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1

Very late coronary spasm inducing acute myocardial infarction in a heart transplant recipient.  

PubMed

We report coronary angio findings of very late (10-year) coronary spasm inducing acute myocardial infarction with typical chest pain in a heart transplant recipient. Coronary spasm was promptly relieved by intra-coronary infusion of nitrates. PMID:25010504

Santoro, Francesco; Lopizzo, Agostino; Centola, Antonio; Cuculo, Andrea; Ruggiero, Antonio; Di Biase, Matteo; Brunetti, Natale Daniele

2014-07-10

2

Induced coronary spasm without electrocardiographic signs or symptoms of myocardial ischemia  

SciTech Connect

Angiographic studies have shown that coronary artery spasm can be induced with ergonovine maleate. Coronary artery spasm induced by ergonovine maleate in these studies was nearly always accompanied by chest pain and electrocardiographic changes of myocardial ischemia. This report demonstrates that coronary artery spasm induced by ergonovine maleate may be diagnosed by angiography in the absence of these signs or symptoms.

Cipriano, P.R.

1983-03-01

3

Angiographic documentation of coronary artery spasm induced by anesthesia.  

PubMed

Many cases of coronary artery spasm during regional or general anesthesia have been reported. To our knowledge, for the first time we report a case of coronary artery spasm induced by general anesthesia that was documented by immediate angiography and treated with intracoronary nitroglycerine. A 68-year-old female was to undergo elective cholecystectomy. General anesthesia was induced by propofol 140 mg, fentanyl 50 microg, and vecuronium bromide 7 mg. Immediately after intubation sudden hypotension (60/40 mmHg) and marked ST-segment elevation on the monitor were noticed. A 12-lead electrocardiogram demonstrated marked ST-segment elevations in inferior leads with reciprocal changes. An immediate diagnostic coronary angiography showed diffuse severe narrowing of the right coronary artery with a non-critical plaque in the midportion. After intracoronary administration of nitroglycerine 0.2 mg into the right coronary artery, there was marked diffuse vasodilatation. A diagnosis of variant angina was made and 2 days of hospital course was uneventful. The patient was discharged taking diltiazem 120 mg two times daily, aspirin 100 mg daily and isosorbidemononitrate 60 mg daily. PMID:20339883

Ornek, Ender; Ornek, Dilsen; Murat, Sani Namik; Turfan, Murat

2010-06-01

4

Diffuse and Severe Left Ventricular Dysfunction Induced by Epicardial Coronary Artery Spasm  

Microsoft Academic Search

Endothelial dysfunction and effectiveness of treatment of calcium antagonists are sugges tive of coronary artery spasm as an underlying disorder in dilated cardiomyopathy (DCM). The aim of this study is to determine whether or not the epicardial coronary artery spasm can induce severe cardiac dysfunction like DCM. Thirty-four consecutive patients with angiographically normal coronary arteries and diffuse left ventricular hypokinesis

Kazuyuki Sakata; Ryuzo Nawada; Kazuhiko Ohbayashi; Hiromichi Tamekiyo; Hiroshi Yoshida

2000-01-01

5

Coronary artery spasm--clinical features, diagnosis, pathogenesis, and treatment.  

PubMed

Coronary (artery) spasm plays an important role in the pathogenesis of ischemic heart disease, including stable angina, unstable angina, myocardial infarction, and sudden death. The prevalence of coronary spasm differs among populations, is higher in Japan and Korea than in the Western countries probably due to genetic as well as environmental factors. Coronary spasm occurs most often from midnight to early morning and is usually not induced by exercise in the daytime. The attacks of coronary spasm are associated with either ST segment elevation or depression, or negative U wave on ECG. Patients with multi-vessel coronary spasm may suffer from lethal arrhythmia, including advanced AV block, ventricular tachycardia or fibrillation, or even sudden death, and they are often resistant to conventional medical therapy including Ca-channel blockers (CCBs). Endothelial nitric oxide (NO) activity is reduced and markers of oxidative stress are elevated in patients with coronary spasm. Thrombogenesis is enhanced and plasma levels of hsCRP and P-selection are elevated in patients with coronary spasm. Thus, patients with coronary spasm have endothelial dysfunction and are suffering from a low-grade chronic inflammation. Polymorphisms of endothelial NO synthase, smoking, and low-grade inflammation are the most important risk factors for coronary spasm. Coronary spasm is a hyper-contraction of coronary smooth muscle triggered by an increase of intracellular Ca2+ in the presence of an increased Ca2+ sensitivity. It has been shown that RhoA/ROCK pathway is involved in Ca2+ sensitivity and that the reduced endothelial NO activity results in increased Ca2+ sensitivity through enhanced RhoA/ROCK pathway. Accordingly, it is possible that in addition to CCBs, RhoA/ROCK pathway blockers may prove to be useful for the treatment of coronary spasm. PMID:18522770

Yasue, Hirofumi; Nakagawa, Hitoshi; Itoh, Teruhiko; Harada, Eisaku; Mizuno, Yuji

2008-02-01

6

[A case of ventricular tachycardia that was probably caused by coronary artery spasm induced by pericardial manipulation].  

