synaptic proteins. To investigate pathways of pathogenesis, we performed bioinformatics analysis on ATXN2 combined with known genes associated with infantile spasms, retinitis pigmentosa, and synaptic function. Results: All patients had a progressive encephalopathy with autonomic dysfunction, 4 had retinitis pigmentosa, and 3 had infantile spasms. The bioinformatics analysis led to several interesting findings. First, an interaction between ATXN2 and SYNJ1 may account for the development of retinitis pigmentosa. Second, dysfunction of postsynaptic vesicle endocytosis may be important in children with this progressive encephalopathy. Infantile spasms may be associated with interactions between ATXN2 and the postsynaptic structural proteins MAGI2 and SPTAN1. Conclusions: Severe phenotype in children with massive expansion of SCA2 may be due to a functional deficit in protein networks in the postsynapse, specifically involving vesicle endocytosis.

Shafrir, Y.; Hrivnak, J.; Patterson, M.C.; Tennison, M.B.; Clark, H.B.; Gomez, C.M.



Effects of dietary supplementation with fish oil on atherosclerosis and myocardial injury during acute coronary occlusion-reperfusion in diet-induced hypercholesterolemic rabbits.  


We studied myocardial injury during acute coronary occlusion-reperfusion and atherosclerosis in rabbits fed a high cholesterol diet with or without fish oil supplementation. New Zealand white male rabbits were divided into 3 groups. Eight control rabbits fed with laboratory standard rabbit chow were group I. In addition to the standard chow, 15 rabbits fed with a 1% cholesterol-enriched diet for 6 weeks were group II, and 10 rabbits fed with a 1% cholesterol-enriched and 10% fish oil supplemented diet for 6 weeks were group III. Acute coronary occlusion was induced by ligating the marginal branch of the left circumflex coronary artery for 1 h, followed by reperfusion for 4 h. Myocardial injury was assessed by tissue creatine kinase activities and amino-nitrogen concentrations from the ischemic (infarct) and nonischemic (normal) myocardium, and the infarct area/risk area ratios of the left ventricle. The surface area of the atherosclerotic lesions of the aorta and pulmonary artery was measured by planimeter. There was significantly more myocardial loss of creatine kinase and amino-nitrogen in the cholesterol-fed rabbits than the controls (p less than 0.01 and 0.02, respectively). The cholesterol and fish oil-treated rabbits had a nonsignificant reduction in myocardial loss of both agents as compared to their corresponding cholesterol-fed ones. The same trend was also found in the infarct area/risk area ratio. Fish oil treated rabbits had a good effect on the reduction of atherosclerotic lesions and tissue cholesterol levels in the aorta and pulmonary artery, but not in the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1612795

Chen, M F; Lee, Y T; Hsu, H C; Yeh, P C; Liau, C S; Huang, P C



Nitric Oxide Attenuates Reoxygenation-induced ICAM-1 Expression in Coronary Microvascular Endothelium: Role of NF ? B  

Microsoft Academic Search

Enhanced leukocyte adhesion has been shown to occur in post-ischemic reperfused hearts due to the upregulation of specific cell-surface adhesion molecules. Therefore, we investigated the influence of 4 h of reoxygenation after 20 h of hypoxia on ICAM-1 induction in primary cultures of rat coronary microvascular endothelial cells (CMEC). ICAM-1 surface expression as well as oxygen free radical formation were

Christian Kupatt; Christian Weber; Dieter A. Wolf; Bernhard F. Becker; Thomas W. Smith; Ralph A. Kelly



Regional myocardial blood flow and coronary vascular reserve in unanesthetized ponies during pacing-induced ventricular tachycardia  

SciTech Connect

To examine the effects of tachycardia on coronary circulation, transmural distribution of myocardial blood flow (MBF, 15-micron diameter radionuclide-labeled microspheres) was studied in six healthy adult ponies at rest (heart rate . 60 +/- 7 beats . min-1), during ventricular pacing at 150 and 200 beats . min-1, as well as with ventricular pacing at 250 beats . min-1 before and during maximal coronary vasodilatation (iv adenosine infusion; 4 mumole . kg-1 . min-1). Mean aortic pressure and cardiac output were unchanged from control values with ventricular pacing. Whereas ventricular pacing at 150 and 200 beats . min-1 resulted in a progressive uniform increase in transmural MBF and well-maintained endo:epi perfusion ratio, pacing at 250 beats . min-1 did not result in a further increase in MBF compared to pacing at 200 beats . min-1 and the left ventricular (LV) subendocardial:subepicardial (endo:epi) perfusion ratio was significantly less than 1.00 (0.87 +/- 0.05). Blood flow to the LV papillary muscles and subendocardium was significantly less than that recorded at 200 beats . min-1. The LV endo:epi perfusion ratio with ventricular pacing at 250 beats . min-1 during adenosine infusion resulted in a decrease in mean aortic pressure (63% of control value) and a marked further reduction in blood flow to the LV papillary muscles as well as the LV subendocardium, while MBF increased dramatically in the LV subepicardium compared to values observed during ventricular pacing at 250 beats . min-1 alone. These data demonstrate that coronary vasomotion functions to maintain LV subendocardial blood flow in the pony myocardium at a heart rate of 200 beats . min-1, while at 250 beats . min-1 exhaustion of coronary vasodilator reserve in the deeper layers limits further increase in MBF.

Parks, C.; Manohar, M.; Lundeen, G.



Improvement in exercise-induced left ventricular dysfunction by infusion of ?-human atrial natriuretic peptide in coronary artery disease  

Microsoft Academic Search

The effects of recombinant ?-human atrial natriureric peptide (?-hANP) infusion on acute left ventricular dysfunction provoked by exercise were examined in 14 men with coronary artery disease. Patients performed symptom-limited, graded exercise on a supine bicycle ergometer. Plasma ?-hANP and guanosine 3?,5?-monophosphate (cyclic GMP) concentrations as well as hemodynamic variables were measured at rest, during and after exercise. In 14

Masahiko Ukai; Yasuto Nishinaka; Toshikazu Sobue; Takashi Miyahara; Mitsuhiro Yokota



The response to drug therapy in unstable angina on the basis of coronary angiography findings.  


Among 366 unstable angina pectoris patients at our hospital, myocardial infarction was common (15.7%) in those with attacks of chest pain lasting for at least 20 min. There was also a high incidence (30.3%) when chest pain continued after the start of inpatient treatment. To investigate the etiology of unstable angina, coronary arteriography was performed in both the unstable and stable stages in these patients and the results were compared. The role of coronary spasm and coronary thrombosis in unstable angina was investigated, and the efficacy of continuous infusion of either diltiazem or isosorbide dinitrate as treatment for these patients was compared. Coronary arteriography in the unstable stage showed, no clear differences in the morphology of the stenotic site and the degree of stenosis between the patients with and without infarcts when urokinase or isosorbide dinitrate were injected into the coronary arteries. When drug treatment was effective, the angina was stabilized without any improvement in the degree of stenosis or the morphology of the involved coronary vessel. Thus, it was difficult to predict the response to treatment from coronary arteriography performed in the unstable stage. Diltiazem was more effective than isosorbide dinitrate, and it appears that some action other than coronary dilatation was involved in achieving the remission of unstable angina. PMID:1453541

Uchida, T; Kaneko, N; Tanino, S; Ogawa, H; Iwasaki, T; Sumiyoshi, T; Hosoda, S



Cold pressor /sup 201/Tl myocardial scintigraphy in the diagnosis of coronary artery disease  

SciTech Connect

/sup 201/Tl myocardial scintigraphy was performed during cold pressor stimulation in 36 patients aged 36 to 69 years. Thirty-one patients had coronary artery disease and 5 patients did not, as confirmed by coronary cineangiography. /sup 201/Tl (1.5 to 2 mCi) was injected at 30 seconds of the cold pressor stimulation. The product of systolic pressure X heart rate increased from a baseline of 77.4 +/- 16 (standard deviation (SD)) to 103.6 +/- 17 at 30 seconds of the cold pressor test (p less than 0.0005). Transient perfusion deficits developed in 24 of 31 patients with coronary artery disease (sensitivity 77%), and all 5 patients without coronary artery disease had normal scintigrams. The sensitivity in detecting coronary artery disease was 40% in patients with 1 vessel disease, 91% in patients with 2 vessel disease, and 100% in patients with 3 vessel disease. Exercise electrocardiograms (available in 29 of 36 patients) were positive for ischemia in 18 of 24 patients with coronary artery disease and in 1 of 5 patients without coronary artery disease (sensitivity 75% and specificity less than 80%). Exercise /sup 201/Tl scintigrams, obtained in 16 patients, were positive in 11 patients with coronary artery disease and positive cold pressor /sup 201/Tl scintigrams. Five patients without coronary artery disease and with normal cold pressor /sup 201/Tl scintigrams had normal exercise /sup 201/Tl scintigrams. Coronary cineangiography performed during cold pressor stimulation in 6 patients who had positive cold pressor and exercise /sup 201/Tl scintigrams did not show coronary spasm. Our data indicate that cold pressor thallium-201 scintigraphy offers promise as a noninvasive test in the diagnosis of coronary artery disease and may be used in patients in whom exercise testing is not feasible.

Ahmad, M.; Dubiel, J.P.; Haibach, H.



Influence of intracoronary nifedipine on left ventricular function, coronary vasomotility, and myocardial oxygen consumption.  

PubMed Central

The effect of intracoronary nifedipine on regional and global left ventricular performance, coronary vasomotility, and myocardial oxygen consumption is reported. Left ventricular pressures and volume indices of contractility and relaxation were simultaneously recorded in five patients without coronary artery disease. In these patients, nifedipine in the left main coronary artery not only delayed (+115 ms) anterior wall contraction but also slowed (3.5 vs 1.9 cm/s) and depressed it (-26%), resulting in a depression of global left ventricular ejection. This asynchrony and depression of regional contraction is considered to be responsible for the slowed isovolumic contraction and relaxation of the whole ventricle. In 10 other patients with coronary artery disease, coronary sinus blood flow and myocardial oxygen consumption were measured before and after intracoronary nifedipine. The observed decrease in myocardial oxygen consumption (-28%) depended primarily on a decrease in contractility and left ventricular performance. In a third study group of 12 patients with coronary artery disease, the effects of intracoronary nifedipine on the coronary vasomotility of 40 coronary segments (normal, prestenotic, stenotic, poststenotic) were quantitatively determined. Left ventricular haemodynamics and coronary sinus saturation were monitored while the cineangiograms were recorded before and after nifedipine. Nifedipine provoked vasodilatation of the normal (+10.3%), prestenotic, stenotic (+4 to 30%), and poststenotic (+16.4%) coronary segments, which persisted after the disappearance of its direct effects on the myocardium. This transient regional "cardioplegic" effect of nifedipine, associated with an increase in coronary blood flow, a reduction in myocardial oxygen consumption, and a vasodilatation of the epicardial vessels is likely to be beneficial during temporary coronary occlusion such as occurs in spasm or transluminal angioplasty. Images

Serruys, P W; Hooghoudt, T E; Reiber, J H; Slager, C; Brower, R W; Hugenholtz, P G



Pravastatin-induced improvement in coronary reactivity and circulating ATP and ADP levels in young adults with type 1 diabetes  

PubMed Central

Aims: Extracellular ATP and ADP regulate diverse inflammatory, prothrombotic and vasoactive responses in the vasculature. Statins have been shown to modulate their signaling pathways in vitro. We hypothesized that altered intravascular nucleotide turnover modulates vasodilation in patients with type 1 diabetes (T1DM), and this can be partly restored with pravastatin therapy. Methods: In this randomized double blind study, plasma ATP and ADP levels and echocardiography-derived coronary flow velocity response to cold pressor test (CPT) were concurrently assessed in 42 normocholesterolemic patients with T1DM (age 30 ± 6 years, LDL cholesterol 2.5 ± 0.6 mmol/L) before and after four-month treatment with pravastatin 40 mg/day or placebo (n = 22 and n = 20, respectively), and in 41 healthy control subjects. Results: Compared to controls, T1DM patients had significantly higher concentrations of ATP (p < 0.01) and ADP (p < 0.01) and these levels were partly restored after treatment with pravastatin (p = 0.002 and p = 0.007, respectively), but not after placebo (p = 0.06 and p = 0.14, respectively). Coronary flow velocity acceleration was significantly lower in T1DM patients compared to control subjects, and it increased from pre- to post-intervention in the pravastatin (p = 0.02), but not in placebo group (p = 0.15). Conclusions: Pravastatin treatment significantly reduces circulating ATP and ADP levels of T1DM patients, and concurrently improves coronary flow response to CPT. This study provides a novel insight in purinergic mechanisms involved in pleiotropic effects of pravastatin.

Kiviniemi, Tuomas O.; Yegutkin, Gennady G.; Toikka, Jyri O.; Paul, Subhadeep; Aittokallio, Tero; Janatuinen, Tuula; Knuuti, Juhani; Ronnemaa, Tapani; Koskenvuo, Juha W.; Hartiala, Jaakko J.; Jalkanen, Sirpa; Raitakari, Olli T.



Distinct mouse coronary anatomy and myocardial infarction consequent to ligation  

Microsoft Academic Search

This study describes the coronary anatomy of C57BL\\/6 mice and the functional impact of that anatomy on myocardial infarctions induced by ligation of the left coronary artery. In contrast to humans, a distinct septal coronary artery was observed in all mice arising either from a separate ostium from the right sinus of Valsalva or as a branch of the right

Dinender Kumar; Timothy A. Hacker; Jennifer Buck; Larry F. Whitesell; Eugene H. Kaji; Pamela S. Douglas; Timothy J. Kamp



Cilnidipine, a slow-acting Ca2+ channel blocker, induces relaxation in porcine coronary artery: role of endothelial nitric oxide and [Ca2+]i  

PubMed Central

Cilnidipine is a dual blocker of L-type voltage-gated Ca2+ channels in vascular smooth muscle and N-type Ca2+ channels in sympathetic nerve terminals that supply blood vessels. However, the clinical benefits of cilnidipine and underlying mechanisms are incompletely understood. This study was designed to compare the time course of relaxant responses to cilnidipine and nifedipine, and to examine the role of endothelial NO and [Ca2+]i in the vasorelaxation. Porcine left circumflex coronary arteries were isolated and isometric tension was measured with Grass force transducers. Endothelial [Ca2+]i in intact arteries was determined by a calcium fluorescence imaging technique. The free radical scavenging capacity was also assayed. Cilnidipine and nifedipine induced concentration-dependent relaxations in high KCl-precontracted artery rings, while the former-induced relaxation was slower as compared to the latter. Treatment with L-NAME or ODQ reduced relaxations to cilnidipine or nifedipine to the same extent as in rings without endothelium. Indomethacin or ?-conotoxin had no effects. L-Arginine antagonized the effect of L-NAME on cilnidipine-induced relaxations. Cilnidipine did not affect sodium nitroprusside-induced relaxation in rings with and without endothelium. Cilnidipine and nifedipine caused extracellular Ca2+-dependent increases in endothelial [Ca2+]i in intact arteries and cilnidipine's action had a slower onset, similar to that of cilnidipine-induced relaxation. Neither cilnidipine nor nifedipine exhibited a free radical scavenging property. The present results demonstrate that cilnidipine can produce endothelium-dependent relaxation in porcine coronary arteries in vitro in addition to blocking Ca2+ channels. Like short-acting nifedipine, cilnidipine-dependent relaxation, albeit to a slower onset, is partly mediated by endothelial NO but not by prostacyclin. The increased release or bioavailability of NO may causally result from elevated endothelial [Ca2+]i in arteries. The Ca2+ channel-independent effect suggests the usefulness of cilnidipine in the treatment of cardiovascular diseases associated with diminished NO release, such as atherosclerosis.

Leung, Hok Sum; Yao, Xiaoqiang; Leung, Fung Ping; Ko, Wing Hung; Chen, Zhen-Yu; Gollasch, Maik; Huang, Yu



Coronary Angioplasty  


... or blocked coronary (heart) arteries. The procedure restores blood flow to the heart muscle. Overview As you age, a waxy substance called ... the plaque against the artery wall. This restores blood flow through the ... heart muscle damage caused by a heart attack. Outlook Serious ...


Coronary arteriography and angioplasty  

SciTech Connect

This book explores biomedical radiography of the heart. Topics considered include six bench marks in the history of cardiac catheterization; normal coronary anatomy; anomalies of the coronary arteries; pathoanotomy of the coronary arteries and complications; indications, limitations, and risks of coronary arteriography and left ventriculography; catheterization techniques in coronary arteriography and left ventriculography: the Sones technique; catheterization techniques in coronary arteriography and left ventriculography: the Judkins technique; modification of Judkins catheters; catheterization techniques in coronary arteriography and left ventriculography multipurpose technique; new views in coronary arteriography; quantitative evaluation of left ventricular function; complications of coronary arteriography: management during and following the procedure; interpretation of coronary arteriograms and left ventriculograms; prevalence and distribution of disease in patients catheterized for suspected coronary disease at Emory University Hospital; the Cardiac Catheterization Laboratory; selection for surgery or percutaneous transluminal coronary angioplasty; intracoronary thrombolysis; and percutaneous transluminal coronary angioplasty.

King, S.B.; Douglas, J.S.



Coronary artery disease and myocardial infarction in pregnancy: A review of epidemiology, diagnosis, and medical and surgical management  

PubMed Central

Ischemic heart disease is uncommon during pregnancy, occurring in approximately one in 10,000 live births. With the increasing age and fertility of mothers, the incidence of coronary artery disease in pregnancy is likely to increase. Atherosclerosis appears to be the most common cause of acute myocardial infarction, although coronary spasm, coronary dissection and thrombus have been reported, among others. The diagnosis of ischemic heart disease in the pregnant population can be challenging and not without risk to the fetus. Although there have been many reports of acute myocardial infarction and cardiopulmonary bypass surgery during pregnancy, most knowledge is based on anecdotal reports. Even less is known about the use of thrombolytics, percutaneous coronary intervention and the optimal medical management of ischemic heart disease during pregnancy. The epidemiology, diagnosis, medical and surgical treatment, and prognosis of ischemic heart disease in pregnancy are the subject of the present review.

Kealey, Angela J



Delayed Unilateral Soft Palate Palsy without Vocal Cord Involvement after Microvascular Decompression for Hemifacial Spasm  

PubMed Central

Microvascular decompression is a very effective and relatively safe surgical modality in the treatment of hemifacial spasm. But rare debilitating complications have been reported such as cranial nerve dysfunctions. We have experienced a very rare case of unilateral soft palate palsy without the involvement of vocal cord following microvascular decompression. A 33-year-old female presented to our out-patient clinic with a history of left hemifacial spasm for 5 years. On postoperative 5th day, patient started to exhibit hoarsness with swallowing difficulty. Symptoms persisted despite rehabilitation. Various laboratory work up with magnetic resonance image showed no abnormal lesions. Two years after surgery patient showed complete recovery of unitaleral soft palate palsy. Various etiologies of unilateral soft palate palsy are reviewed as the treatment and prognosis differs greatly on the cause. Although rare, it is important to keep in mind that such complication could occur after microvascular decompression.

Park, Jae Han; Jo, Kyung Il



Atypical presentation in Rasmussen encephalitis: delayed late-onset periodic epileptic spasms.  


A five-and-a-half-year-old girl started experiencing progressive left hemiparesis at age two and a half years. At age five years and four months she started presenting clusters of asymmetric periodic epileptic spasms with no hypsarrhythmia. The ictal EEG showed periodic, constant and stereotyped complexes. Serial brain imaging revealed progressive atrophy of the right hemisphere with increased T2 signal on MRI. She underwent a right hemispherotomy, and histological examination showed signs of inflammation and features of focal cortical dysplasia (FCD). She has been seizure-free for 16 months. This case is unique in the following aspects: the presence of typical Rasmussen encephalitis features of progressive unilateral brain involvement without seizures, a delay of almost three years prior to seizure onset; an atypical seizure type presentation with periodic epileptic spasms and the presence of FCD associated with inflammatory changes. [Published with video sequences]. PMID:21896424

Ferrari, Taíssa P F; Hamad, Ana P A; Caboclo, Luís Otávio S F; Centeno, Ricardo S; Zaninotto, Ana Luiza; Scattolin, Monica; Carrete Junior, Henrique; Lancellotti, Carmem L P; Yacubian, Elza Márcia T



Transient hemifacial spasm associated with subarachnoid brainstem cysticercosis: A case report  

Microsoft Academic Search

The authors present the case of a 69 year old woman who developed bladder incontinence and confusion. A CT scan showed severe\\u000a hydrocephalus and calcifictions, prompting a ventriculoperitoneal shunt placement. On the day after operation the patient\\u000a presented left hemifacial spasm. MR revealed a subarachnoid cysticercus rostral to the pons, and surgical excision was proposed.\\u000a She refused surgery and was

Rogelio Revuelta Gutierrez; José Luis Soto-Hernández; Roberto Suastegui-Roman; Jaime Ramos-Peek



Chronic Prostatitis\\/Chronic Pelvic Pain Syndrome and Pelvic Floor Spasm: Can We Diagnose and Treat?  

Microsoft Academic Search

National Institutes of Health category III prostatitis, also known as chronic prostatitis\\/chronic pelvic pain syndrome, is\\u000a a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology\\u000a and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several\\u000a approaches to therapy including biofeedback,

Karin E. Westesson; Daniel A. Shoskes



Hemifacial spasm and reinnervation synkinesias: long-term treatment with either Botox ® or Dysport ®  

Microsoft Academic Search

Botulinum toxin is considered the treatment of choice for hemifacial spasm (HFS) and reinnervation synkinesias (RS). We present\\u000a 133 patients with HFS (n = 97) and RS (n = 36) who have been treated with either Botox® (n = 78) or Dysport® (n = 55) exclusively for 6 years (range 2–12 years). The Botox® dose was 21 ± 8 MU, the Dysport® dose 46 ± 22 MU. The therapeutic effect started after 7.1 ± 2.3 days and lasted for

Katja Kollewe; Bahram Mohammadi; Reinhard Dengler; Dirk Dressler



Coronary steal and ST elevation during dipyridamole stress testing leading to coronary artery bypass grafting  

Microsoft Academic Search

Conclusion  Although our patient had a very rare manifestation of vasodilatory-induced coronary steal, it is important to be aware of\\u000a this type of event during routine stress testing. This case reinforces the potential for acute myocardial infarction (1\\/10.000)13 as a life-threatening adverse event during dipyridamole infusion. This type of event appears to warrant expeditious coronary\\u000a angiography and appropriate coronary revascularization.

Halil Mutlu; Jeffrey Leppo



Coronary artery disease  

MedlinePLUS Videos and Cool Tools

The coronary arteries supply blood to the heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, if the ...


Vasomotor Function of Pig Coronary Arteries after Chronic Coronary Occlusion  

Microsoft Academic Search

Placement of an ameroid constrictor in large-conduit pig coronary arteries causes progressive stenosis and distal myo- cardial ischemia. Blood perfusion in the ischemic region is partly dependent on vasomotor responses to neural and humoral factors distal to the occlusion site. To ascertain the degree of impairment of vascular function in pigs, the authors induced myocardial is- chemia by placing an

Jinsheng Li; Hector De Leon; Takafumi Ueno; Jianhua Cui; Patrick K. Coussement; Spencer B. King; Nicolas A. F. Chronos; Keith A. Robinson


Comparative vascular responses three months after paclitaxel and everolimus-eluting stent implantation in streptozotocin-induced diabetic porcine coronary arteries  

PubMed Central

Background Diabetes remains a significant risk factor for restenosis/thrombosis following stenting. Although vascular healing responses following drug-eluting stent (DES) treatment have been characterized previously in healthy animals, comparative assessments of different DES in a large animal model with isolated features of diabetes remains limited. We aimed to comparatively assess the vascular response to paclitaxel-eluting (PES) and everolimus-eluting (EES) stents in a porcine coronary model of streptozotocin (STZ)-induced type I diabetes. Method Twelve Yucatan swine were induced hyperglycemic with a single STZ dose intravenously to ablate pancreatic ?-cells. After two months, each animal received one XIENCE V® (EES) and one Taxus Liberte (PES) stent, respectively, in each coronary artery. After three months, vascular healing was assessed by angiography and histomorphometry. Comparative in vitro effects of everolimus and paclitaxel (10-5?M–10-12?M) after 24 hours on carotid endothelial (EC) and smooth muscle (SMC) cell viability under hyperglycemic (42?mM) conditions were assayed by ELISA. Caspase-3 fluorescent assay was used to quantify caspase-3 activity of EC treated with everolimus or paclitaxel (10-5?M, 10-7?M) for 24 hours. Results After 3?months, EES reduced neointimal area (1.60?±?0.41?mm, p?induced diabetic swine model. PES exhibited greater neointimal area, increased inflammation, greater medial necrosis, and persistent fibrin compared to EES. Differential effects of everolimus and paclitaxel on vascular cell viability may potentially be a factor in regulating delayed healing observed with PES. Further investigation of molecular mechanisms may aid future development of stent-based therapies in treating coronary artery disease in diabetic patients.



Cholinergic mechanisms in human coronary artery preparations: implications of species differences.  

PubMed Central

Acetylcholine dilates most arteries, including dog coronaries, if the endothelium is intact. The present study has shown only contraction of human coronary arteries to acetylcholine. Both strip and ring preparations of human coronary epicardial vessels, the latter done particularly to protect the intimal surface from unintentional denudation, contracted to acetylcholine at low to high concentrations (6.84 X 10(-9)-2.05 X 10(-5) M). These responses were blocked by atropine (3.45 X 10(-6) M). Acetylcholine contracted the arteries about as much as ergonovine and considerably more than noradrenaline. Field stimulation of coronary artery strips caused a vasoconstriction which was partially antagonized by atropine (3.45 X 10(-6) M). The release of [3H]noradrenaline from superfused coronary artery preparations during field stimulation was inhibited by methacholine (6.24 X 10(-6) M), a stable muscarinic analogue of acetylcholine. Dog coronary arteries relaxed to acetylcholine but not if the endothelium was intentionally denuded, in which case there was either no response at all or a weak relaxation. Coronary arteries of sheep, pig and cattle always contracted to acetylcholine, and those of monkey contracted in two out of three responsive preparations. Histological examination of the intimal surface of human coronary vascular segments confirmed the presence of an intact endothelial cell layer. Rabbit aorta gave dilator responses to acetylcholine even after being left in the animal for as long after death as the human arteries had been; they did not give dilator responses after the endothelium was rubbed off. It is concluded that cholinergic vasoconstriction of coronary arteries occurs in humans, though not in the dog, and is probably important in some cases of coronary artery spasm. Images Plate 1

Kalsner, S



Approaches to mechanical coronary thrombectomy.  


Coronary thrombi are an integral part of acute coronary syndromes. Since the introduction of the AngioJet Rheolytic thrombectomy device in 1999, mechanical thrombectomy has replaced intracoronary thrombolysis during catheter-based procedures. Other approaches include simple suction aspiration, cut and aspirate devices and clot disruption by ultrasound or laser-induced cavitation. These device classes differ in the completeness of thrombus removal, ease of use, complication profile, as well as clinical evidence of benefit. The current approaches to mechanical thrombectomy are reviewed from these perspectives. PMID:16883030

Baim, Donald S



Outcomes of epileptic spasms in patients aged less than 3 years: single-center United States experience.  


Retrospective review was performed of children aged <3 years with epileptic spasms at our center from 2004-2010. Short-term (<6 months) and long-term (?6 months) outcomes were assessed. We included 173 children (104 boys; median age of onset, 6.8 months) with epileptic spasms of known (62%) and unknown (38%) etiology. Treatments included adrenocorticotropic hormone (n = 103), vigabatrin (n = 82), phenobarbital (n = 34), and other agents (n = 121). Short-term treatment with adrenocorticotropic hormone and vigabatrin provided better epileptic spasm control in groups with known and unknown etiology than other agents. At follow-up (6-27 months), 54% of children manifested seizures, and 83% manifested developmental delay. Known etiology was a predictor of poor developmental outcome (P = 0.006), whereas bilateral/diffuse brain lesions predicted both poor development and seizures (P = 0.001 and 0.005, respectively). Initial presentations of epileptic spasms with hypotonia or developmental delay most strongly predicted both seizures and neurodevelopmental outcomes (P < 0.001). In a child presenting with epileptic spasms with developmental delay or hypotonia, no specific treatment may offer superior benefit. PMID:22520347

Vendrame, Martina; Guilhoto, Laura M F F; Loddenkemper, Tobias; Gregas, Matt; Bourgeois, Blaise F; Kothare, Sanjeev V



Sex differences in chest pain in patients with documented coronary artery disease and exercise-induced ischemia: Results from the PIMI study  

Microsoft Academic Search

Background Sex differences in the pathophysiologic course of coronary artery disease (CAD) are widely recognized, yet accurate diagnosis of coronary artery disease in women remains challenging. Methods To determine sex differences in the clinical manifestation of CAD, we studied chest pain reported during daily activities, exercise, and mental stress in 170 men and 26 women. All patients had documented CAD

David S. Sheps; Peter G. Kaufmann; David Sheffield; Kathleen C. Light; Robert P. McMahon; Robert Bonsall; William Maixner; Robert M. Carney; Kenneth E. Freedland; Jerome D. Cohen; A. David Goldberg; Mark W. Ketterer; James M. Raczynski; Carl J. Pepine



Characterization of basal hepatic bile flow and the effects of intravenous cholecystokinin on the liver, sphincter, and gallbladder in patients with sphincter of Oddi spasm  

Microsoft Academic Search

The major objectives of this project were to establish the pattern of basal hepatic bile flow and the effects of intravenous administration of cholecystokinin on the liver, sphincter of Oddi, and gallbladder, and to identify reliable parameters for the diagnosis of sphincter of Oddi spasm (SOS). Eight women with clinically suspected sphincter of Oddi spasm (SOS group), ten control subjects

Gerbail T. Krishnamurthy; Shakuntala Krishnamurthy; Randy D. Watson



Symptomatic diffuse esophageal spasm as a major ictal manifestation of post-traumatic epilepsy: a case report.  


Post-traumatic epilepsy (PTE) can create diagnostic confusion when typical epileptic seizures are not manifest. Abdominal symptoms as a manifestation of PTE are rare in this setting. We present a 43-year-old female with paroxysmal chest and abdominal pain, nausea, salivation, and intermittent dysphagia. Esophageal testing demonstrated diffuse esophageal spasm, but smooth muscle relaxants provided no relief. Finally, after history revealed that a motor vehicle accident temporally preceded symptom onset, video electroencephalography confirmed PTE. Therapy with anti-epileptic drug completely resolved symptoms, and the esophageal motor pattern normalized. We speculate that abnormal epileptiform discharges from the seizure focus altered cerebral input to intrinsic esophageal innervation, resulting in inhibitory dysfunction and a picture resembling diffuse esophageal spasm. This is the first report of symptomatic esophageal spasm as a major ictal manifestation of PTE. PMID:23121455

He, Y-Q; Sheng, J-Q; Wang, J-H; An, H-J; Wang, X; Li, A-Q; Wang, X-W; Gyawali, C P



Exercise limits the production of endothelin in the coronary vasculature.  