PubMed

We present a case of ventricular tachycardia (VT) that was probably caused by coronary artery spasm. A 74-year-old man was scheduled to undergo right lower lobectomy for lung cancer. Although he had never suffered from any episodes of ischemic heart disease, he had several risk factors for coronary artery disease (CAD); i. e., a history of smoking, a low high-density lipoprotein cholesterol level, and diabetes mellitus type 2. Anesthesia for one-lung ventilation was maintained by inhalation of sevoflurane (1-1.5%), the continuous intravenous infusion of remifentanil (0.1-0.15 ?g x kg(-1) x min(-1)), and the intermittent administration of epidural (T4-5) 2% mepivacaine (4 ml) and 0.75% ropivacaine (5 ml). During manipulation of the pericardium, the patient's systolic blood pressure suddenly increased to 200 mmHg, followed by an ST elevation on his electrocardiogram. Despite the immediate infusion of nitroglycerin (1 mg), he developed non-sustained VT, lasting for about 30 seconds. Then, diltiazem (0.5 ?g x kg(-1) x min(-1)) was continuously administered, and the infusion rate of remifentanil was increased to 0.3 ?g x kg(-1) x min(-1). The patient recovered smoothly from anesthesia and his postoperative course was uneventful. Anesthesiologists should be aware of the possibility of coronary artery spasms induced by sudden modulation of the autonomic nervous system, particularly in patients who are at high risk of CAD. PMID:25731063

Kimura, Hiroko; Ogawa, Sae; Koga, Yukari; Mishima, Yasunori; Ushijima, Kazuo

2014-11-01

7

Coronary spasm in acute myocardial infarction  

PubMed Central

A 30 year old man had an acute anterolateral myocardial infarction following which he developed unstable angina requiring percutaneous transluminal coronary angioplasty. He subsequently developed further angina with recurrence of coronary artery lesions that were reversed by intracoronary nitrate. A diagnosis of prinzmetal (vasospastic) angina was made and this had been the apparent cause of his myocardial infarction. He was treated with a calcium antagonist and an oral long acting nitrate with resolution of symptoms. He remained well and symptom free, and was reviewed in the outpatient clinic six weeks after discharge without problems.?? Keywords: coronary spasm;  acute myocardial infarction;  syndrome X;  prinzmetal's angina PMID:9813570

Lip, G; Ray, K; Shiu, M

1998-01-01

8

Coronary Artery Spasm: Review and Update  

PubMed Central

Coronary artery spasm (CAS), an intense vasoconstriction of coronary arteries that causes total or subtotal vessel occlusion, plays an important role in myocardial ischemic syndromes including stable and unstable angina, acute myocardial infarction, and sudden cardiac death. Coronary angiography and provocative testing usually is required to establish a definitive diagnosis. While the mechanisms underlying the development of CAS are still poorly understood, CAS appears to be a multifactorial disease but is not associated with the traditional risk factors for coronary artery disease. The diagnosis of CAS has important therapeutic implications, as calcium antagonists, not ?-blockers, are the cornerstone of medical treatment. The prognosis is generally considered benign; however, recurrent episodes of angina are frequently observed. We provide a review of the literature and summarize the current state of knowledge regarding the pathogenesis of CAS. PMID:25249785

Hung, Ming-Jui; Hu, Patrick; Hung, Ming-Yow

2014-01-01

9

Coronary artery spasm leading to life threatening arrhythmias.  

PubMed

A 39 year old woman sustained life threatening arrhythmias associated with coronary artery spasm. On both occasions she was attending hospital outpatient clinics and was successfully resuscitated. Electrocardiography performed during further episodes of pain suggested that spasm could occur in either the right or left coronary artery. PMID:9764068

Adams, J N; Denver, M A; Rae, A P

1998-07-01

10

Heart failure in which coronary spasms played an important role.  

PubMed

A 69-year-old woman was admitted for further examinations and treatment of chest pain. Emergency cardiac catheterization showed no significant stenosis on coronary angiograms; however, diffuse wall hypokinesis was observed on a left ventriculogram. After treating the patient's heart failure, cardiac catheterization was performed again. A spasm provocation test showed coronary spasms of the right and left coronary arteries. A right ventricular endomyocardial biopsy revealed denaturation and fibrosis of the myocardium under the endocardium, thus suggesting the presence of myocardial ischemia. This case highlights coronary spasms as a cause of heart failure. PMID:24492691

Oda, Shinsuke; Fujii, Yuichi; Takemoto, Hiroaki; Nomura, Shuichi; Nakayama, Hirofumi; Toyota, Yasushi; Nakamura, Hiroshi; Teragawa, Hiroki

2014-01-01

11

Postoperative coronary artery spasm after mitral valve replacement?  

PubMed Central

Introduction Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease Presentation of case We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal. Discussion A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment. Conclusion This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surgery PMID:25680533

Pragliola, Claudio; Gaudino, Mario; Farina, Piero; Massetti, Massimo

2015-01-01

12

Refractory vascular spasm associated with coronary bypass grafting.  

PubMed

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management. PMID:25346903

Kim, Young Sam; Yoon, Yong Han; Kim, Jeoung Taek; Shinn, Helen Ki; Woo, Seong Ill; Baek, Wan Ki

2014-10-01

13

Refractory Vascular Spasm Associated with Coronary Bypass Grafting  

PubMed Central

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management. PMID:25346903

Kim, Young Sam; Yoon, Yong Han; Kim, Jeoung Taek; Shinn, Helen Ki; Woo, Seong Ill; Baek, Wan Ki

2014-01-01

14

Coronary artery spasm: An often overlooked diagnosis.  

PubMed

Coronary vasospasm can lead to myocardial injury and even sudden cardiac death. It has generally been overlooked as a diagnosis since atherosclerosis is a more common cause of acute coronary syndromes and because of the dilemma involved in its diagnosis. A middle-aged man with a history of smoking and cocaine use presented to the emergency department with left-sided arm/chest discomfort and diaphoresis. The electrocardiogram showed anterior ST elevation and hyper-acute T waves, which completely resolved shortly after sublingual nitroglycerin was administered. Subsequent angiogram revealed a 70% focal stenosis in the mid-left anterior descending artery. Coronary vasospasm occurs more commonly in arteries with underlying atheromatous disease, although normal vessels are not excluded. Cigarette smoking and cocaine use are among the major culprits that have been implicated as risk factors for the occurrence of coronary vasospasm. Eventually, the patient had percutaneous coronary intervention of his left-anterior descending artery and remained asymptomatic. PMID:25114375