We previously demonstrated that endothelin (ET)-mediated coronary vasoconstriction wanes with increasing exercise intensity via a nitric oxide- and prostacyclin-dependent mechanism (Ref. 23). Therefore, we hypothesized that the waning of ET coronary vasoconstriction during exercise is the result of decreased production of ET and/or decreased ET receptor sensitivity. We investigated coronary ET receptor sensitivity using intravenous infusion of ET and coronary ET production using intravenous infusion of the ET precursor Big ET, at rest and during continuous treadmill exercise at 3 km/h in 16 chronically instrumented swine. In the systemic vasculature, Big ET and ET induced similar changes in hemodynamic parameters at rest and during continuous exercise at 3 km/h, indicating that exercise does not alter ET production or receptor sensitivity in the systemic vasculature. In the coronary vasculature, infusion of ET resulted in similar dose-dependent decreases in coronary blood flow and coronary venous oxygen tension and saturation at rest and during exercise. In contrast, administration of Big ET resulted in dose-dependent decreases in coronary blood flow, as well as coronary venous oxygen tension and saturation at rest. These effects of Big ET were significantly reduced during exercise. Altogether, our data indicate that continuous exercise at 3 km/h attenuates ET-mediated coronary vasoconstriction through reduced production of ET from Big ET rather than through reduced ET sensitivity of the coronary vasculature. The decreased ET production during exercise likely contributes to metabolic coronary vasodilation. PMID:21317308

de Beer, Vincent J; Bender, Shawn B; Taverne, Yannick J; Gao, Fen; Duncker, Dirk J; Laughlin, M Harold; Merkus, Daphne



Exercise limits the production of endothelin in the coronary vasculature  

PubMed Central

We previously demonstrated that endothelin (ET)-mediated coronary vasoconstriction wanes with increasing exercise intensity via a nitric oxide- and prostacyclin-dependent mechanism (Ref. 23). Therefore, we hypothesized that the waning of ET coronary vasoconstriction during exercise is the result of decreased production of ET and/or decreased ET receptor sensitivity. We investigated coronary ET receptor sensitivity using intravenous infusion of ET and coronary ET production using intravenous infusion of the ET precursor Big ET, at rest and during continuous treadmill exercise at 3 km/h in 16 chronically instrumented swine. In the systemic vasculature, Big ET and ET induced similar changes in hemodynamic parameters at rest and during continuous exercise at 3 km/h, indicating that exercise does not alter ET production or receptor sensitivity in the systemic vasculature. In the coronary vasculature, infusion of ET resulted in similar dose-dependent decreases in coronary blood flow and coronary venous oxygen tension and saturation at rest and during exercise. In contrast, administration of Big ET resulted in dose-dependent decreases in coronary blood flow, as well as coronary venous oxygen tension and saturation at rest. These effects of Big ET were significantly reduced during exercise. Altogether, our data indicate that continuous exercise at 3 km/h attenuates ET-mediated coronary vasoconstriction through reduced production of ET from Big ET rather than through reduced ET sensitivity of the coronary vasculature. The decreased ET production during exercise likely contributes to metabolic coronary vasodilation.

de Beer, Vincent J.; Bender, Shawn B.; Taverne, Yannick J.; Gao, Fen; Duncker, Dirk J.; Laughlin, M. Harold



CGRP receptors mediating CGRP-, adrenomedullin- and amylin-induced relaxation in porcine coronary arteries. Characterization with 'Compound 1' (WO98/11128), a non-peptide antagonist  

PubMed Central

Calcitonin gene-related peptide (CGRP), amylin and adrenomedullin (AM) belong to the same family of peptides. Accumulating evidence indicate that the calcitonin (CT) receptor, the CT receptor-like receptor (CRLR) and receptor-activity-modifying proteins (RAMPs) form the basis of all the receptors in this family of peptides. Using reverse transcriptase–polymerase chain reaction the presence of mRNA sequences encoding the CRLR, RAMP1 and RAMP2 were demonstrated in porcine left anterior descending (LAD) coronary arteries, whereas porcine calcitonin (CT) receptor mRNA was not present. The partial porcine mRNA sequences shared 82–92% nucleotide identity with human sequences. The human peptides ?CGRP, ?CGRP, AM and amylin induced relaxation with pEC50 values of 8.1, 8.1, 6.7 and 6.1?M respectively. The antagonistic properties of a novel non-peptide CGRP antagonist ‘Compound 1' (WO98/11128), ?CGRP8–37 and the proposed AM receptor antagonist AM22–52 were compared to the well-known CGRP1 receptor antagonist ?CGRP8–37. The ?CGRP8–37 and ?CGRP8–37 induced concentration-dependent (10?7–10?5?M) rightward shift of both the ?CGRP and ?CGRP concentration-response curves. ?CGRP8–37 (10?6?M) had the same effect as ?CGRP8–37 (10?6?M), but with less potent rightward shift of the concentration-response curves for ?CGRP, AM and amylin. Preincubation with ‘Compound 1' (10?7–10?5?M) and AM22–52 (10?6?M) had no significant antagonistic effect. In conclusion, the building blocks forming CGRP and AM receptors were present in the porcine LAD, whereas those of the amylin receptor were not. ?CGRP, ?CGRP, AM and amylin mediated vasorelaxation via the CGRP receptors. No functional response was detected to adrenomedullin via the adrenomedullin receptor.

Hasbak, Philip; Sams, Anette; Schifter, S?ren; Longmore, Jenny; Edvinsson, Lars



Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease  

Microsoft Academic Search

The ability of exercise-induced myocardial hypoperfusion on thallium scintigraphy to predict coronary events was assessed in 1,689 patients with symptoms suggestive of coronary artery disease but without prior myocardial infarction or coronary artery bypass surgery. A total of 74 patients had a coronary event in the year after testing (12 cardiac deaths, 20 nonfatal infarctions and 42 referrals for bypass

Marc L. Ladenheim; Brad H. Pollock; Alan Rozanski; Daniel S. Berman; Howard M. Staniloff; James S. Forrester; George A. Diamond



Role of the excessive amounts of circulating catecholamines and glucocorticoids in stress-induced heart disease.  


Various stressful stimuli are known to activate the sympathetic nervous system to release catecholamines and the hypothalamic-pituitary-adrenal axis to release glucocorticoids in the circulation. Although initial actions of both catecholamines and glucocorticoids are beneficial for the function of the cardiovascular system, their delayed effects on the heart are deleterious. Glucocorticoids not only increase plasma levels of catecholamines by inhibiting their extraneuronal uptake, but they have also been shown to induce supersensitivity to catecholamines in the heart by upregulating different components of the betta-adrenoceptor signal transduction system. Low concentrations of catecholamines stimulate the heart by promoting Ca2+ movements, whereas excessive amounts of catecholamines produce cardiac dysfunction by inducing intracellular Ca2+ overload in cardiomyocytes. Several studies have shown, however, that under stressful conditions high concentrations of catecholamines become oxidized to form aminolutins and generate oxyradicals. These oxidation products of catecholamines have been demonstrated to produce coronary spasm, arrhythmias, and cardiac dysfunction by inducing Ca2+-handling abnormalities in both sarcolemmal and sarcoplasmic reticulum, defects in energy production by mitochondria, and myocardial cell damage. In this article we have focused the discussion to highlight the interrelationship between catecholamines and glucocorticoids and to emphasize the role of oxidation products of catecholamines in the development of stress-induced heart disease. PMID:19767873

Adameova, Adriana; Abdellatif, Yasser; Dhalla, Naranjan S



Matrix Metalloproteinases Modulated by PKC? Mediate Resistin-Induced Migration of Human Coronary Artery Smooth Muscle Cells  

PubMed Central

Background Emerging evidence showed that resistin induces vascular smooth muscle cell (VSMC) migration, a critical step to initiating vascular restenosis. Mechanistically, adhesion molecule expression and cytoskeletal rearrangement have been observed in this progress. Given that matrix metalloproteinases (MMPs) also regulates cell migration, we hypothesized that MMPs may mediate resistin-induced VSMC migration. Materials and Methods Human VSMCs were treated with recombinant human resistin at physiological (10 ng/mL) and pathological (40 ng/mL) concentrations for 24 hours. Cell migration was determinate by Boyden chamber assay. MMP and TIMP mRNA and protein levels were measured with real-time PCR and ELISA. MMP enzymatic activity was measured by zymography on precast gels. In another experiment, neutralizing antibodies against MMP-2 and MMP-9 were co-incubated with resistin in cultured VSMCs. The regulation of MMP by protein kinase C (PKC) was determined by ?V1–2, a selective PKC? inhibitor. Results Resistin-induced SMC migration was confirmed by Boyden chamber assay. 40ng/mL Resistin increased SMC migration by 3.7 fold. Molecularly, resistin stimulated MMP-2 and - MMP9 mRNA and protein expressions. In contrast, the TIMP-1 and TIMP-2 mRNA levels were inhibited by resistin. Neutralizing antibodies against MMP-2 and MMP-9 effectively reversed VSMC migration. Furthermore, resistin activated PKC? and selective PKC? inhibitor suppressed resistin-induced MMP expression, activity and cell migration. Conclusions Our study confirmed that resistin increases vascular smooth muscle cell migration in vitro. Mechanistically, resistin-stimulated cell migration was associated with increased MMP expression and activity, which was dependent on PKC? activation.

Ding, Qinxue; Chai, Hong; Mahmood, Nausheen; Tsao, Jerry; Mochly-Rosen, Daria; Zhou, Wei



Urinary IL18 and NGAL as Early Predictive Biomarkers in Contrast-Induced Nephropathy after Coronary Angiography  

Microsoft Academic Search

Background\\/Aims: Contrast-induced nephropathy (CIN) is at present the third leading cause of hospital-acquired acute kidney injury (AKI). Traditionally, it is diagnosed by measuring the increase of the serum creatinine concentration. However, in patients with acute changes in their glomerular filtration rate, serum creatinine is an insensitive marker. This clinical study was designed to investigate whether human urinary interleukin-18 (IL-18) and

Wang Ling; Ni Zhaohui; He Ben; Gu Leyi; Liu Jianping; Dai Huili; Qian Jiaqi



Sequential thallium-201 myocardial perfusion studies after successful percutaneous transluminal coronary artery angioplasty: delayed resolution of exercise-induced scintigraphic abnormalities  

Microsoft Academic Search

To characterize the sequential changes of myocardial perfusion scintigraphy in patients with coronary artery disease (CAD) after complete revascularization, 43 patients underwent exercise thallium-201 (²°¹Tl) myocardial perfusion scintigraphy before and at 9 +\\/- 5 days, 3.3 +\\/- 0.6, and 6.8 +\\/- 1.2 months after percutaneous transluminal coronary angioplasty (PTCA). Only patients with single-vessel CAD, without previous myocardial infarction, and without

D. E. Manyari; M. Knudtson; R. Kloiber; D. Roth



Functional end-plate recovery in long-term botulinum toxin therapy of hemifacial spasm: a nerve conduction study.  


Botulinum toxin type-A is currently thought to be effective and safe for hemifacial spasm (HFS). The pre-synaptic block of acetylcholine release at the neuromuscular junction induces depression of orbicularis oculi muscle compound motor action potential (CMAP). The aim of our study was to evaluate at what extent end-plate functional recovery is possible even in botulinum toxin treatments lasting up to 15 years. We examined 81 outpatients with primary HFS (mean treatment duration = 7.2 ± 4.2 years) who underwent neurophysiologic study, once clinical effect of the previous treatment had vanished. The mean CMAP amplitude, mean rectified amplitude of response 1 (R1) of the blink reflex and area of response 2 (R2) of treated orbicularis oculi muscle were measured in comparison to the controlateral side. Mean amplitude of the above mentioned parameters was slightly lower (about 20%; p < 0.001) in the treated side at the end of the follow-up period (4.7 ± 1.7 months). The CMAP amplitude reduction weakly correlated with the interval from last treatment, while other neurophysiologic parameters did not change due to treatment duration or total toxin amount. Our study demonstrates that botulinum toxin affects compound motor action potential and blink-reflex responses for at least 4-5 months in HFS patients. The residual block is slight and does not increase with repeated injections after several years of treatment. Our study, beside confirming the long-term efficacy of botulinum toxin treatment for HFS, provides neurophysiologic evidence that therapeutic effect may be obtained without hindering the regenerative potential of the nerve-muscle complex. PMID:22367224

Butera, C; Guerriero, R; Amadio, S; Ungaro, D; Tesfaghebriel, H; Bianchi, F; Comi, G; Del Carro, U



A Triplet Repeat Expansion Genetic Mouse Model of Infantile Spasms Syndrome, Arx(GCG)10+7, with Interneuronopathy, Spasms in Infancy, Persistent Seizures, and Adult Cognitive and Behavioral Impairment  

PubMed Central

Infantile spasms syndrome (ISS) is a catastrophic pediatric epilepsy with motor spasms, persistent seizures, mental retardation, and in some cases, autism. One of its monogenic causes is an insertion mutation (c.304ins (GCG)7) on the X chromosome, expanding the first polyalanine tract of the interneuron-specific transcription factor ARX from 16 to 23 alanine codons. Null mutation of the Arx gene impairs GABA- and cholinergic interneuronal migration but results in a neonatal lethal phenotype. We developed the first viable genetic mouse model of ISS that spontaneously recapitulates salient phenotypic features of the human triplet-repeat expansion mutation. Arx (GCG)10+7 (“Arx Plus7”) pups display abnormal spasm-like myoclonus and other key EEG features, including multifocal spikes, electrodecremental episodes, and spontaneous seizures persisting into maturity. The neurobehavioral profile of Arx mutants was remarkable for lowered anxiety, impaired associative learning, and abnormal social interaction. Laminar decreases of Arx+ cortical interneurons and a selective reduction of calbindin-, but not parvalbumin- or calretinin-expressing interneurons in neocortical layers and hippocampus indicate that specific classes of synaptic inhibition are missing from the adult forebrain, providing a basis for the seizures and cognitive disorder. A significant reduction of calbindin, NPY-expressing and cholinergic interneurons in the mutant striatum suggest that dysinhibition within this network may contribute to the dyskinetic motor spasms. This mouse model narrows the range of critical pathogenic elements within brain inhibitory networks essential to recreate this complex neurodevelopmental syndrome.

Price, Maureen G.; Yoo, Jong W.; Burgess, Daniel L.; Deng, Fang; Hrachovy, Richard A.; Frost, James D.; Noebels, Jeffrey L.



Episodic coronary artery vasospasm and hypertension develop in the absence of Sur2 KATP channels  

PubMed Central

KATP channels couple the intracellular energy state to membrane excitability and regulate a wide array of biologic activities. KATP channels contain a pore-forming inwardly rectifying potassium channel and a sulfonylurea receptor regulatory subunit (SUR1 or SUR2). To clarify the role of KATP channels in vascular smooth muscle, we studied Sur2 gene-targeted mice (Sur2–/–) and found significantly elevated resting blood pressures and sudden death. Using in vivo monitoring, we detected transient, repeated episodes of coronary artery vasospasm in Sur2–/– mice. Focal narrowings in the coronary arteries were present in Sur2–/– mice consistent with vascular spasm. We treated Sur2–/– mice with a calcium channel antagonist and successfully reduced vasospastic episodes.

Chutkow, William A.; Pu, Jielin; Wheeler, Matthew T.; Wada, Tomoyuki; Makielski, Jonathan C.; Burant, Charles F.; McNally, Elizabeth M.



Cyanotic Congenital Heart Disease The Coronary Arterial Circulation  

PubMed Central

Background: The coronary circulation in cyanotic congenital heart disease (CCHD) includes the extramural coronary arteries, basal coronary blood flow, flow reserve, the coronary microcirculation, and coronary atherogenesis. Methods: Coronary arteriograms were analyzed in 59 adults with CCHD. Dilated extramural coronaries were examined histologically in six patients. Basal coronary blood flow was determined with N-13 positron emission tomography in 14 patients and in 10 controls. Hyperemic flow was induced by intravenous dipyridamole pharmacologic stress. Immunostaining against SM alpha-actin permitted microcirculatory morphometric analysis. Non-fasting total cholesterols were retrieved in 279 patients divided into four groups: Group A---143 cyanotic unoperated, Group B---47 rendered acyanotic by reparative surgery, Group C---41 acyanotic unoperated, Group D---48 acyanotic before and after operation. Results: Extramural coronary arteries were mildly or moderately dilated to ectatic in 49/59 angiograms. Histologic examination disclosed loss of medial smooth muscle, increased medial collagen, and duplication of internal elastic lamina. Basal coronary flow was appreciably increased. Hyperemic flow was comparable to controls. Remodeling of the microcirculation was based upon coronary arteriolar length, volume and surface densities. Coronary atherosclerosis was absent in both the arteriograms and the necropsy specimens. Conclusions: Extramural coronary arteries in CCHD dilate in response to endothelial vasodilator substances supplemented by mural attenuation caused by medial abnormalities. Basal coronary flow was appreciably increased, but hyperemic flow was normal. Remodeling of the microcirculation was responsible for preservation of flow reserve. The coronaries were atheroma-free because of the salutory effects of hypocholesterolemia, hypoxemia, upregulated nitric oxide, low platelet counts, and hyperbilirubinrmia.

Perloff, Joseph K



Diagnostic ultrasound induced inertial cavitation to non-invasively restore coronary and microvascular flow in acute myocardial infarction.  


Ultrasound induced cavitation has been explored as a method of dissolving intravascular and microvascular thrombi in acute myocardial infarction. The purpose of this study was to determine the type of cavitation required for success, and whether longer pulse duration therapeutic impulses (sustaining the duration of cavitation) could restore both microvascular and epicardial flow with this technique. Accordingly, in 36 hyperlipidemic atherosclerotic pigs, thrombotic occlusions were induced in the mid-left anterior descending artery. Pigs were then randomized to either a) ½ dose tissue plasminogen activator (0.5 mg/kg) alone; or same dose plasminogen activator and an intravenous microbubble infusion with either b) guided high mechanical index short pulse (2.0 MI; 5 usec) therapeutic ultrasound impulses; or c) guided 1.0 mechanical index long pulse (20 usec) impulses. Passive cavitation detectors indicated the high mechanical index impulses (both long and short pulse duration) induced inertial cavitation within the microvasculature. Epicardial recanalization rates following randomized treatments were highest in pigs treated with the long pulse duration therapeutic impulses (83% versus 59% for short pulse, and 49% for tissue plasminogen activator alone; p<0.05). Even without epicardial recanalization, however, early microvascular recovery occurred with both short and long pulse therapeutic impulses (p<0.005 compared to tissue plasminogen activator alone), and wall thickening improved within the risk area only in pigs treated with ultrasound and microbubbles. We conclude that although short pulse duration guided therapeutic impulses from a diagnostic transducer transiently improve microvascular flow, long pulse duration therapeutic impulses produce sustained epicardial and microvascular re-flow in acute myocardial infarction. PMID:23922797

Xie, Feng; Gao, Shunji; Wu, Juefei; Lof, John; Radio, Stanley; Vignon, Francois; Shi, William; Powers, Jeffry; Unger, Evan; Everbach, E Carr; Liu, Jinjin; Porter, Thomas R



Acute arterial spasm in an extremity caused by inadvertent intra-arterial injection successfully treated in the emergency department.  


We present a case of limb ischemia in a young man. For acute alcohol withdrawal, this patient was given chlordiazepoxide (Librium) through an angiocatheter inadvertently placed into a brachial arterial line. This caused severe spasm of the brachial artery and its branches. These findings were confirmed by angiography. Successful treatment occurred with intra-arterial papaverin. PMID:10903461

Arquilla, B; Gupta, R; Gernshiemer, J; Fischer, M



Representation in Color of Spasms of Bronchial Asthma by Children in the Experiment of Coloring Pictures of the Human Body  

Microsoft Academic Search

A b s t r a c t Children's pictures fall into the following groups; those consciously depicted, those unconsciously depicted, and those that characterize their developmental stage. In this experiment, children who had a medical history, especially of spasms of bronchial asthma, were asked to color pictures of the human body to see whether or not there is any

Asami Makabe



Long term results of botulinum toxin type A (Dysport) in the treatment of hemifacial spasm: a report of 175 cases  

Microsoft Academic Search

OBJECTIVETo describe the long term efficacy and side effects of the treatment of hemifacial spasm with Dysport and to evaluate two different sites of injection to hopefully reduce side effects.METHODSThis study was designed as a prospective descriptive study. Injections were made subcutaneously around the eye. Peak improvement was subjectively assessed by using a visual analogue scale and reported in percentages

Suthipun Jitpimolmard; Somsak Tiamkao; Malinee Laopaiboon



Coronary Microvascular Disease (MVD)  


... Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Heart Disease in Women Atherosclerosis Coronary Heart Disease Coronary Heart Disease Risk Factors ...


Coronary Artery Bypass Grafting  


... Are the Risks Clinical Trials Links Related Topics Heart Surgery Coronary Heart Disease Heart Attack Cardiac Rehabilitation Coronary ... CABG is the most common type of open-heart surgery in the United States. Doctors called cardiothoracic (KAR- ...


The coronary circulation in exercise training  

PubMed Central

Exercise training (EX) induces increases in coronary transport capacity through adaptations in the coronary microcirculation including increased arteriolar diameters and/or densities and changes in the vasomotor reactivity of coronary resistance arteries. In large animals, EX increases capillary exchange capacity through angiogenesis of new capillaries at a rate matched to EX-induced cardiac hypertrophy so that capillary density remains normal. However, after EX coronary capillary exchange area is greater (i.e., capillary permeability surface area product is greater) at any given blood flow because of altered coronary vascular resistance and matching of exchange surface area and blood flow distribution. The improved coronary capillary blood flow distribution appears to be the result of structural changes in the coronary tree and alterations in vasoreactivity of coronary resistance arteries. EX also alters vasomotor reactivity of conduit coronary arteries in that after EX, ?-adrenergic receptor responsiveness is blunted. Of interest, ?- and ?-adrenergic tone appears to be maintained in the coronary microcirculation in the presence of lower circulating catecholamine levels because of increased receptor responsiveness to adrenergic stimulation. EX also alters other vasomotor control processes of coronary resistance vessels. For example, coronary arterioles exhibit increased myogenic tone after EX, likely because of a calcium-dependent PKC signaling-mediated alteration in voltage-gated calcium channel activity in response to stretch. Conversely, EX augments endothelium-dependent vasodilation throughout the coronary arteriolar network and in the conduit arteries in coronary artery disease (CAD). The enhanced endothelium-dependent dilation appears to result from increased nitric oxide bioavailability because of changes in nitric oxide synthase expression/activity and decreased oxidant stress. EX also decreases extravascular compressive forces in the myocardium at rest and at comparable levels of exercise, mainly because of decreases in heart rate and duration of systole. EX does not stimulate growth of coronary collateral vessels in the normal heart. However, if exercise produces ischemia, which would be absent or minimal under resting conditions, there is evidence that collateral growth can be enhanced. While there is evidence that EX can decrease the progression of atherosclerotic lesions or even induce the regression of atherosclerotic lesions in humans, the evidence of this is not strong due to the fact that most prospective trials conducted to date have included other lifestyle changes and treatment strategies by necessity. The literature from large animal models of CAD also presents a cloudy picture concerning whether EX can induce the regression of or slow the progression of atherosclerotic lesions. Thus, while evidence from research using humans with CAD and animal models of CAD indicates that EX increases endothelium-dependent dilation throughout the coronary vascular tree, evidence that EX reverses or slows the progression of lesion development in CAD is not conclusive at this time. This suggests that the beneficial effects of EX in CAD may not be the result of direct effects on the coronary artery wall. If this suggestion is true, it is important to determine the mechanisms involved in these beneficial effects.

Bowles, Douglas K.; Duncker, Dirk J.



Effect of brief periods of paced ventricular tachycardia on coronary blood flow in dogs before and after graded coronary stenosis  

Microsoft Academic Search

Summary The effect of short bouts (1 min) of electrically induced ventricular tachycardias (VT) of increasing rates (160–240\\/min) was studied in 8 anesthetized dogs before and after graded constrictions of the left anterior descending (LAD) and the circumflex (CCA) coronary arteries. In the absence of coronary stenosis, paroxysmal VT caused a significant decrease in tension-time index (TTI), coronary blood flow

J. Senges; U. Mittmann; I. Rizos; J. Brachmann; L. Beck; H.-D. Hammann; W. Braun; W. Kübler



Coronary angioplasty in pregnancy.  

PubMed Central

Myocardial infarction is rare in pregnancy. A 30 year old white primigravida had an anterior infarct at 20 weeks' gestation, which was followed by troublesome angina. Coronary angiography showed a tight stenosis of the left anterior descending coronary artery. This was treated successfully by percutaneous transluminal coronary angioplasty. Images Fig 1 Fig 2

Cowan, N C; de Belder, M A; Rothman, M T



Coronary venous oximetry using MRI.  


Based on the Fick law, coronary venous blood oxygen measurements have value for assessing functional parameters such as the coronary flow reserve. At present, the application of this measure is restricted by its invasive nature. This report describes the design and testing of a noninvasive coronary venous blood oxygen measurement using MRI, with a preliminary focus on the coronary sinus. After design optimization including a four-coil phased array and an optimal set of data acquisition parameters, quality tests indicate measurement precision on the order of the gold standard optical measurement (3%O(2)). Comparative studies using catheter sampling suggest reasonable accuracy (3 subjects), with variability dominated by sampling location uncertainty ( approximately 7%O(2)). Intravenous dipyridamole (5 subjects) induces significant changes in sinus blood oxygenation (22 +/- 9% O(2)), corresponding to flow reserves of 1.8 +/- 0.4, suggesting the potential for clinical utility. Underestimation of flow reserve is dominated by right atrial mixing and the systemic effects of dipyridamole. Magn Reson Med 42:837-848, 1999. PMID:10542342

Foltz, W D; Merchant, N; Downar, E; Stainsby, J A; Wright, G A



Endovascular Treatment of Hemifacial Spasm Associated with a Petrosal DAVF Using Transarterial Onyx Embolization  

PubMed Central

Summary This paper reports that decompression of the facial nerve by transarterial Onyx embolization may relieve hemifacial spasm (HFS) caused by dilated veins due to a right petrosal dural arteriovenous fistula (DAVF). A 56-year-old man suffered severe chronic right HFS associated with a dilated right petrosal vein lying in the vicinity of the facial nerve. The right petrosal DAVF was reached through the middle meningeal artery using a transfemoral arterial approach and was occluded with Onyx 18 (M.T.I.- ev3, Irvine, CA, USA). There was complete remission of HFS without recurrence after two months of follow-up. This case supports vascular compression in the pathogenesis of HFS and suggests that facial nerve injury caused by a DAVF could be treated with transarterial Onyx embolization.

Li, T.; Lv, X.; Wu, Z.



Tail spasms in rat spinal cord injury: changes in interneuronal connectivity.  


Uncontrolled muscle spasms often develop after spinal cord injury. Structural and functional maladaptive changes in spinal neuronal circuits below the lesion site were postulated as an underlying mechanism but remain to be demonstrated in detail. To further explore the background of such secondary phenomena, rats received a complete sacral spinal cord transection at S(2) spinal level. Animals progressively developed signs of tail spasms starting 1 week after injury. Immunohistochemistry was performed on S(3/4) spinal cord sections from intact rats and animals were sacrificed 1, 4 and 12 weeks after injury. We found a progressive decrease of cholinergic input onto motoneuron somata starting 1 week post-lesion succeeded by shrinkage of the cholinergic interneuron cell bodies located around the central canal. The number of inhibitory GABAergic boutons in close contact with Ia afferent fibers was greatly reduced at 1 week after injury, potentially leading to a loss of inhibitory control of the Ia stretch reflex pathways. In addition, a gradual loss and shrinkage of GAD65 positive GABAergic cell bodies was detected in the medial portion of the spinal cord gray matter. These results show that major structural changes occur in the connectivity of the sacral spinal cord interneuronal circuits below the level of transection. They may contribute in an important way to the development of spastic symptoms after spinal cord injury, while reduced cholinergic input on motoneurons is assumed to result in the rapid exhaustion of the central drive required for the performance of locomotor movements in animals and humans. PMID:22569103

Kapitza, Sandra; Zörner, Björn; Weinmann, Oliver; Bolliger, Marc; Filli, Linard; Dietz, Volker; Schwab, Martin E



Constitutively active 5-HT2/?1 receptors facilitate muscle spasms after human spinal cord injury.  


In animals, the recovery of motoneuron excitability in the months following a complete spinal cord injury is mediated, in part, by increases in constitutive serotonin (5-HT2) and norepinephrine (?1) receptor activity, which facilitates the reactivation of calcium-mediated persistent inward currents (CaPICs) without the ligands serotonin and norepinephrine below the injury. In this study we sought evidence for a similar role of constitutive monoamine receptor activity in the development of spasticity in human spinal cord injury. In chronically injured participants with partially preserved sensory and motor function, the serotonin reuptake inhibitor citalopram facilitated long-lasting reflex responses (spasms) previously shown to be mediated by CaPICs, suggesting that in incomplete spinal cord injury, functional descending sources of monoamines are present to activate monoamine receptors below the lesion. However, in participants with motor or motor/sensory complete injuries, the inverse agonist cyproheptadine, which blocks both ligand and constitutive 5-HT2/?1 receptor activity, decreased long-lasting reflexes, whereas the neutral antagonist chlorpromazine, which only blocks ligand activation of these receptors, had no effect. When tested in noninjured control participants having functional descending sources of monoamines, chlorpromazine was effective in reducing CaPIC-mediated motor unit activity. On the basis of these combined results, it appears that in severe spinal cord injury, facilitation of persistent inward currents and muscle spasms is mainly mediated by the activation of constitutive 5-HT2 and ?1 receptor activity. Drugs that more selectively block these constitutively active monoamine receptors may provide better oral control of spasticity, especially in motor complete spinal cord injury where reducing motoneuron excitability is the primary goal. PMID:23221402

D'Amico, Jessica M; Murray, Katherine C; Li, Yaqing; Chan, K Ming; Finlay, Mark G; Bennett, David J; Gorassini, Monica A



Priming of neutrophils after elective percutaneous transluminal coronary angioplasty is unrelated to accompanying brief myocardial ischemia  

Microsoft Academic Search

Objective: The purpose of this study was to investigate the effect of brief myocardial ischemia and vascular trauma induced by elective percutaneous transluminal coronary angioplasty on in vivo `priming' and activation of neutrophils. Patients and Methods: We studied 16 patients undergoing elective coronary angioplasty for symptomatic coronary artery disease and a control group of seven patients undergoing diagnostic cardiac catheterization.

Evangelos Giannitsis; Ivo Tettenborn; Georg Schmücker; Rolf Mitusch; Uwe Wiegand; Juergen Potratz; Abdolhamid Sheikhzadeh; Ulrich Stierle



Robotically assisted coronary endarterectomy.  


Robotic assistance has enabled coronary artery bypass surgery to be performed safely in a completely endoscopic fashion, but diffusely diseased target vessels may pose a technical challenge. We present a case in which coronary endarterectomy was performed on the left anterior descending coronary artery during a two-vessel totally endoscopic coronary artery bypass procedure. A 52-year-old woman presented with intermittent substernal pain. Preoperative studies showed diffuse disease in the left coronary artery system. Bilateral internal mammary arteries were harvested robotically using a skeletonized technique in a completely endoscopic fashion. Cardiopulmonary bypass was achieved via peripheral cannulation, and the heart was arrested with intermittent cold antegrade hyperkalemic blood cardioplegia delivered via an ascending aortic occlusion balloon catheter. The first obtuse marginal anastomosis was performed. The left anterior descending coronary artery was diffusely diseased and heavily calcified. An end-to-side anastomosis was attempted to the right internal mammary artery with unsatisfactory results. A localized coronary endarterectomy was performed, and an extended anastomosis was completed using the right internal mammary artery. The patient recovered uneventfully and was discharged home on postoperative day 6. Diffuse coronary artery disease was once thought to be a prohibitive challenge for minimally invasive coronary bypass procedures. This case demonstrates that local coronary endarterectomy is feasible and safe in robotic totally endoscopic coronary artery bypass surgery. PMID:22436776

Dawood, Murtaza Y; Lehr, Eric J; de Biasi, Andreas; Haque, Reyaz; Grigore, Alina; Griffith, Bartley P; Bonatti, Johannes O



Effects of Cardiac Motion on Right Coronary Artery Hemodynamics  

Microsoft Academic Search

The purpose of this work was to investigate the effects of physiologically realistic cardiac-induced motion on hemodynamics in human right coronary arteries. The blood flow patterns were numerically simulated in a modeled right coronary artery (RCA) having a uniform circular cross section of 2.48 mm diam. Arterial motion was specified based on biplane cineangiograms, and incorporated physiologically realistic bending and

Dehong Zeng; Zhaohua Ding; Morton H. Friedman; C. Ross Ethier



Eutectic Mixture of Local Anesthesia Cream Can Reduce Both the Radial Pain and Sympathetic Response During Transradial Coronary Angiography  

PubMed Central

Background and Objectives adial artery spasm is one of the most common complications of transradial coronary angiography (TRA): the radial artery is prone to cathecholamine-induced contraction and radial pain during TRA could increase the sympathetic tone. The object of this study was to evaluate whether the eutectic mixture of local anesthesia (EMLA) cream, in addition to lidocaine infiltration, could reduce the sympathetic response by reducing radial pain during TRA. Subjects and Methods Seventy-six patients were randomized 1 : 1 to either EMLA or control groups. Radial pain was measured by the visual analogue scale (VAS) and the verbal rating scale (VRS-4). Sympathetic response, including systolic (SBP) and diastolic blood pressure (DBP), pulse rate (PR), stroke volume (SV) and total peripheral resistance (TPR), was measured by photoplethysmography. Results Radial pain measured during lidocaine infiltration was significantly lower in the EMLA group (VAS: 3.1 vs. 4.0, p=0.04; VRS-4: 2.0 vs. 2.2, p=0.03) and the sympathetic response was significantly blunted in the EMLA group from baseline to lidocaine infiltration (?SBP, mm Hg: 5 vs. 13, p<0.01; ?DBP, mm Hg: 2 vs. 7, p=0.03; ?PR, beat/min: 2 vs. 8, p<0.01, ?SV, mL: 3 vs. 21, p<0.01; ?TPR, mm Hg · L/min: 1.0 vs. 5.9, p<0.01). Conclusion In patients undergoing TRA, the EMLA cream, in addition to lidocaine infiltration, effectively reduces the radial pain and thereby the sympathetic response, during lidocaine infiltration.