Davies, Oluwaseun; Ajayeoba, Olumide; Kurian, Damian

2014-07-01

15

Coronary Spasm in Neurosurgical Patients and Role of Trigeminocardiac Reflex  

PubMed Central

Background. Coronary artery spasm (CAS) is a rarely reported complication in neurosurgical patients and its main causative mechanism was attributed to vagal mediated responses. However, these may be the unusual manifestations of trigeminal cardiac reflex (TCR) which is a well established brain stem reflex observed in various neurosurgical patients. Methods and Results. In this review, we have searched for the case reports/papers related to intraoperative coronary spasm in neurosurgical patients and described the role of TCR in this regard. TCR is a possible mechanism in producing CAS in most of the cases in which stimulation occurred at or near the vicinity of trigeminal nerve. It is likely that TCR mediated coronary spasm may be a physiological mechanism and not related to actual myocardial insult apparent by cardiac enzymes or echocardiography studies in most of the cases. Some common risk factors may also exist related to occurrence of CAS as well as TCR. Conclusions. In conclusion, neurosurgical procedures occurring at the vicinity of trigeminal nerve may produce CAS even in previously healthy patients and may produce catastrophic consequences. There is a need for future reports and experimental studies on the interaction of TCR and pathophysiological mechanisms related to CAS. PMID:24587903

Sandu, Nora; Cappellani, Ronald B.

2014-01-01

16

Coronary spasm in neurosurgical patients and role of trigeminocardiac reflex.  

PubMed

Background. Coronary artery spasm (CAS) is a rarely reported complication in neurosurgical patients and its main causative mechanism was attributed to vagal mediated responses. However, these may be the unusual manifestations of trigeminal cardiac reflex (TCR) which is a well established brain stem reflex observed in various neurosurgical patients. Methods and Results. In this review, we have searched for the case reports/papers related to intraoperative coronary spasm in neurosurgical patients and described the role of TCR in this regard. TCR is a possible mechanism in producing CAS in most of the cases in which stimulation occurred at or near the vicinity of trigeminal nerve. It is likely that TCR mediated coronary spasm may be a physiological mechanism and not related to actual myocardial insult apparent by cardiac enzymes or echocardiography studies in most of the cases. Some common risk factors may also exist related to occurrence of CAS as well as TCR. Conclusions. In conclusion, neurosurgical procedures occurring at the vicinity of trigeminal nerve may produce CAS even in previously healthy patients and may produce catastrophic consequences. There is a need for future reports and experimental studies on the interaction of TCR and pathophysiological mechanisms related to CAS. PMID:24587903

Chowdhury, Tumul; Meuwly, Cyrill; Sandu, Nora; Cappellani, Ronald B; Schaller, Bernhard

2014-01-01

17

Coronary spasm that caused non-ST elevation myocardial infarction appeared in cath lab due to vasovagal reaction  

PubMed Central

Coronary artery spasm is sometimes an unrecognized cause of myocardial ischemia. Myocardial ischemia is not always a product of fixed stenosis; it can also be induced by dynamic, transient stenosis. The angiogram represents the current state of vasculature at the time of examination and absence of stenosis does not mean disease absence. We present a case of right coronary artery spasm that caused non-ST elevation myocardial infarction and arrhythmias and was induced again in the cath lab due to vasovagal reaction. PMID:25061465

Jagic, Nikola; Zdravkovic, Vladimir; Nikolic, Dusan; Tasic, Mladen; Sreckovic, Ana Maksimovic; Miloradovic, Vladimir

2014-01-01

18

Coronary spasm during cardiac electrophysiological study following isoproterenol infusion  

PubMed Central

Sudden cardiac death (SCD) remains the leading cause of death in industrialized world. The majority of SCD is caused by ventricular fibrillation associated with structural and/or ischemic heart disease. Ventricular fibrillation represents the final common pathway for SCD and, thus, is an attractive target for ablation. According to class I recommendation level of evidence A, an implantable cardioverter defibrillator (ICD) should be implanted for such patients [1]. Other than programmed electrical extrastimulus technique, isoproterenol infusion is commonly used in invasive cardiac electrophysiology labs for arrhythmia induction. We hereby report a rare case of transient coronary spasm during isoproterenol infusion for ventricular tachycardia induction testing. PMID:25598993

Aksoy, Ismail; Phan, Kevin; Vainer, Jindra; Timmermans, Carl

2014-01-01

19

Impact of low-dose aspirin on coronary artery spasm as assessed by intracoronary acetylcholine provocation test in Korean patients.  

PubMed

High-dose aspirin has been reported to aggravate coronary artery spasm (CAS). However, it is unknown whether low-dose aspirin (LDA; 100 mg) has deleterious impact on CAS. We assessed the impact of LDA on CAS induced by intracoronary acetylcholine (ACh) provocation test. A total of 2789 consecutive patients without significant coronary artery disease who underwent ACh test between November 2004 and March 2010 were enrolled. The patients were divided into two groups: the aspirin group taking LDA before ACh test (n=221) and the no aspirin group not taking aspirin (n=2568). At baseline, the prevalence of old age, diabetes mellitus, hypertension, and hyperlipidemia were higher in the aspirin group. During the ACh test, the incidence of significant CAS, ischemic chest pain, as well as severe and multivessel spasm was higher in the aspirin group. The response rate to lower ACh dose was higher in the aspirin group. Multivariate analysis showed that the previous use of LDA was an independent predictor of CAS (adjusted odds ratio, 1.6, 95% confidence interval, 1.0-2.3; p=0.031). However, it is likely that the association of LDA and CAS that we have observed is not causal but may be hypothesis generating due to significant baseline differences. Further, male gender, old age, lipid-lowering drugs, baseline spasm, and myocardial bridge were independent predictors of CAS. LDA was more frequently associated with CAS and ischemic symptoms, as well as severe and multivessel spasm, suggesting the patients who have received LDA would require more intensive medical therapies and close follow up. PMID:22770476

Park, Ji Young; Rha, Seung-Woon; Poddar, Kanhaiya L; Ramasamy, Sureshkumar; Chen, Kang-Yin; Li, Yong-Jian; Choi, Byoung Geol; Ryu, Sung Kee; Choi, Jae Woong; Park, Sang Hyun; Park, Songree; Elnagar, Amro; Im, Sung Il; Kim, Sun Won; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Han, Seong Woo; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo

2012-09-01

20

A missense Glu298Asp variant in the endothelial nitric oxide synthase gene is associated with coronary spasm in the Japanese  

Microsoft Academic Search

Coronary spasm plays an important role in the pathogenesis of not only variant angina but also ischemic heart disease in\\u000a general. However, the precise mechanism(s) by which coronary spasm occurs remains to be elucidated. Coronary spasm may arise\\u000a from interactions between environmental and genetic factors. Endothelial derived nitric oxide (NO) has been implicated in\\u000a the control of vascular tone. We

Michihiro Yoshimura; H. Yasue; Masafumi Nakayama; Yukio Shimasaki; Hitoshi Sumida; Seigo Sugiyama; Kiyotaka Kugiyama; Hisao Ogawa; Yoshihiro Ogawa; Yoshihiko Saito; Yoshihiro Miyamoto; Kazuwa Nakao

1998-01-01

21

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.

1987-11-01

22

Malignant Multivessel Coronary Spasm Complicated by Myocardial Infarction, Transient Complete Heart Block, Ventricular Fibrillation, Cardiogenic Shock and Ischemic Stroke  

PubMed Central

Multivessel coronary spasm resulting to cardiogenic shock and malignant ventricular arrhythmias though rare has been reported in the literature. The disease seems to be more prevalent in Asians. There have been isolated reports of coronary spasm in patients with reactive airway disease. We report the first case of spontaneous multivessel spasm in a male patient with bronchial asthma of Arab ethnicity resulting in acute myocardial infarction complicated by cardiogenic shock, recurrent ventricular arrhythmias, and transient complete heart block. Literature review of similar cases suggests a strong association with bronchial asthma and a more malignant course in patients with reactive airway disease. The role of intracoronary nitroglycerin in proving the diagnosis even in patients in shock on maximal inotropic supports and intra-aortic balloon pump is highlighted and the importance of considering multivessel coronary spasm as a cause for acute coronary syndrome even in patients with conventional risk factors for atherosclerotic coronary artery disease is reinforced in the discussion of this case. PMID:25170414

Thomson, Viji S.; Tariq, Osama; Al Hadhi, Hafidh

2014-01-01

23

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.

1984-10-01

24

Spasm provocation tests performed under medical therapy: a new approach for treating patients with refractory coronary spastic angina on emergency admission.  

PubMed

Objective There are no objective methods for evaluating the severity of vasospasms in patients with refractory coronary spastic angina (R-CSA) under adequate medical therapy. We examined whether spasm provocation tests performed under adequate medication are useful for evaluating the severity of disease in R-CSA patients on emergency admission. Methods and Results We performed spasm provocation tests before and after the administration of medical therapy in eight R-CSA patients, including one ventricular fibrillation survivor (VF-S) and seven patients with unstable angina (UAP) on emergency readmission. We also performed these tests only after medical therapy on urgent admission in four R-CSA patients, including two patients with UAP, one patient with VF-S and one patient with acute coronary syndrome. All 12 R-CSA patients had been medicated with ? 2 vasodilator drugs. Positive coronary spasms were defined as >99% transient narrowing. The coronary artery spasms disappeared in three patients under medication, and mitigation of vasospasticity was observed in three patients. In these six cases we continued the same medications. Meanwhile in two patients, we recommended a consultation for psychosomatic medicine. In contrast, the remaining six R-CSA patients exhibited higher levels of vasospasticity, irrespective of the administration of aggressive medical therapy, in which the doses of vasoactive drugs were increased in order to suppress coronary artery spasms. Conclusion In some R-CSA patients on emergency admission, performing spasm provocation tests under medical therapy is useful for determining the subsequent treatment strategy. Therefore, this test may become a new tool in the treatment of R-CSA. PMID:25130103

Sueda, Shozo; Kohno, Hiroaki; Miyoshi, Toru; Sasaki, Yasuhiro; Sakaue, Tomoki; Habara, Hirokazu

2014-01-01

25

Hemifacial Spasm  

MedlinePLUS

NINDS Hemifacial Spasm Information Page Table of Contents (click to jump to sections) What is Hemifacial Spasm? Is there any treatment? ... being done? Clinical Trials Organizations What is Hemifacial Spasm? Hemifacial spasm is a neuromuscular disorder characterized by ...

26

Infantile Spasms  

MedlinePLUS

NINDS Infantile Spasms Information Page Synonym(s): West Syndrome Table of Contents (click to jump to sections) What are Infantile Spasms? Is ... being done? Clinical Trials Organizations What are Infantile Spasms? An infantile spasm (IS) is a specific type ...

27

T27863C Mutation in the 5*-Flanking Region of the Endothelial Nitric Oxide Synthase Gene Is Associated With Coronary Spasm  

Microsoft Academic Search

Conclusions—Taken together, these findings strongly suggest that the T 27863 C mutation in the eNOS gene reduces the endothelial NO synthesis and predisposes the patients with the mutation to coronary spasm. (Circulation. 1999;99:2864-2870.)

Masafumi Nakayama; Hirofumi Yasue; Michihiro Yoshimura; Yukio Shimasaki; Kiyotaka Kugiyama; Hisao Ogawa; Takeshi Motoyama; Yoshihiko Saito; Yoshihiro Ogawa; Yoshihiro Miyamoto; Kazuwa Nakao

28

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))

1989-08-01

29

Hand or foot spasms  

MedlinePLUS

Foot spasms; Carpopedal spasm; Spasms of the hands or feet; Hand spasm ... Cramps or spasms in the muscles often have no clear cause. Possible causes of hand or foot spasms include: Abnormal levels ...

30

Coronary artery spasm  

MedlinePLUS

... 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 ...