Youn, Young Jin; Kim, Woo-Taek; Lee, Jun-Won; Ahn, Sung-Gyun; Ahn, Min-Soo; Kim, Jang-Young; Yoo, Byung-Su; Lee, Seung-Hwan; Choe, Kyung-Hoon



Effect of coronary collateral circulation on exercise stress test.  


In this study, patients who have recovery-only ST segment depression in exercise stress test were chosen. It is proposed that coronary collateral circulation could improve with stress-increased coronary perfusion, and accordingly, patients with recovery-only ST segment depression were evaluated by coronary angiography for grading the coronary collateral circulation. Twenty-one men and five women were assigned to the study group. Sixteen men and two women who had exercise-induced ST segment depression were assigned to the control group. Age and gender of both groups were not statistically different (p>0.05). The reason for terminating the exercise stress test was chest pain in two of 26 patients in the study group versus 15 of 18 in the control group (p<0.001). In both groups coronary collateral frequency and grade were directly correlated with the severity of the coronary artery disease (p<0.001 in the study group, and p<0.05 in the control group). When both groups were compared for the frequency of significant coronary collateral circulation, 14 of 26 patients in the study group versus 4 of 18 patients in the control group had significant coronary collateral circulation (p=0.035). The authors conclude that recovery-only ST segment depression correlates well with the frequency of significant coronary collateral circulation, and coronary collaterals may prevent myocardial ischemia during exercise. PMID:9717891

Kumbasar, S D; Pamir, G; Ca?lar, N; Oral, D; Aslan, S M



Effects of exercise training on coronary transport capacity  

SciTech Connect

Coronary transport capacity was estimated in eight sedentary control and eight exercise-trained anesthetized dogs by determining the differences between base line and the highest coronary blood flow and permeability-surface area product (PS) obtained during maximal adenosine vasodilation with coronary perfusion pressure constant. The anterior descending branch of the left coronary artery was cannulated and pump- perfused under constant-pressure conditions (approximately equal to 100 Torr) while aortic, central venous, and coronary perfusion pressures, heart rate, electrocardiogram, and coronary flow were monitored. Myocardial extraction and PS of /sup 51/Cr-labeled ethylenediaminetetraacetic acid were determined with the single-injection indicator-diffusion method. The efficacy of the 16 +/- 1 wk exercise training program was shown by significant increases in the succinate dehydrogenase activities of the gastrocnemius, gluteus medialis, and long head of triceps brachii muscles. There were no differences between control and trained dogs for either resting coronary blood flow or PS. During maximal vasodilation with adenosine, the trained dogs had significantly lower perfusion pressures with constant flow and, with constant-pressure vasodilation, greater coronary blood flow and PS. It is concluded that exercise training in dogs induces an increased coronary transport capacity that includes increases in coronary blood flow capacity (26% of control) and capillary diffusion capacity (82% of control).

Laughlin, M.H.



Determination of Safe Contrast Media Dosage to Estimated Glomerular Filtration Rate Ratios to Avoid Contrast-Induced Nephropathy After Elective Percutaneous Coronary Intervention  

PubMed Central

Background and Objectives To avoid the risk of developing contrast-induced nephropathy (CIN), it has been suggested that patients be subjected to a minimal necessary dose of contrast medium (CM-dose). However, often it is not easy to determine such a dose. This study assessed the usefulness of the ratio of CM-dose to estimated glomerular filtration rate (eGFR) in predicting the risks of CIN and sought to determine the safe level of CM-dose/eGFR in patients undergoing non-emergent percutaneous coronary intervention (PCI). Subjects and Methods We enrolled a total of 226 patients and calculated the ratio of CM-dose using grams of iodine (g-I) to eGFR, thus expressing it as g-I/eGFR. Among the CIN patients, those with ne-phropathy requiring dialysis (NRD) were also evaluated. Results Overall, there were 16 cases (7.1%) of CIN. On univariate and multivariate regression analysis, g-I/eGFR alone was found to be an independent predictor for CIN (hazard ratio=10.73, p<0.001). In an receiver operating characteristic analysis, fair discrimination for CIN was found at a g-I/eGFR level of 1.42 (C statics=0.867), and at this value, the sensitivity and specificity were 81.3% and 80%, respectively. Of patients (n=51) with g-I/eGFR ?1.42, 23.6% (13/51) and 7.8% (4/51) developed, while those with g-I/eGFR <1.42 (n=171) had a lower incidences of CIN (1.8%, 2/171, p<0.001) and NRD (0%, 0/171, p<0.001). Conclusion It can be concluded that a g-I/eGFR <1.42 is a simple, useful indicator for determining the safe CM-dose based on the pre-PCI eGFR values. Furthermore, g-I/eGFR might have a close relationship with the development of NRD as well as CIN.

Yoon, Hyuck-Jun



Impact of hypertension on the diagnostic accuracy of coronary angiography with computed tomography  

Microsoft Academic Search

Objective Hypertension induces coronary artery disease (CAD) and progression of arterial wall calcification. As coronary calcifications\\u000a may cause artefacts in 64-slice computed tomography coronary angiography (CTCA), we sought to determine the diagnostic accuracy\\u000a of CTCA in patients with and without arterial hypertension. Methods Eighty-five consecutive patients with suspected CAD underwent CTCA, calcium-scoring and conventional coronary angiography,\\u000a and were grouped as

Lars Husmann; Hans Scheffel; Ines Valenta; Tiziano Schepis; Oliver Gaemperli; Ursina Aepli; Patrick T. Siegrist; Sebastian Leschka; Lotus Desbiolles; Paul Stolzmann; Borut Marincek; Hatem Alkadhi; Philipp A. Kaufmann



Microvascular decompression in the posterior fossa of the trigeminal nerve for tic douloureux and microvascular decompression of the facial nerve for hemi-facial spasm.  


In a 12-month period, eight patients have been treated for trigeminal neuralgia and one for hemifacial spasm by microvascular decompression through a suboccipital craniectomy. The results and morbidity are mentioned and discussed. PMID:7457081

Naessens, P J; De Waele, L F


Acute coronary insufficiency with normal coronary arteriograms.  

PubMed Central

Two patients presenting with apparent symptomatic and electrocardiographic evidence of acute coronary insufficiency and found to have normal coronary arteriograms are documented. The patients remain symptom free at follow-up 9 and 14 months later although one requires 160 mg propranolol daily. The electrocardiographic, myocardial metabolic and haemodynamic data in 413 patients with angina and normal coronary arteriograms are reviewed and the suggested aetiologies documented. Follow-up of patients in these series indicates a good prognosis for symptom-free survival. Images Fig. 1 Fig. 2

Lawson, R. M.; Rosch, J.; Rahimtoola, S.



Balloon-pump-induced pulsatility improves coronary and carotid flows in an experimental model of BioMedicus left ventricular assistance.  


The aim of this study is to evaluate the benefit of the simultaneous use of a BioMedicus left ventricular assistance device (Medtronic, Minneapolis, MN, U.S.A.) and an intra-aortic balloon pump on regional blood flows, pressure, and pulsatility. Twelve pigs are studied. A BioMedicus pump was placed between the left atrium and the ascending aorta and an intra-aortic balloon pump was inserted through the left femoral artery. Blood flow and pressure were measured in the carotid, femoral, and coronary arteries and in the thoracic aorta below the intra-aortic balloon in the basal experimental condition with a full-flow BioMedicus pump and with a full-flow BioMedicus pump + intra-aortic balloon. The BioMedicus pump eliminates pulsatility in all sites and significantly decreases coronary and carotid blood flow. The adjunction of an intra-aortic balloon restores pulsatility to values comparable to those recorded in basal conditions. Coronary and carotid flows even increase to values higher than in the basal conditions. The simultaneous use of an intra-aortic balloon combined with the BioMedicus pump provides a pulsatile flow and increases coronary and carotid blood flows in pigs. An intra-aortic balloon can easily be combined with a BioMedicus pump whenever possible and may improve myocardial recovery in patients with postcardiotomy ventricular failure. PMID:15270957

Collart, Frédéric; Kerbaul, Francois; Mekkaoui, Choukri; Riberi, Alberto; Gariboldi, Vlad; Rolland, Pierre-Henry; Métras, Dominique; Mesana, Thierry G




Microsoft Academic Search

Background: A small dose of intravenous bolus injection of lobeline (LB) gives rise to a range of sensations in the upper respiratory tract (named J sensations) including dryness, swelling, burning, suffocation in the upper respiratory tract, and dry cough. We were interested in investigating: a) whether people with coronary artery disease (CAD) feel the same kind of sensations with LB

Gholam-Abbas Dehghani; Mohammad-Bagher Sharif-Kazemi; Mohammad-Reza Parvizi; Ashima Anand; Athar S. Paintal


Analysis of Exercise-Induced R-Wave-Amplitude Changes in Detection of Coronary Artery Disease in Patients with Typical or Atypical Chest Pain under Digitalis Treatment  

Microsoft Academic Search

Specificity and sensitivity of exercise ECG were compared to exercise stress thallium 201 scanning and coronary arteriograms in 70 male patients with typical or atypical chest pain complaints, without previous myocardial infarction. 50 patients (group I) did not receive any treatment; 20 patients (group II) received digitalis as preventive treatment of atrial arrythmias or for no particular reason. Only subjects

S. Degre; B. Longo; M. Thirion; E. Stoupel; J. Sobolski; G. Berkenboom; P. Vandermoten; J. C. Brion



Safety of Coronary Reactivity Testing in Women with No Obstructive Coronary Artery Disease: Results from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE) Study  

PubMed Central

Objective We evaluated the safety of coronary reactivity testing (CRT) in symptomatic women with evidence of myocardial ischemia and no obstructive coronary artery disease (CAD). Background Microvascular coronary dysfunction (MCD) in women with no obstructive CAD portends an adverse prognosis of 2.5% annual major adverse cardiovascular event (MACE) rate. The diagnosis of MCD is established by invasive CRT, yet the risk of CRT is unknown. Methods We evaluated 293 symptomatic women with ischemia and no obstructive CAD, who underwent CRT at three experienced centers. Microvascular function was assessed using a Doppler wire and injections of adenosine, acetylcholine, and nitroglycerin in the left coronary artery. CRT-related serious adverse events (SAE), adverse events (AE), and follow-up MACE (death, nonfatal myocardial infarction (MI), nonfatal stroke, or hospitalization for heart failure) were recorded. Results CRT-SAEs occurred in 2 women (0.7%) during the procedure: one had coronary artery dissection, and one developed MI associated with coronary spasm. CRT-AEs occurred in 2 women (0.7%) and included one transient air microembolism and one deep venous thrombosis. There was no CRT-related mortality. In the mean follow-up period of 5.4 years, the MACE rate was 8.2%, including 5 deaths (1.7%), 8 non-fatal MIs (2.7%), 8 nonfatal strokes (2.7%), and 11 hospitalizations for heart failure (3.8%). Conclusions In women undergoing CRT for suspected MCD, contemporary testing carries a relatively low risk compared to the MACE rate in these women. These results support the use of CRT by experienced operators for establishing definitive diagnosis and assessing prognosis in this at-risk population.

Wei, Janet; Mehta, Puja K.; Johnson, B. Delia; Samuels, Bruce; Kar, Saibal; Anderson, R. David; Azarbal, Babak; Petersen, John; Sharaf, Barry; Handberg, Eileen; Shufelt, Chrisandra; Kothawade, Kamlesh; Sopko, George; Lerman, Amir; Shaw, Leslee; Kelsey, Sheryl F.; Pepine, Carl J.; Bairey Merz, C. Noel



Acute Coronary Events  

PubMed Central

In the United States alone, more than 400,000 Americans die annually from coronary artery disease and more than 1,000,000 suffer acute coronary events, i.e., myocardial infarction and sudden cardiac death.1 Considering the aging of our population and increasing incidence of diabetes and obesity, the morbidity from coronary artery disease, and its associated costs, will place an increasing, substantial burden on our society.2 Between 2010 and 2030, total direct medical costs spent in the US for cardiovascular diseases are projected to triple from 273 to 818 billion dollars.2 Although effective treatments are available and considerable efforts are ongoing to identify new strategies for the prevention of coronary events, predicting such events in an individual has been challenging.3 In hopes of improving our ability to determine the risk of coronary events, it is prudent to review our knowledge of factors that lead to acute coronary events.

Arbab-Zadeh, Armin; Nakano, Masataka; Virmani, Renu; Fuster, Valentin



Effects of midazolam on the coronary circulation in patients with coronary artery disease.  


The effects of midazolam on coronary sinus blood flow (CSBF), myocardial oxygen consumption (MVO2), and myocardial lactate balance were investigated in eight patients with stable coronary artery disease undergoing cardiac catheterization. Coronary sinus blood flow was measured by continuous thermodilution. Arterial and coronary sinus blood were analyzed for oxygen and lactate content. The determinants of left ventricular (LV) performance were obtained from the cardiac output measured by thermodilution and from left heart catheterization data. All data were obtained before, and 5 and 15 min after midazolam, 0.2 mg X kg-1 iv. Sleep was induced in all patients after administration of midazolam and persisted throughout the entire study period. Mean aortic and LV end-diastolic pressure were decreased from control values (-15 and -44%, respectively), as well as cardiac index and stroke index (-10 and -15%, respectively). Heart rate increased moderately (+8%), while no change in systemic vascular resistance and maximum velocity of shortening (Vmax) were observed. Midazolam administration was followed by a decrease of CSBF (-24%) and of MVO2 (-26%). Coronary vascular resistance did not change, but coronary sinus oxygen tension increased slightly, suggesting a mild alteration in normal autoregulation. However, no evidence of myocardial ischemia occurred, as judged by the absence of changes in the: 1) ECG, 2) myocardial lactate extraction, and 3) relaxation time constant. These results suggest that midazolam may be used safely in patients with coronary artery disease. PMID:2936281

Marty, J; Nitenberg, A; Blanchet, F; Zouioueche, S; Desmonts, J M



Assessment of coronary thrombolysis  

SciTech Connect

The efficacy of coronary thrombolysis may be assessed by several invasive and noninvasive means, including coronary angiography, contrast and radionuclide angiography, thallium 201 or /sup 99m/Tc-pyrophosphate scintigraphy, positron emission tomography, cardiac ultrasonography, electrocardiography, and analysis of plasma creatine kinase activity. Each technique has its own strengths and limitations, but when used in concert these methods may provide insight into the physiology of coronary reperfusion and the efficacy of reperfusion in individual patients and populations. 104 references.

Geltman, E.M.; Abendschein, D.R.; Devries, S.R.