31

Myocardial Infarction Temporally Related to Ephedra - A Possible Role for the Coronary Microcirculation  

Microsoft Academic Search

Myocardial infarction has been reported with ephedrine and pseudoephedrine use. It has been sug- gested that these agents may induce coronary artery spasm, hypercoagulable states, or oxygen demand imbalance. We report a 25-year-old male with my- ocardial infarction after receiving a diet pill contain- ing ephedra. Coronary angiography revealed normal coronary arteries with very slow flow, suggestive of microcirculation abnormalities.

Shereif H. Rezkalla; Juan Mesa; Param Sharma; Robert A. Kloner

32

Coronary vasospasm and acute myocardial infarction induced by a topical capsaicin patch.  

PubMed

Capsaicin is the active component of chili peppers, which has been shown to possess several beneficial effects. Currently, the best-known medical use of capsaicin is as a topical painkiller. Drug-induced myocardial infarction is not a common phenomenon and the underlying mechanism has been related with coronary spasm in the majority of cases. We present a 29-year-old man who experienced coronary vasospasm and acute myocardial infarction (AMI) which were possibly induced by the use of a topical capsaicin patch to relieve lumbago. He presented with chest pain of one hour onset. The electrocardiogram showed ST-segment elevation in the leads II, III, and aVF, consistent with inferior wall AMI. Echocardiography confirmed inferior hypokinesia. Urgent coronary angiography showed normal right and left coronary arteries. Since he had no cardiac risk factors for coronary artery disease, nor a history of recent emotional or physical stress, or ingestion of any illicit substance, the vasospasm and subsequent AMI was attributed to the use of the capsaicin patch for six days. Upon institution of appropriate treatment and removal of the patch, no new anginal attacks or ischemic episodes were seen within a follow-up of one month. This is the first case report of AMI induced by the use of a topical capsaicin patch. PMID:20098047

Akçay, Adnan Burak; Ozcan, Türkay; Seyis, Sabri; Acele, Arma?an

2009-10-01

33

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))

1988-03-01

34

Effect of atenolol and celiprolol on acetylcholine-induced coronary vasomotion in coronary artery disease  

Microsoft Academic Search

Earlier studies have reported on the potentiated muscarinic vasoconstriction of intracoronary acetylcholine after metoprolol application in patients with coronary artery disease. The present study investigated the effect of celiprolol, atenolol, and placebo on acetylcholine-induced vasomotion in patients with coronary artery disease. Furthermore, direct effects on coronary vasomotion and on hemodynamics were evaluated. Acetylcholine (intracoronary concentrations of 6.3 × 10?7, 2.0

Wolfram Burger; Christian Hampel; Martin Kaltenbach; Andreas Hartmann; Manfred Herrmann; Josef A Hoffmann; Harald Klepzig

2000-01-01

35

Potentiation by endothelin-1 of 5-hydroxytryptamine-induced contraction in coronary artery of the pig.  

PubMed Central

1. In order to elucidate the physiological and potential pathological roles of endothelin-1 (ET-1) in coronary artery contraction and relaxation, we undertook the present study to examine the action of ET-1 itself, and the combined effects of ET-1 with vasoconstrictor agonists such as acetylcholine (ACh), histamine, and 5-hydroxytryptamine (5-HT), all of which have been implicated in the genesis of coronary spasm. 2. Isometric tension and cytosolic Ca2+ concentration ([Ca2+]i) in a ring segment of porcine coronary artery loaded with fura-2 were measured simultaneously. 3. ET-1 contracted the artery in a concentration-dependent manner; and nisoldipine, a Ca2+ channel blocking drug of the 1,4-dihydropyridine type, antagonized the ET-1 action non-competitively. A radio-receptor binding assay also indicated the mutually exclusive binding of ET-1 and (+)-[3H]-PN200-110, a Ca2+ channel ligand, to the membrane fraction of porcine coronary artery. 4. ET-1 (10-100 pM) increased tension and [Ca2+]i in a parallel manner, while at higher concentrations (1-10 nM) it produced further contraction with a small increase in [Ca2+]i. 5. ET-1 (30-100 pM) selectively potentiated the 5-HT-induced contraction 1.5 to 2 times over the control without causing a significant increase in [Ca2+]i, which seems to be qualitatively similar to a tumour promoting phorbol ester, 12-deoxyphorbol 13-isobutylate (DPB). Bay K 8644 (10 nM), on the other hand, potentiated the contraction in response to practically all agonists used and affected a concomitant increase in [Ca2+]i.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1810605

Nakayama, K.; Ishigai, Y.; Uchida, H.; Tanaka, Y.

1991-01-01

36

Latanoprost in hemifacial spasm  

Microsoft Academic Search

An empirical observation that the prostaglandin derivate latanoprost quited facial spasms in patients with glaucoma prompted us to study latanoprost in non-glaucomatous patients with hemifacial spasms [HFS]. This explorative trial followed an open-label, prospective treatment design. At short term, most patients showed no or only mild improvement and subsequently needed therapy with Botulinum toxin A. Although these results are not

Luc Crevits; Maarten Goethals; Niels Libbrecht; Koen Paemeleire

2002-01-01

37

Radiation-induced coronary artery disease  

SciTech Connect

This report describes three patients who developed myocardial infarction at an untimely age, 4 to 12 years after radiation therapy for Hodgkin's disease. These cases lend credence to the cause and effect relation of such therapy to coronary artery disease.

Dunsmore, L.D.; LoPonte, M.A.; Dunsmore, R.A.

1986-07-01

38

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

2008-01-01

39

Exercise-induced regional dysfunction with subcritical coronary stenosis.  