Infantile Spasms: Hypothesis-Driven Therapy and Pilot Human Infant Experiments Using Corticotropin-Releasing Hormone Receptor Antagonists  

Microsoft Academic Search

Background and Rationale: Infantile spasms (IS) are an age-specific seizure disorder occurring in 1:2,000 infants and associated with mental retardation in ?90% of affected individuals. The costs of IS in terms of loss of lifetime productivity and emotional and financial burdens on families are enormous. It is generally agreed that the seizures associated with IS respond poorly to most conventional

Tallie Z. Baram; Wendy G. Mitchell; Kristen Brunson; Elizabeth Haden



Hemifacial spasm non-motor and motor-related symptoms and their response to botulinum toxin therapy  

Microsoft Academic Search

Hemifacial spasm (HFS) is a chronic movement disorder which presents as clonic and\\/or tonic facial muscle contractions frequently\\u000a accompanied by many other sensory (visual or auditory disturbances, pain), motor (facial weakness, trismus, bruxism, dysarthria)\\u000a and\\/or autonomic (lacrimation, salivation) symptoms. The aim of the study was to assess the occurrence of HFS non-motor and\\u000a motor-related symptoms and their responsiveness to botulinum

Monika Rudzi?ska; Magdalena Wójcik; Andrzej Szczudlik



Outcome predictors, efficacy and safety of Botox and Dysport in the long-term treatment of hemifacial spasm  

Microsoft Academic Search

Background and purpose: To review the clinical characteristics and the long-term outcome of patients with hemifacial spasm (HFS) who received botulinum neurotoxin (BoNT) over the past 10 years. Results: A total of 108 patients received 665 treat- ments. Mean latency of clinical effect was 5.4 ± 5.3 days for Botox and 4.9 ± 4.6 days for Dysport (P > 0.05).

A. R. Bentivoglio; A. Fasano; T. Ialongo; F. Soleti; S. Lo Fermo; A. Albanese



Coronary Heart Disease  


... Women's Health Pregnant Women Coronary Heart Disease Depression Eating Disorders Polycystic Ovarian Syndrome (PCOS) Sexual Health Women and Diabetes: Frequently Asked Questions Health Care Professional ...


[AICA anatomic variation as a factor of worse prognosis for the surgical treatment of hemi-facial spasm].  


Hemifacial spasm is a neurovascular compression syndrome. These consist in a contacting vessel (most often an artery) to a cranial nerve in cerebelar-pontine angle. The most common is trigeminal neuralgia caused by contact between the superior cerebellar artery and the trigeminal nerve, and less commonly hemifacial spasm, vertiginous syndrome by contact of the antero inferior cerebelar artery with the eighth cranial nerve, glossopharyngeal neuralgia by contact of the postero inferior cerebelar artery and the IX cranial nerve, etc. These syndromes typically occur after the fifth decade of life, when the arterial tortuosity increases due to the arteriosclerosis process. They are however associated anatomical variations of the origin and course of the arteries, which facilitate contact with the nerves of the cerebellar-pontine angle. In hemifacial spasm, the vessel most often related is antero inferior cerebelar and the authors describe a case of a rare anatomical variant in the course of the artery that motivated the development of the disease, which was identified intraoperatively on a surgical approach to the cerebellar-pontine for vascular microdescompression. PMID:23815844

Reizinho, Carla; Casimiro, Miguel; Luís, Ana; Dominguez, Manuel



Percutaneous transluminal coronary angioplasty (PTCA)  

MedlinePLUS Videos and Cool Tools

Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. The procedure ...


[Haemodynamic and coronary effects of Risordan injection in patients with coronary disease (author's transl)].  


Nitro-compounds exert a preventive action on myocardial ischaemia through their peripheral effects (reduction of left ventricular preload) and their effects on the coronary system (increase of collateral flow and imprevement in the endocardium: epicardium perfusion ratio). The haemodynamic, coronary and metabolic effects of Risordan i.v. infusions (5 mg/h) in acute myocardial ischaemia induced by rapid atrial stimulation (RAS) were investigated in 15 male patients with angiographic or ECG signs of non-perfusion of the coronary network. Coronary sinus blood flow was measured by the thermodilution method. The values measured or calculated were: heart rate (HR), cardiac index (CI), aortic pressure (PAo), pulmonary capillary pressure (PCP), right atrial pressure (RAP), systemic arterial resistance (SAR), double product (DP), coronary blood flow (QCcor), total coronary resistance (TCR), O2 arterio venous difference (DAVO2), myocardial O2 consumption (MVO2) and myocardial lactate extraction (K %). RAS produced a significant increase of PAo, CI, DP, MVO2 and QCcor, with inversion of K % (-3.3%) indicatif anaerobic metabolism by myocardial ischaemia. Risordan produced significant diminution of PAo and CI with subsequent increase of HR; there was little increase of DP, MVO2 and QCcor and little change n myocardial metabolism (K % = 14 %). Risordan corrected the myocardial ischaemia induced by RAS, with decrease of PAo, PCP, RAP, CI, DP and QCcor, K % became positive (+ 11.5 % vs -3.3 % during RAS) suggesting a decrease in myocardial ischaemia. PMID:7110966

Lellouche, D; Ben Salah, K; Szwarc, G; Vernant, P



HMG-CoA Reductase Inhibitors Reduce Nicotine-Induced Expression of Cellular Adhesion Molecules in Cultured Human Coronary Endothelial Cells  

Microsoft Academic Search

Background: Smoking predisposes to the development of atherosclerosis and of its complications. The mechanisms responsible for these effects are not completely understood. We have investigated whether nicotine might promote a proatherosclerotic state in human coronary endothelial cells (HCAECs), studying the role of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors in preventing these phenomena. Methods and Results: Real-time PCR showed that nicotine

Plinio Cirillo; Mario Pacileo; Salvatore De Rosa; Paolo Calabrò; Annarita Gargiulo; Valeria Angri; Nella Prevete; Isabella Fiorentino; Grazia Ucci; Laura Sasso; Gianluca Petrillo; Sergio Musto D’Amore; Massimo Chiariello



Vasorelaxant mechanism of KRN2391 and nicorandil in porcine coronary arteries of different sizes.  

PubMed Central

1. The relaxant mechanisms of action of KRN2391, a novel vasodilator, and nicorandil on epimyocardial coronary artery (2.5- 3.0 mm outer diameter) and mid-myocardial coronary artery (0.8-1.0 mm outer diameter) were investigated in porcine isolated coronary arteries. In addition, the vasorelaxant responses of KRN2391 and nicorandil were compared with those of nitroglycerin and cromakalim, a K+ channel opener, in epi- and mid-myocardial coronary arteries. 2. Nitroglycerin showed a more potent relaxant effect on epi-myocardial coronary arteries than on mid-myocardial coronary arteries, whereas cromakalim produced greater relaxation responses in mid-myocardial coronary arteries. There was no difference between epi- and mid-myocardial coronary arteries in terms of the relaxant effect of KRN2391 and nicorandil. 3. Relaxation induced by KRN2391 in epi- and mid-myocardial coronary arteries was inhibited by oxyhaemoglobin, a pharmacological antagonist of nitrovasodilators, and glibenclamide, a pharmacological antagonist of K+ channel opening drugs. However, the inhibitory effect of glibenclamide on KRN2391-induced relaxation was greater in mid-myocardial coronary artery than in epi-myocardial coronary artery. 4. Relaxation induced by nicorandil was inhibited by oxyhaemoglobin alone in epi-myocardial coronary arteries and by both oxyhaemoglobin and glibenclamide in mid-myocardial coronary arteries. 5. In epi- and mid-myocardial coronary arteries, relaxation induced by cromakalim was inhibited by glibenclamide but not by oxyhaemoglobin, whereas relaxation induced by nitroglycerin was inhibited by oxyhaemoglobin but not by glibenclamide.(ABSTRACT TRUNCATED AT 250 WORDS)

Miwa, A.; Kaneta, S.; Motoki, K.; Jinno, Y.; Kasai, H.; Okada, Y.; Fukushima, H.; Ogawa, N.



Subepicardial endothelial cells invade the embryonic ventricle wall to form coronary arteries.  


Coronary arteries bring blood flow to the heart muscle. Understanding the developmental program of the coronary arteries provides insights into the treatment of coronary artery diseases. Multiple sources have been described as contributing to coronary arteries including the proepicardium, sinus venosus (SV), and endocardium. However, the developmental origins of coronary vessels are still under intense study. We have produced a new genetic tool for studying coronary development, an AplnCreER mouse line, which expresses an inducible Cre recombinase specifically in developing coronary vessels. Quantitative analysis of coronary development and timed induction of AplnCreER fate tracing showed that the progenies of subepicardial endothelial cells (ECs) both invade the compact myocardium to form coronary arteries and remain on the surface to produce veins. We found that these subepicardial ECs are the major sources of intramyocardial coronary vessels in the developing heart. In vitro explant assays indicate that the majority of these subepicardial ECs arise from endocardium of the SV and atrium, but not from ventricular endocardium. Clonal analysis of Apln-positive cells indicates that a single subepicardial EC contributes equally to both coronary arteries and veins. Collectively, these data suggested that subepicardial ECs are the major source of intramyocardial coronary arteries in the ventricle wall, and that coronary arteries and veins have a common origin in the developing heart. PMID:23797856

Tian, Xueying; Hu, Tianyuan; Zhang, Hui; He, Lingjuan; Huang, Xiuzhen; Liu, Qiaozhen; Yu, Wei; He, Liang; Yang, Zhongzhou; Zhang, Zhen; Zhong, Tao P; Yang, Xiao; Yang, Zhen; Yan, Yan; Baldini, Antonio; Sun, Yunfu; Lu, Jie; Schwartz, Robert J; Evans, Sylvia M; Gittenberger-de Groot, Adriana C; Red-Horse, Kristy; Zhou, Bin



Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring.  


There is considerable evidence that primary Hemi-Facial Spasm (HFS) is in almost all cases related to a vascular compression of the facial nerve at its Root Exit Zone (REZ) from brainstem, and that Micro-Vascular Decompression (MVD) constitutes its curative treatment. Clinical as well as electrophysiological features plead for mechanisms of the disease in structural lesions at the neural fibers (putatively: focal demyelination at origin of ephapses) and functional changes in the nuclear cells (hyperactivity of the facial nucleus). Lateral Spread Responses (LSRs) elicited by stimulation of the facial nerve branches testify of these electrophysiological perturbations. Monitoring LSRs during surgery is feasible; however the practical value of their intraoperative disappearance as control-test of an effective decompression remains controversial.MVD allows cure of the disease in most cases. Because the VIIIth nerve is at risk during surgery, intraoperative monitoring of Brainstem Auditory Evoked Potentials (BEAPs) is of value to reduce occurrence of hearing loss. Increase in latency of Peak V and decrease in amplitude of Peak I are warning-signals of an excessive stretching of the the cochlear nerve and impairment of the cochlear vascular supply, respectively. PMID:16094508

Sindou, M P



Hemifacial spasm and reinnervation synkinesias: long-term treatment with either Botox or Dysport.  


Botulinum toxin is considered the treatment of choice for hemifacial spasm (HFS) and reinnervation synkinesias (RS). We present 133 patients with HFS (n = 97) and RS (n = 36) who have been treated with either Botox (n = 78) or Dysport (n = 55) exclusively for 6 years (range 2-12 years). The Botox dose was 21 +/- 8 MU, the Dysport dose 46 +/- 22 MU. The therapeutic effect started after 7.1 +/- 2.3 days and lasted for 12.5 +/- 3.9 weeks. It was stable throughout the observation period in 85% of all patients. Adverse effects occurred in 5.4% of injection series. No patient terminated treatment because of unsatisfactory results. Secondary therapy failure did not occur. With an effective conversion ratio of Botox:Dysport = 1:2.56 there were no differences between both drugs with respect to therapeutic efficacy and adverse effects thus confirming the hypothesis that there may not be intrinsic differences between both products. PMID:20437061

Kollewe, Katja; Mohammadi, Bahram; Dengler, Reinhard; Dressler, Dirk



The role of coronary artery calcifications in coronary artery disease  

Microsoft Academic Search

Coronary atherosclerosis – Introduction Calcification within the wall of a coronary artery is a recognized marker of atherosclerosis. Imaging modalities used in detection of coronary calcification are the chest film, fluoroscopy, and conventional, electron beam and helical CT. The faster electron beam CT (EBT) and helical CT (HCT) scanners are especially sensitive in detecting coronary artery calcification. Thus, these imaging

William Stanford



Multiframe quantitative coronary arteriography  

Microsoft Academic Search

Single-frame quantitative coronary angiography (QCA) requires a human operator to select one frame for analysis out of typically 90 or more acquired in each sequence. QCA measurements for the same arterial segment differ from frame to frame due to a variety of factors including: rapid coronary motion, overlapping arteries, patient scatter, and structure noise from imaging the ribs, spine and

Craig A. Morioka; James S. Whiting; Miguel P. Eckstein; Kokila Shah



Transradial artery coronary angioplasty  

Microsoft Academic Search

This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty

Ferdinand Kiemeneij; Gert Jan Laarman; Edwin de Melker



Phenoxybenzamine treatment is insufficient to prevent spasm in the radial artery: the effect of other vasodilators  

Microsoft Academic Search

ObjectivesAfter its reintroduction as an arterial graft in coronary artery surgery, the radial artery is now established as an alternative arterial conduit, with good early and midterm patency. However, because of the concern about its vasospasticity, numerous vasodilator strategies have been used. Recently the use of the irreversible ?-adrenergic antagonist phenoxybenzamine has been proposed. Although this treatment is effective in

Alan R Conant; Michael J Shackcloth; Aung Y Oo; Michael R Chester; Alec W. M Simpson; Walid C Dihmis



Increased expression and co-localization of ACE, angiotensin II AT1 receptors and inducible nitric oxide synthase in atherosclerotic human coronary arteries  

PubMed Central

Using immunohistochemistry and quantitative in vitro autoradiography, the present study was undertaken to examine whether co-expression of pro-atherosclerotic factors, ACE, the AT1 receptor, and iNOS, is increased in early and advanced atherosclerotic lesions of human coronary arteries. In normal coronary arteries, ACE and eNOS were strongly co-expressed in endothelial cells (ECs), whereas the AT1 receptor was expressed in medial smooth muscle cells (SMCs). By contrast, iNOS was not expressed in ECs and SMCs. In early atherosclerotic lesions and atheromatous plaques, ACE, the AT1 receptor and iNOS immunostaining were primarily co-localized in infiltrated macrophages and SMCs adjacent to macrophages. eNOS expression was lower in ECs than in normal arteries, and absent in accumulated macrophages and SMCs. In fibrosclerotic plaques, ACE, the AT1 receptor, and iNOS immunostaining were still positive in macrophages as well as new microvessels within the plaques. Interestingly, SMCs in vasa vasorum of the adventitia in atheromatous and fibrosclerotic plaques were also strongly positive for AT1 receptor and iNOS, while ECs of the vasa vasorum were positive for ACE and eNOS. The present study demonstrates that multiple pro-atherosclerotic factors ACE, AT1 receptor and iNOS are co-localized almost exclusively in infiltrated macrophages and SMCs that have accumulated in or adjacent to early and advanced atherosclerotic plaques, while the anti-atherosclerotic enzyme eNOS is reduced in ECs. These data therefore suggest that increased formation of Ang II and iNOS in infiltrated macrophages and medial SMCs might well play important roles in the development and progression of human coronary atherosclerosis.

Ohishi, Mitsuru; Dusting, Gregory J; Fennessy, Paul A; Mendelsohn, Frederick AO; Li, Xiao C; Zhuo, Jia L



'Is tinnitus accompanied by hemifacial spasm in normal-hearing patients also a type of hyperactive neurovascular compression syndrome? : A magnetoencephalography study  

PubMed Central

Background Traditionally, tinnitus accompanied by hemifacial spasm has been considered a type of hyperactive neurovascular compression syndrome that is similar to hemifacial spasm alone because of the anatomically close relationship between the facial nerve and cochlear nerve as well as the hyperactive clinical nature. Methods Participants were 29 subjects who presented with hemifacial spasm and neuroradiological evidence of vascular compression of the cranial (facial/cochlear) nerve. We used magnetoencephalography (MEG) to estimate the activity of the cochlear nerve in patients with and without tinnitus on the ipsilateral side. We compared the difference in the latency and the ratio of the equivalent current dipole (ECD) strength between the ipsilateral and contralateral sides of the spasm and tinnitus. Results Cochlear nerve activity in patients with tinnitus was increased with a shorter latency (p?=?0.016) and stronger ECD strength (p?=?0.028) compared with patients without tinnitus. Conclusion The MEG results from normal-hearing patients who had tinnitus accompanied by hemifacial spasm suggest that the hyperactivity of the auditory central nervous system may be a crucial pathophysiological factor in the generation of tinnitus in these patients. The neurovascular compression that causes sensory input from the pathologic facial nerve activity may contribute to this hyperactivity of the central auditory nervous system.