PubMed

The hypothesis was tested that regional myocardial contractile dysfunction can detect subtle regional coronary blood flow maldistribution induced by exercise. In seven dogs, left ventricular pressure (micromanometer), regional systolic wall thickening (WTh, sonomicrometry), and myocardial blood flow (MBF, microspheres) were measured when mild degrees of coronary artery stenosis were produced during treadmill exercise. During exercise without coronary stenosis, WTh increased by 21 +/- 12% (SD), and transmural MBF increased uniformly. In each dog, two levels of coronary stenosis were produced during exercise by adjusting the coronary hydraulic cuff: (1) St-Ex I, where WTh during exercise failed to increase significantly (average change 0 +/- 7%), and (2) St-Ex II, where WTh during exercise decreased moderately from the resting control value (average -20 +/- 8%). In the potentially ischemic zone coronary hyperemia occurred with each run: resting subendocardial MBF was 1.09 +/- 0.30 mg/g/min, and it was 3.04 +/- 0.83 during control exercise, 2.48 +/- 0.75 during St-Ex I, and 1.55 +/- 0.59 ml/g/min during St-Ex II (p less than .01 compared with control exercise and control area). The subendocardial-subepicardial blood flow ratio fell from 1.32 +/- 0.27 during control exercise to 1.07 +/- 0.20 (p less than .05) during St-Ex I, and to 0.64 +/- 0.15 (p less than .01) with St-Ex II. Changes in the subendocardial electrogram and reactive hyperemia occurred more consistently during St-Ex II than St-Ex I. Thus, failure of regional function to increase during exercise detected slight maldistribution of regional MBF, whereas reduction of regional function during exercise of 10% or more below the resting value was a reliable marker of a regional flow defect and was always associated with other evidence of ischemia. Therefore, regional dysfunction during exercise can detect subcritical but functionally significant coronary stenosis, which may allow regional wall motion to be used for detecting coronary artery disease at a relatively early stage. PMID:3512122

Lee, J D; Tajimi, T; Guth, B; Seitelberger, R; Miller, M; Ross, J

1986-03-01

40

Experimental coronary sclerosis induced by immobilization of rabbits: A new model of arteriosclerosis  

NASA Technical Reports Server (NTRS)

A new method for producing arteriosclerosis with coronary insufficiency in rabbits by means of immobilization is described and discussed. The experimentally induced atherosclerosis develops due to hypodynamics imposed by the reduced muscular activity without overloading with exogenous cholesterol. The atherosclerosis and coronary insufficiency are associated. With variations in the duration and extent of immobilization, coronary insufficiency alone or with atherosclerosis can be produced.

Tyavokin, V. V.; Tjawokin, W. W.

1980-01-01

41

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))

1989-11-01

42

Hemifacial spasm: Successful treatment with felbamate  

Microsoft Academic Search

Medical treatment of hemifacial spasm has generally been ineffectual. This report describes a 36 year-old man with a 7-year history of right hemifacial spasm who responded to felbamate (Felbatol®) at doses of 1800–2800 mg per day. During treatment, he was able to achieve complete control of all spontaneous facial muscle spasms at rest. Activated hemifacial spasms, initiated by chewing, speaking,

Gary A. Mellick

1995-01-01

43

Hemifacial spasm and involuntary facial movements  

Microsoft Academic Search

Summary Hemifacial spasm (HFS) is characterized by tonic and clonic contractions of the muscles innervated by the ipsilateral facial nerve. It is important to distinguish this from other causes of facial spasms, such as psychogenic facial spasm, facial tic, facial myokymia, blepharospasm, and tardive dyskinesia. Magnetic resonance imaging and angiography studies frequently demonstrate vascular compression of the root exit zone

N.-C. TAN; L.-L. CHAN; E.-K. TAN

2002-01-01

44

Reversal of rejection-induced coronary vasculitis detected early after heart transplantation with increased immunosuppression.  

PubMed

Four patients who underwent heart transplantation, in whom coronary obstruction was seen early after transplantation, are described. Repeated acute rejection episodes were detected within the first 2 months in each patient. Coronary obstruction or ischemia was shown through a combination of T1-201 isotopic study findings, evidence of vasculitis of a small coronary arteriole seen at endomyocardial biopsy, or coronary angiographic results. Vigorous treatment for rejection (antithymocyte globulin and bolus methylprednisolone) was given, and coronary artery lesions or myocardial ischemia resolved after treatment. Rejection-induced coronary obstruction should be considered in patients with repeated acute rejection episodes who are predisposed to the development of vascular rejection. Early after transplantation such obstruction is caused by diffuse vasculitis of small and medium-sized vessels and may be reversed with increased immunosuppression. PMID:2795284

Ballester, M; Obrador, D; Carrió, I; Bordes, R; Augé, J M; Crexells, C; Oriol, A; Padró, J M; Arís, A; Caralps, J M

1989-01-01

45

Control of coronary vasomotor tone in ischaemic myocardium by local metabolism and neurohumoral mechanisms.  

PubMed

There is no doubt that under normal conditions powerful local metabolic regulation adjusts coronary blood flow to myocardial oxygen consumption. However, despite substantial experimental efforts the responsible mediators are still largely unknown. Adenosine, a purported mediator of local metabolic control of coronary blood flow, is probably only involved in transient flow adaptations but not in steady state coronary autoregulation. Even below the autoregulatory range a substantial vasodilator reserve persists, and recruitment of such a vasodilator results in improved regional myocardial blood flow and attenuated regional ischaemic dysfunction. Beta-adrenergic coronary dilation is of minor functional importance. Alpha-adrenergic coronary constriction acts to attenuate increases in coronary blood flow during sympathetic activation under normal conditions, so that myocardial oxygen extraction increases to match the increased oxygen consumption. Alpha-adrenergic coronary constriction remains operative in ischaemic myocardium, thus precipitating or contributing to acute myocardial ischaemia during sympathetic activation and exercise in experimental animals, as well as in patients with stable angina. The vagal transmitter acetylcholine-upon exogenous intracoronary infusion-induces critical constriction of epicardial coronary arteries with endothelial dysfunction and atherosclerosis. However, a vagal initiation of coronary spasm or myocardial ischaemia has not been documented so far. Similarly, peptide hormones/transmitters such as NPY, vasopressin and angiotensin can induce myocardial ischaemia upon exogenous administration. Their pathophysiological role in myocardial ischaemia, however, remains to be established. PMID:1666559