Noninvasive Quantification of Coronary Calcium  

Microsoft Academic Search

Calcium in the form of hydroxyapatite (HA) is regarded as a known marker for the presence of atherosclerotic lesions of the\\u000a coronary arteries. Several studies have demonstrated that the risk for coronary events is associated and strongly correlated\\u000a with the amount of coronary calcium (1,2). The absence of coronary calcium does almost certainly imply the absence of coronary artery disease

Stefan Ulzheimer; Kaiss Shanneik; Willi A. Kalender


(1) Coronary Events Caused by Myocardial Bridge  

PubMed Central

Myocardial bridge (MB), which covers a part of the left anterior descending coronary artery (LAD), is a normal anatomical variant structure (45% in frequency by autopsy) in LAD. MB contraction plays the role of a “double-edged sword” on the coronary events, suppressing coronary atherosclerosis under the MB, yet generating abnormal blood flow associated with coronary heart diseases (CHDs). High shear stress driven by MB compression causes the suppression of vascular permeability and vasoactive protein expression such as e-NOS and endothelin-1, which leads to the suppression of atherosclerosis in the LAD segment under the MB. However, despite the prevalent view of MB as benignancy by conventional coronary angiography (5-6% in frequency), with advance of imaging technique such as multislice spiral computed tomography [(MSCT); 16% in frequency], cardiologists are now frequently aware of symptomatic MB occurring not only in hospitalized patients, but also in young athletes free from atherosclerosis. Moreover, the large mass volume of MB muscle induces atherosclerosis evolution at the settled site in LAD proximal to MB and contributes to the occurrence of myocardial infarction. These events upon the coronary events result from the different pathophysiological mechanisms induced by contractile force of MB, which is solely determined just by the integration of anatomical properties of MB, such as the location, length and thickness of MB in an individual LAD. A recent MSCT provides the objective quantification of the anatomical variables that correlate with the histopathological results in relation to the occurrence of CHD. In this review, we therefore discuss the necessity to explore MB as a inherent chance anatomical risk factor for CHD.

Yoko, Kawawa; Ehiichi, Kohda; Toshiharu, Ishii



Outcome of Coronary Bypass Surgery Versus Coronary Angioplasty in Diabetic Patients With Multivessel Coronary Artery Disease  

Microsoft Academic Search

Objectives. This study sought to compare the outcome of percutaneous transluminal coronary angioplasty (PTCA) (n = 834) and coronary artery bypass graft surgery (CABG) (n = 1805) in diabetic patients with multivessel coronary disease from an observational database.Background. There is concern about selection of revascularization in diabetic patients with multivessel coronary artery disease.Methods. Data were collected prospectively and entered into

William S Weintraub; Bernardo Stein; Andrzej Kosinski; John S Douglas; Ziyad M. B Ghazzal; Ellis L Jones; Douglas C Morris; Robert A Guyton; Joseph M Craver; Spencer B King



Impact of Coronary Risk Factors on Contribution of Nitric Oxide and Adenosine to Metabolic Coronary Vasodilation in Humans 1 1 This study was supported by Grant-in-Aid for JSPS Fellows from the Ministry of Education, Science, and Culture and by the Japan Heart Foundation–Pfizer Pharmaceuticals Grant for Research on Coronary Artery Disease, Tokyo, Japan  

Microsoft Academic Search

Objectives. The contribution of nitric oxide (NO) and adenosine to the increase in coronary blood flow (CBF) induced by cardiac pacing was investigated in 28 subjects with angiographically normal coronary arteries with and without one or more risk factors for atherosclerosis.Background. NO and adenosine are important in the regulation of coronary circulation, and the inhibition of NO synthesis increases adenosine

Tetsuo Minamino; Masafumi Kitakaze; Yasushi Matsumura; Kazuhiko Nishida; Yoji Kato; Kazuhiko Hashimura; Yasuhiko Matsu-ura; Hiroharu Funaya; Hiroshi Sato; Tsunehiko Kuzuya; Masatsugu Hori



Effects of flunitrazepam on left ventricular performance, coronary haemodynamics and myocardial metabolism in patients with coronary artery disease.  


The effects of flunitrazepam 15 micrograms kg-1, on left ventricular (LV) performance, coronary sinus blood flow (CSBF), myocardial oxygen uptake and myocardial lactate balance were studied in nine patients with coronary artery disease undergoing cardiac catheterization. Flunitrazepam produced a decrease in mean aortic pressure (MAP) and in systemic vascular resistance (SVR) with maximal changes from control value observed at 15 min for MAP and at 5 min for SVR. No change in cardiac index was observed. The following changes in variables related to LV performance were observed: (1) a transient increase in heart rate and left ventricular contractility (Vmax); (2) a sustained decrease of left ventricular end-diastolic pressure, maximum at 15 min. Myocardial oxygen consumption was decreased at 15 min but CSBF did not change, whereas total coronary vascular resistance was decreased. Since myocardial lactate extraction was increased and no change in ECG was observed, a coronary steal induced by coronary vasodilatation did not appear to take place. PMID:6418185

Nitenberg, A; Marty, J; Blanchet, F; Zouioueche, S; Baury, A; Desmonts, J M



Regional Coronary Endothelial Function is Closely Related to Local Early Coronary Atherosclerosis in Patients with Mild Coronary Artery Disease: A Pilot Study  

PubMed Central

Background Coronary endothelial function (endoFx) is abnormal in patients with established coronary artery disease (CAD) and was recently shown by MRI to relate to the severity of luminal stenosis. Recent advances in MRI now allow the non-invasive assessment of both anatomic and functional (endoFx) changes that previously required invasive studies. We tested the hypothesis that abnormal coronary endoFx is related to measures of early atherosclerosis such as increased coronary wall thickness (CWT). Methods and Results Seventeen arteries in fourteen healthy adults and seventeen arteries in fourteen patients with non-obstructive CAD were studied. To measure endoFx, coronary MRI was performed before and during isometric handgrip exercise, an endothelial-dependent stressor and changes in coronary cross-sectional area (CSA) and flow were measured. Black blood imaging was performed to quantify CWT and other indices of arterial remodeling. The mean stress-induced change in CSA was significantly higher in healthy adults (13.5%±12.8%, mean±SD, n=17) than in those with mildly diseased arteries (-2.2±6.8%, p<0.0001, n=17). Mean CWT was lower in healthy subjects (0.9±0.2mm) than in CAD patients (1.4±0.3mm, p<0.0001). In contrast to healthy subjects, stress-induced changes in CSA, a measure of coronary endoFx, correlated inversely with CWT in CAD patients (r= -0.73, p=0.0008). Conclusions There is an inverse relationship between coronary endothelial function and local CWT in CAD patients but not in healthy adults. These findings demonstrate that local endothelial-dependent functional changes are related to the extent of early anatomic atherosclerosis in mildly diseased arteries. This combined MRI approach enables the anatomic and functional investigation of early coronary disease.

Hays, Allison G.; Kelle, Sebastian; Hirsch, Glenn A.; Soleimanifard, Sahar; Yu, Jing; Agarwal, Harsh K.; Gerstenblith, Gary; Schar, Michael; Stuber, Matthias; Weiss, Robert G.



Differentiating Non-Motor Symptoms in Parkinson's Disease from Controls and Hemifacial Spasm  

PubMed Central

Background and Aims Non-motor symptoms (NMS) are important manifestations of Parkinson's disease (PD) that reduce patients' health-related quality of life. Some NMS may also be caused by age-related changes, or manifested as a psychological reaction to a chronic neurological condition. This case-control study compared the NMS burden among PD patients, healthy controls and hemifacial spasm (HFS) patients. In addition, we determined the NMS that discriminated between PD and non-PD subjects. Methods 425 subjects were recruited from a tertiary hospital in Singapore (200 PD patients, 150 healthy controls and 75 HFS patients). NMS burden in subjects was measured using the Non-Motor Symptoms Scale (NMSS). Results NMSS total score was significantly higher in PD patients (37.9±2.6) compared to healthy controls (11.2±0.9) (p<0.0001) and HFS patients (18.0±2.1) (p<0.0001). In addition, NMSS total score was significantly higher in HFS patients compared to healthy controls (p?=?0.003). PD patients experienced a higher NMS burden than healthy controls in all domains, and a higher NMS burden than HFS patients in all but attention/memory and urinary domains. NMS burden for HFS and healthy controls differed only in the sleep/fatigue and urinary domains. Using stepwise logistic regression, problems of ‘constipation’, ‘restless legs’, ‘dribbling saliva’, ‘altered interest in sex’ and ‘change in taste or smell’ were found to have significant discriminative power in differentiating between PD patients and healthy controls and between PD patients and HFS patients. Conclusion PD patients experienced a greater overall NMS burden compared to both healthy controls and HFS patients. HFS patients demonstrated a higher NMS burden than controls, and some NMS may be common to chronic neurological conditions while others are more specific to PD. Differentiating patients using NMS domains may help refine the clinical management of NMS in PD patients.

Yong, Ming-Hui; Allen, John C.; Prakash, Kumar M.; Tan, Eng-King



Infranuchal Infrafloccular Approach to the More Vulnerable Segments of the Facial Nerve in Microvascular Decompressions for the Hemifacial Spasm  

PubMed Central

Objective We investigated the locations of compressing vessels in hemifacial spasm. To approach compression sites, we described and evaluated the efficacy of the infranuchal infrafloccular (INIF) approach. Methods A retrospective review of 31 consecutive patients who underwent microvascular decompression (MVD) through INIF with a minimum follow-up of 1 year was performed. Along the intracranial facial nerve, we classified the compression sites into the transitional zone (TRZ), the central nervous system (CNS) segment and the peripheral nervous system (PNS) segment. The INIF approach was used to inspect the CNS segment and the TRZ. Subdural patch graft technique was used in order to achieve watertight dural closure. The cranioplasty was performed using polymethylmethacrylate. The outcome and procedure-related morbidities were evaluated. Results Twenty-nine patients (93%) showed complete disappearance of spasm. In two patients, the spasm was resolved gradually in 2 and 4 weeks, respectively. Late recurrence was noted in one patient (3%). The TRZ has been identified as the only compression site in 19 cases (61.3%), both the TRZ and CNS segment in 11 (35.5%) and the CNS segment only in 1 (3.2%). There was no patient having a compressing vessel in the PNS segment. Infection as a result of cerebrospinal fluid leak occurred in one patient (3%). Delayed transient facial weakness occurred in one patient. Conclusion The TRZ and the CNS segment were more vulnerable area to the compression of vessels. We suggest that surgical avenue with the INIF approach provides early identification of this area.c

Park, Heung-Sik; Chang, Dong Kyu



In vitro effects of L-carnitine on coronary artery bypass grafts  

PubMed Central

BACKGROUND: The gold standard treatment for multivessel coronary revascularization is coronary artery bypass grafting. The internal mammary artery and saphenous vein grafts are the conduits most frequently used for these operations. Spasm of arterial and venous grafts is a significant problem during the operation. OBJECTIVES: To evaluate the acute in vitro effects of L-carnitine on internal mammary artery and saphenous vein grafts using a tissue bath. METHODS: Ten consecutive patients who underwent elective coronary artery bypass grafting were enrolled in the present study (nine men, one woman; mean [± SD] age 62±9.1 years). Samples from left internal mammary artery and saphenous vein grafts were collected from each patient. Submaximal smooth muscle contraction was achieved by adding 1 ?M phenylephrine, and L-carnitine was then added to the solution. The concentration-response curves of the vasodilation response were obtained. RESULTS: In the internal mammary graft samples, the vasodilation response to L-carnitine was 64.3±11.1% at a concentration of 5 mM. In the saphenous vein graft samples, the vasodilation response to L-carnitine was 41.5±11.4% at a concentration of 5 mM. There was a statistically significant difference (P<0.001) between the response of the internal mammary artery and saphenous vein grafts in the in vitro tissue bath system. CONCLUSIONS: These results indicate that L-carnitine is a potential vasodilatory drug for internal mammary artery and saphenous vein grafts.

Guclu, Orkut; Yuksel, Volkan; Huseyin, Serhat; Ege, Turan; Canbaz, Suat; Sungun, Mutasim



Angioscopic evaluation of periprocedural and postprocedural abrupt closure after percutaneous coronary angioplasty.  


Abrupt closure remains a significant complication of PTCA. On the basis of the presumption of underlying cause (thrombus, dissection, spasm), various empiric medical and mechanical interventions have been used to prevent and/or treat this event. Despite these measures, however, abrupt closure remains a highly unpredictable occurrence with a substantial incidence of myocardial infarction and angioplasty-related morbidity and mortality. Direct visualization of the site of abrupt closure may allow determination of responsible mechanisms and appropriate treatment strategies. Intracoronary visualization using a new angioscope was carried out in two cases of abrupt closure after percutaneous coronary angioplasty. The angioscope features a movable fiberoptic bundle that provides continuous and uninterrupted imaging of the coronary artery segment incorporating the site of abrupt closure. In one patient with intraprocedural closure angioscopy revealed obstruction of the lumen with extruded plaque material. In a second patient with postprocedural closure, however, imaging at the site of coronary artery occlusion revealed a mass consistent with a large platelet thrombus. Intracoronary evaluation with angioscopy may yield important characteristics that identify lesions at risk for abrupt closure. Further elucidation of the mechanisms underlying abrupt closure may allow more appropriate selection of therapeutic interventions. PMID:8338018

Sassower, M A; Abela, G S; Koch, J M; Manzo, K M; Friedl, S E; Vivino, P G; Nesto, R W



[Use of the radial artery for coronary artery bypass. A new experience after 20 years].  


Twenty years after its first introduction by A. Carpentier, the use of the radial artery (RA) for coronary bypass was reinvestigated because of unexpected good long term results in some patients. Since July 1989, 158 patients (pts) underwent myocardial revascularization using 189 RA grafts (31 pts received 2 grafts). The left internal mammary artery (LIMA) was concomitantly used as a pedicled graft in 151 cases and the right internal mammary artery (RIMA) in 31 cases, a free IMA graft was used in 29 cases and a saphenous vein graft in 40 cases. A mean of 2.8 graft/pt was performed. The target artery receiving the RA was: circumflex (n = 93), diagonal (n = 39), right coronary (n = 47) and LAD (n = 10). Two patients died (1.3%) and three presented a perioperative myocardial infarct (2.5%). Sternal wound infection was noted in three cases of double IMA implant. No ischemia of the hand was observed. All patients received diltiazem started intraoperatively and continued after discharge. In addition, aspirin (100 mg/day) was given at discharge. Early angiographic controls (< 3 weeks) were obtained in the first 60 consecutive patients and revealed: 73/73 patent RA grafts, 58/58 patent LIMA grafts, 16/16 patent RIMA grafts, 15/19 patent free IMA grafts and 10/11 patent vein grafts. Six patients presented a localized narrowing of the RA conduit unrelated to the anastomotic lines (spasm). Late angiographic control (6 to 24 months) was obtained after a mean follow-up of 11 months in 37 patients: 42/46 RA grafts were patent (91.3%) and free of spasm and 4 were occluded.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8024369

Acar, C; Farge, A; Chardigny, C; Beyssen, B; Pagny, J Y; Grare, P; Fabiani, J N; Deloche, A; Guermonprez, J L; Carpentier, A



Acute Coronary Syndrome  


... coronary syndrome. But what about heart attack , or unstable angina ? Those well-known conditions are both acute ... worse even with rest, both hallmark symptoms of unstable angina . People who experience chronic chest pain resulting ...


[Severe coronary vasospasm].  