Heusch, G

1991-12-01

46

Placental Induced Growth Factor (PIGf) in Coronary Artery Disease  

NASA Technical Reports Server (NTRS)

Our previous studies on normal human lymphocytes have shown a five-fold increase (p less than 0.001) in angiogenic inducers such as Placental Induced Growth Factor (PIGf) in physiologically stressful environments such as modeled microgravity, a space analog. This suggests de-regulation of cardiovascular signalling pathways indicated by upregulation of PIGf. In the current study, we measured PIGf in the plasma of 33 patients with and without coronary artery disease (CAD) to investigate whether such disease is associated with increased levels of PIGf. A control consisting of 31 sex matched apparently healthy subjects was also included in the study. We observed that the levels of PIGf in CAD patients were significantly increased compared to those in healthy control subjects (p less than 0.001) and usually increased beyond the clinical threshold level (greater than 27ng/L). The mechanisms leading to up-regulation of angiogenic factors and the adaptation of organisms to stressful environments such as isolation, high altitude, hypoxia, ischemia, microgravity, increased radiation, etc are presently unknown and require further investigation in spaceflight and these other physiologically stressed environments.

Sundaresan, Alamelu; Carabello, Blaise; Mehta, Satish; Schlegel, Todd; Pellis, Neal; Ott, Mark; Pierson, Duane

2010-01-01

47

Protective effect of total flavones from Elsholtzia blanda (TFEB) on myocardial ischemia induced by coronary occlusion in canines  

Microsoft Academic Search

This study was undertaken to determine the effect of total flavones from Elsholtzia blanda (Benth.) Benth. (TFEB), a traditional Chinese medicine, on myocardial ischemia induced by coronary occlusion in Beagle dogs. Infarct size of left ventricle, serum activity of creatine kinase-MB (CK-MB) and malondialdehyde (MDA), hemorrheologic variables and homodynamic parameters including mean arterial pressure (MAP), coronary blood flow (CBF), coronary

Ling Haiyun; Lou Yijia; Lou Honggang; Wu Honghai

2004-01-01

48

Imaging of cocaine-induced global and regional myocardial ischemia  

SciTech Connect

Severe and often fatal cardiac complications have been reported in cocaine users with narrowed coronary arteries caused by atherosclerosis as well as in young adults with normal coronaries. The authors have found that in normal dogs cocaine induces severe temporary hypoperfusion of the left ventricle as indicated by a significantly lower 201Tl concentration compared to the baseline state. The most significant decrease in uptake occurred 5 min after injection and was more pronounced in the septal and apical segments. Following intravenous administration of cocaine, instead of gradual disappearance of 201Tl from the left ventricle, there was continuous increase in 201Tl concentration in the left ventricle. These imaging experiments indicate that the deleterious effects of cocaine on the heart are probably due to spasm of the coronaries and decreased myocardial perfusion. Since spasm of the large subpericardial vessels does not seem to explain the magnitude of the increased coronary resistance and decreased coronary flow after cocaine as described in the literature, it is suggested that microvascular spasm of smaller vessels plays a major role in the temporary decrease in perfusion. The data may also suggest that severe temporary myocardial ischemia is probably the initiating factor for the cardiac complications induced by cocaine.

Oster, Z.H.; Som, P.; Wang, G.J.; Weber, D.A. (Brookhaven National Laboratory, Medical Department, Upton, New York (USA))

1991-08-01

49

Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions  

Microsoft Academic Search

Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions.BackgroundThe relationship between low hematocrit and contrast-induced nephropathy has not been investigated.MethodsOf 6,773 consecutive patients treated with percutaneous coronary intervention, contrast-induced nephropathy (an increase of ?25% or ?0.5 mg\\/dL in preprocedure serum creatinine, at 48 hours postprocedure) occurred in 942 (13.9%) patients.ResultsRates of contrast-induced nephropathy steadily increased as baseline hematocrit quintile decreased

EUGENIA NIKOLSKY; ROXANA MEHRAN; ZORAN LASIC; Gary S. Mintz; Alexandra J. Lansky; YINGBO NA; STUART POCOCK; MANUELA NEGOITA; ISSAM MOUSSA; Gregg W. Stone; Jeffrey W. Moses; Martin B. Leon; GEORGE DANGAS

2005-01-01

50

Activation of serotonin 5-HT? receptor induces coronary flow increase in isolated rat heart.  

PubMed

Serotonin (5-Hydroxytryptamine, 5-HT) can elicit both vasoconstrictive and relaxant responses on rat coronary artery. The constrictive response has been well discussed, but the mechanism of relaxant response is less studied. In the present study, we found serotonin (0.3 and 1 ?M) increased coronary flow on isolated rat hearts, and treatment of nitric oxide synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) 300 ?M reduced but not totally blocked this coronary flow increasing effect. In L-NAME 10 ?M treated heart, treatment of selective serotonin 5-HT? receptor antagonist SB269970 0.1 ?M blocked serotonin induced coronary flow increasing response, and in the presence of 1 ?M SB269970, serotonin turned into reducing coronary flow. Treatment of TCW295 (8-(2,4-Dimethoxyphenyl)-6-methoxy-2-phenethyl-1,2,3,4-tetrahydroisoquinolin-7-ol hydrochloride), a novel serotonin 5-HT?A/? receptor antagonist, inhibited both serotonin induced coronary flow increasing and decreasing effects. In conclusion, we found serotonin increases coronary flow of isolated rat heart by activating serotonin 5-HT? receptor activation, and this effect can be, at least partially, resistant to L-NAME. PMID:25196212