A 50-year-old man, with chronic kidney disease and on dialysis, underwent coronary angiography in the context of acute coronary syndrome, which revealed focal lesions (type A) in the proximal left anterior descending and mid circumflex arteries. Ad-hoc angioplasty was performed on both lesions with direct stenting. An immediate drop in arterial blood pressure was observed and the angiogram showed new lesions with reduced flow throughout the coronary tree, progressing to cardiogenic shock and electromechanical dissociation. During cardiopulmonary resuscitation maneuvers, intracoronary verapamil was administered and TIMI 3 flow, sinus rhythm and a rise in blood pressure were obtained. Clinical stability was progressively restored. The patient was discharged medicated with calcium channel blockers and nitrates. During follow-up, he was twice readmitted for unstable angina. Coronary angiography revealed findings that could easily have been interpreted as new obstructive lesions, but these resolved after administration of intracoronary nitrates. PMID:22824758

Guardado, Jorge Humberto; Vinhas, Hugo; Martins, Cristina; Pereira, Ernesto; Pereira, Hélder



Coronary Artery Disease  


Coronary artery disease (CAD) is the most common type of heart disease. It is the leading cause of death ... both men and women. CAD happens when the arteries that supply blood to heart muscle become hardened ...


Isolated retinal cotton wool spot after coronary angiography  

PubMed Central

Visual symptoms after coronary angiography are rarely encountered and mostly related to contrast induced transient cortical blindness or retinal artery occlusions. We report an intriguing case of a 50-year-old woman, who presented with vision deterioration in her right eye 12 h after coronary angiography for cardiac palpitation. Fundoscopy and optical coherence tomography scan revealed an isolated parafoveal cotton wool spot in her right eye that has totally resolved 6 weeks after initial presentation. This is the first case report of this rare post coronary angiography complication.

Kopsachilis, Nikolaos; Brar, Manpreet; Marinescu, Anca I. C.; Sivaprasad, Sobha



Endothelial regulation of coronary microcirculation in health and cardiometabolic diseases  

PubMed Central

Cardiometabolic disorders have been shown to impair coronary microvascular functions leading to diminished cardiac performance and increased mortality. In this review, we focus on the molecular pathomechanisms of impaired endothelium-dependent and flow-induced dysregulation of coronary vasomotor tone in cardiometabolic disorders such as obesity, diabetes mellitus or hyperhomocysteinemia based on animal experiments and human studies. We also briefly summarize the relationship among key signaling mechanisms that contribute to the development of coronary dysfunctions in these disorders, which may help develop new targets for efficient cardiometabolic prevention and treatments.

Balasko, Marta; Bagi, Zsolt



Future of Coronary Thrombolysis  

Microsoft Academic Search

\\u000a Despite its now established efficacy, the evolution of coronary thrombolysis has been protracted. Delay in its acceptance\\u000a after initial attempts in 1958 (1) resulted from the initial lack of optimal end points such as coronary arteriography and\\u000a the “mind set” in the cardiovascular community that did not favor thrombosis as the proximate cause of acute myocardial infarction\\u000a and that did

Burton E. Sobel


Acute coronary vasospasm secondary to industrial nitroglycerin withdrawal. A case presentation and review.  


A Black employee exposed to industrial nitroglycerin (NG) in an explosives factory presented with severe precordial pain. The clinical presentation was that of significant transient anteroseptal and anterolateral transmural myocardial ischaemia which responded promptly to sublingual isosorbide dinitrate. Despite being removed from exposure to industrial NG and receiving therapy with long-acting oral nitrates and calcium antagonists, the patient continued to experience repeated attacks of severe retrosternal pain, although transient myocardial ischaemia was not demonstrated electrocardiographically during these episodes. Cardiac catheterization revealed a normal myocardial haemodynamic system and selective coronary arteriography delineated coronary arteries free from any obstructive lesions. An ergonovine (ergometrine) maleate provocative test failed to elicit coronary artery spasm, although this was undertaken while the patient was on nitrate and calcium-blocker therapy. Clinical records of previous significant constrictive pericarditis (probably due to tuberculosis) with resultant abnormalities on the ECG complicated the diagnosis. Evaluation was further hindered by the known "variant pattern' seen on the ECGs of members of the Black population. We postulate that this patient's clinical features were a direct result of severe vasospasm affecting the left coronary artery; it is also strongly suggested that withdrawal from contact with industrial NG precipitated this potentially lethal coronary vasospasm. The role played by industrial NG in ischaemic heart disease is reviewed, as well as the importance of the "normal variant pattern' in the assessment of cardiac disease in Black patients. As far as we are aware this is the first time that the use of the ergonovine maleate provocative test has been documented in the industrial NG withdrawal syndrome. PMID:6401366

Przybojewski, J Z; Heyns, M H



Massive right coronary air embolism in the right coronary artery during left coronary angiography: A case report.  


Coronary air embolism is one of the inadvertent complications of coronary angiography. We report a case of unexpected massive right coronary air embolism during left coronary angiography with a JL4 diagnostic catheter. This report demonstrates that air embolism may occur in the contralateral coronary artery and therefore complete air aspiration must be ensured during coronary angiography. PMID:23596473

Park, Chang-Bum; Hwang, Hui-Jeong; Cho, Jin-Man; Jo, Byung-Hyun; Kim, Chong-Jin



Current concepts: converting enzyme inhibitors in coronary artery disease  

Microsoft Academic Search

Studies investigating the antiischemic action of converting enzyme inhibitors (CEIs) in patients with coronary artery disease (CAD) have, after single dosing, provided evidence for mechanisms of action such as coronary vasodilation and reduction of myocardial oxygen-consumption due to pre- and afterload reduction. Measurements of exercise-induced ST-segment depression and exercise duration as criteria for clinical efficacy have revealed contradictory findings. Patient

P. Thürmann; N. Rietbrock



[Angina pectoris without coronary stenosis--current concepts].  


This review aims at demonstrating current concepts for the occurrence of angina pectoris (AP) and myocardial ischemia in patients without significant epicardial stenoses based on typical clinical examples. For applying these concepts, it is of utmost importance to clinically distinguish patients with resting AP only from those with exercise-induced symptoms or both. Resting AP may not only be caused by plaque rupture and subsequent coronary thrombosis, but may also be due (especially when repeated attacks occur in the early morning hours) to coronary vasospasm (in the microvasculature as well as in epicardial coronary segments). Similarly, exercise-induced AP and/or a pathological exercise test result may not only be caused by severe coronary stenoses, but may also be due to a reduced coronary perfusion reserve secondary to microvascular dysfunction. Hence, a pathological non-invasive stress-test result should not be necessarily described as "false positive" in case of the absence of any significant stenosis. In principle, proatherogenic cardiovascular risk factors are not only associated with atherosclerotic coronary artery disease (CAD), but also with the occurrence of a coronary vasomotility disorder. Both disease entities are characterised by the occurrence of myocardial ischemia. So far, the exact pathomechanism of respective subforms of coronary vasomotility disorders has not yet been not elucidated in detail. Endothelial dysfunction, abnormalities of the smooth muscle cells in the media as well as genetic predisposition or specific immunological abnormalities are discussed as underlying reasons. Intracoronary provocative testing (such as the acetylcholine-test) may help to diagnose as well as to differentiate the different subforms of coronary vasomotility disorders. PMID:20830663

Yilmaz, A; Sechtem, U



Clinical and quantitative coronary angiographic predictors of coronary restenosis  

Microsoft Academic Search

OBJECTIVESWe sought to assess whether coronary stents have modified the predictive value of demographic, clinical and quantitative coronary angiographic (QCA) predictors of coronary restenosis.BACKGROUNDA systematic analysis in a large cohort of registries and randomized trials of the percutaneous transluminal coronary angioplasty (PTCA) and stent era has never been performed.METHODSA total of 9,120 treated lesions in 8,156 patients included in nine

Nestor Mercado; Eric Boersma; William Wijns; Bernard J Gersh; Carlos A Morillo; Vincent de Valk; Gerrit-Anne van Es; Diederick E Grobbee; Patrick W Serruys



Suppression of exercise-induced angina by magnesium sulfate in patients with variant angina  

SciTech Connect

The effects of intravenous magnesium on exercise-induced angina were examined in 15 patients with variant angina and in 13 patients with stable effort angina and were compared with those of placebo. Symptom-limited bicycle exercise and thallium-201 myocardial scintigraphy were performed after intravenous administration of 0.27 mmol/kg body weight of magnesium sulfate and after placebo on different days. In all patients, serum magnesium levels after administration of magnesium sulfate were about twofold higher than levels after placebo. Exercise-induced angina associated with transient ST segment elevation occurred in 11 patients with variant angina receiving placebo and in only 2 of these patients receiving magnesium (p less than 0.005). On the other hand, exercise-induced angina was not suppressed by magnesium in any patient with stable effort angina. In these patients there was no significant difference in exercise duration after administration of placebo versus after administration of magnesium. The size of the perfusion defect as measured by thallium-201 scintigraphy was significantly less in patients with variant angina receiving magnesium than that in those receiving placebo (p less than 0.001), whereas it was not significantly different in patients with stable effort angina receiving placebo versus magnesium. In conclusion, exercise-induced angina is suppressed by intravenous magnesium in patients with variant angina but not in patients with stable effort angina. This beneficial effect of magnesium in patients with variant angina is most likely due to improvement of regional myocardial blood flow by suppression of coronary artery spasm.

Kugiyama, K.; Yasue, H.; Okumura, K.; Goto, K.; Minoda, K.; Miyagi, H.; Matsuyama, K.; Kojima, A.; Koga, Y.; Takahashi, M.



Total arterial coronary revascularization-patient selection, stenoses, conduits, targets.  


Graft patency determines prognosis in coronary artery bypass grafting (CABG). Numerous reports over the past 20 years have documented superior patencies and prognosis when multiple arterial grafts are used, yet less than 10% of CABG have multiple arterial grafts. Several conduits have been proposed, with varying degrees of success. Saphenous vein grafts (SVG) begin to fail with intimal hypertrophy and then atheroma after 5 years, with patency rates of 50% to 60% at 10 years, and <30% at 15 years. In contrast, left internal thoracic artery (LITA) patency is >95% at 10 years and >90% at 20 years. The radial artery is extremely versatile and can reach all territories, but is muscular and vulnerable to spasm and competitive flow. Similarly, the right gastroepiploic artery is also muscular, and is best suited to the posterior descending coronary artery, especially in reoperations and is also affected by competitive flow. In addition, bilateral internal thoracic artery grafting (BITA) grafts and total arterial revascularization (TACR) can be performed with identical perioperative mortality (1%) and perioperative morbidity to LITA + SVG. Importantly, survival is superior-85% to 90% at 10 years versus 75% to 80% respectively. BITA/TACR patients also suffer fewer late cardiac events and reoperations, with superior results for older patients, those requiring urgent surgery, diabetics, patients with renal dysfunction and in reoperations. Contraindications to BITA include obesity, insulin dependent diabetics, and severe chronic obstructive airways disease. As such, arterial grafts have better patencies and clinical results. BITA/TACR is often underutilized, but can be achieved in the majority of patients. Opportunities exist to enhance BITA/TACR use in CABG to the potential benefit of our patients. PMID:23977629

Tatoulis, James



Neointimal tissue response at sites of coronary stenting in humans: macroscopic, histological, and immunohistochemical analyses  

Microsoft Academic Search

Background—Experimental animal studies have shown that coronary stenting induces neointimal proliferation. However, the histopathological events after coronary stenting in humans have not been studied systematically. Methods and Results—We investigated 11 stented coronary arteries (9 Palmaz-Schatz stents, 1 Wiktor stent, and 1 ACS Multi-Link stent) obtained from 11 patients who had died 2 days to 21 months after stenting. We focused

Ryushi Komatsu; Makiko Ueda; Takahiko Naruko; Akiko Kojima; Anton E. Becker



Does acute improvement of endothelial dysfunction in coronary artery disease improve myocardial ischemia?  

Microsoft Academic Search

Objectives. Parenteral L-arginine will improve myocardial ischemia in patients with obstructive coronary artery disease.Background. Endothelial dysfunction causes coronary arterial constriction during stress, and L-arginine improves endothelial dysfunction.Methods. Twenty-two patients with stable coronary artery disease and exercise-induced ST-segment depression underwent assessment of forearm endothelial function with acetylcholine and symptom-limited treadmill exercise testing during dextrose 5% infusion and after double-blind intravenous administration

Arshed A Quyyumi



Prolonged antispasmodic effect in isolated radial artery graft and pronounced platelet inhibition induced by the inodilator drug, levosimendan.  


Radial artery frequently develops spasm and requires vasodilator therapy during coronary artery bypass graft surgery (CABG). Levosimendan was recently shown to oppose 5-hydroxytryptamine-induced contraction of radial artery (RA) grafts. The aim of the present study was to explore whether levosimendan retains its vasodilatory capacity following in vitro pre-incubation of RA segments with the inodilator. A possible cumulative effect of the drug in human platelets was also studied. Human isolated RA segments were pre-incubated in 0.16??mol/L levosimendan containing solution or in 0.9% NaCl, Bretschneider, 5% albumin and a 5% human serum protein solution (Biseko) as controls for 45?min. Contractions were induced by three consecutive administrations of 5-hydroxytryptamine (0.31??M) 45, 90 and 120?min. after exchanging the pre-incubation solutions with Krebs-Henseleit solution, uniformly. Receptor-independent contractions (KCl, 80?mmol/L), endothelium-dependent (acetylcholine, 1??mol/L) and independent relaxations (papaverine, 100??mol/L) were also investigated. Washed human platelets were pre-incubated with levosimendan (0.06??mol/L) for 2 or 15?min. and aggregated with thrombin (0.1?IU/mL). Contractions of RA grafts induced by 5-hydroxytryptamine were significantly smaller 45?min. and 90?min. after the replacement of levosimendan with Krebs-Henseleit solution. Biseko solution also decreased the contraction of the graft at 45?min. Contractions did not change in time following the pre-incubations of radial arteries with 0.9% NaCl, Bretschneider and 5% albumin solutions. The grafts remained intact as assessed by their maximum contractions and endothelium-dependent and endothelium-independent relaxations at the end of the investigations. Platelets revealed larger anti-aggregatory effect to levosimendan following the enhancement of the incubation time. Results indicate that the antispasmodic and anti-aggregatory effects of levosimendan cumulate in the vascular tissue and in platelets. The storage of RA with the inodilator before implantation may help to prevent the intraoperative spasm of the graft and also thrombotic occlusion during CABG surgery. PMID:21952040

Ambrus, Nóra; Szolnoky, Jen?; Pollesello, Piero; Kun, Attila; Varró, András; Papp, J Gyula; Pataricza, János



Oxidative Stress and Homocysteine in Coronary Artery Disease  

Microsoft Academic Search

Background: Oxidative stress is present in cardiovascu- lar diseases (CVDs), and hyperhomocysteinemia, an independent risk factor for these diseases, may play a role by inducing production of oxygen free radicals. Methods: To evaluate the possible role of homocysteine (Hcy) in inducing oxidative stress in coronary artery disease (CAD), plasma Hcy was measured in 68 consec- utive cardiovascular patients, and plasma

Viviana Cavalca; Giuliana Cighetti; Fabrizia Bamonti; Alessandro Loaldi; Luana Bortone; Cristina Novembrino; Michela De Franceschi; Romualdo Belardinelli; Maurizio D. Guazzi



Stress and Coronary Heart Disease  

Microsoft Academic Search

There has been a rapid increase in the rates of illness and death due to coronary heart disease in most Western countries. Several factors such as a diet rich in fat, hypertension, age, male sex, increased serum cholesterol, cigarette smoking and a sedentary life have been associated with coronary heart disease. The evidence relating psycho-social stress to coronary heart disease




Merosin-negative congenital muscular dystrophy, occipital epilepsy with periodic spasms and focal cortical dysplasia. Report of three Italian cases in two families  

Microsoft Academic Search

We report clinical, EEG and neuroimaging findings of three patients in two Italian families with merosin-negative congenital muscular dystrophy (CMD), drug-resistant occipital epilepsy, diffuse persistent cerebral white matter changes and focal cortical dysplasia. Clinical and epilepsy histories, EEG and neuroimaging findings were very similar in all patients. Seizures started in childhood and mainly consisted of periodic spasms, a particular type

Antonella Pini; Luciano Merlini; Fernando M. S. Tome´; Martine Chevallay; Giuseppe Gobbi