Chang Chien, Ching-Chia; Hsin, Ling-Wei; Su, Ming-Jai

2015-02-01

51

BMPER-induced BMP signaling promotes coronary artery remodeling  

PubMed Central

Summary The connection of the coronary vasculature to the aorta is one of the last essential steps of cardiac development. However, little is known about the signaling events that promote normal coronary artery formation. The bone morphogenetic protein (BMP) signaling pathway regulates multiple aspects of endothelial cell biology but has not been specifically implicated in coronary vascular development. BMP signaling is tightly regulated by numerous factors, including BMP-binding endothelial cell precursor-derived regulator (BMPER), which can both promote and repress BMP signaling activity. In the embryonic heart, BMPER expression is limited to the endothelial cells and the endothelial-derived cushions, suggesting that BMPER may play a role in coronary vascular development. Histological analysis of BMPER?/? embryos at early embryonic stages demonstrates that commencement of coronary plexus differentiation is normal and that endothelial apoptosis and cell proliferation are unaffected in BMPER?/? embryos compared with wild-type embryos. However, analysis between embryonic days 15.5-17.5 reveals that, in BMPER?/? embryos, coronary arteries are either atretic or connected distal to the semilunar valves. In vitro tubulogenesis assays indicate that isolated BMPER?/? endothelial cells have impaired tube formation and migratory ability compared with wild-type endothelial cells, suggesting that these defects may lead to the observed coronary artery anomalies seen in BMPER?/? embryos. Additionally, recombinant BMPER promotes wild-type ventricular endothelial migration in a dose-dependent manner, with a low concentration promoting and high concentrations inhibiting migration. Together, these results indicate that BMPER-regulated BMP signaling is critical for coronary plexus remodeling and normal coronary artery development. PMID:24373957

Dyer, Laura; Wu, Yaxu; Moser, Martin; Patterson, Cam

2014-01-01

52

[Infantile spasms and modified hypsarrhythmia].  

PubMed

The West syndrome was described by the physician West in his own son in 1841 and is defined as a triad of myoclonic seizures called "infantile spasms", electrographic abnormalities called "hypsarrhythmia" and arrest of psychomotor development and mental retardation. These symptoms are so pathognomonic that the impression is that the syndrome is caused by a single mechanism, but actually there is heterogeneity of etiologies, different recommendations of treatment and prognosis. The West syndrome was established as an infantiLe epileptic syndrome (ILAE Task Force, 1989). Infantile spasm is the most common epileptic syndrome during infancy and entails 50% of all epilepsies between ages one month to one year. Its incidence is 1:3200-3500 live births. Despite its absolute definition, the variability of etiologies, clinical presentation and electrographic make it difficult to set rigid, clear treatment guidelines and research methodology. This review aims to present modified hypsarrhythmia, the etiologies and prognosis of symptomatic infantile spasms, and emphasize the importance of early recognition of modified hypsarrhythmia by surveillance of electroencephalograms. PMID:22164920

Halevy, Ayelet; Kiviti, Sara; Goldberg-Stern, Hadassa; Shuper, Avinoam

2011-04-01

53

Radiation-induced stenosis of the left main coronary artery  

SciTech Connect

A case of isolated left main coronary artery stenosis ten years following irradiation of the mediastinum for Hodgkin's disease is presented. Aortic biopsies were consistent with changes suggestive of radiation arteritis.

Tenet, W.; Missri, J.; Hager, D.

1986-01-01

54

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)

1998-05-15

55

Atorvastatin and prevention of contrast induced nephropathy following coronary angiography  

PubMed Central

Background: Contrast induced nephropathy (CIN) is one of the most common complications after radiographic procedures using intravascular radiocontrast media. The aim of the current study was to assess the effect of atorvastatin on prevention of CIN in patients undergoing coronary angiography. Materials and Methods: In a clinical trial study, 200 patients referred for angiography were randomly divided into two groups of using 80 mg atorvastatin and placebo before the procedure. Furthermore, 100 patients who were under chronic treatment of statins were included as the third group. Serum creatinine (Scr) levels before and after the procedure were evaluated and incidence of CIN (post-procedural Scr of >0.5 mg/dl or >25% from baseline) was assessed. Results: Mean age of the participants was 60.06 ± 0.69 years and 276 (92%) were male. There were no significant differences between group with respect to age and gender. In pre-operation atorvastatin, placebo and long term statin groups, the incidence of CIN was 1%, 2% and 1%, and mean changes of Glomerular filtration rate (GFR) was 3.68 ± 1.32, ?0.77 ± 1.21 and 1.37 ± 0.86; and mean changes of creatinine (Cr) was ?0.05 ± 0.02, 0.02 ± 0.02 and ?0.01 ± 0.01 respectively. (P = 0.776, 0.026 and 0.041 respectively). In pre-operation atorvastatin group, Cr decreased, and GFR increased significantly (P = 0.019 and 0.007 respectively). Conclusion: pre-operation short term high dose atorvastatin use was associated with a significant decrease in serum Cr level and increase in GFR after angiography.

Bidram, Peyman; Roghani, Farshad; Sanei, Hamid; Hedayati, Zahraparin; Golabchi, Allahyar; Mousavi, Mehdi; Hajiannejad, Alireza; Pourheidar, Behrouz; Badalabadi, Mehdi Mohseni; Gharaati, Maryam; Akhbari, Mohammadreza; Salesi, Asieh

2015-01-01

56

Vasoreactivity in isolated perfused atherosclerotic human coronary arteries.  

PubMed

Atherosclerosis may be important in the modulation of arterial vasoreactivity and coronary artery flow. Since the endothelium is reduced or absent in atherosclerosis, drug effects are enhanced or modulated. To examine this hypothesis, vasoreactivity induced by serotonin (5-HT) was studied in isolated, perfused, and pharmacologically responsive normal and atherosclerotic human coronary arteries obtained within five hours post mortem. In this model, flow was maintained through the vessels and the effects of vasospasm and vasorelaxation on decreasing and increasing flow respectively were measured. Vessels 3 cm long and approximately 1.5 mm in internal diameter were dissected free and perfused at constant pressure (30 mm Hg) with oxygenated Krebs bicarbonate solution. 5-HT was introduced in the perfusate at 10(-5) M final concentration as a pulse of 100 ml followed by a 1-l washout with drug-free solution. Flow rate and total flow were measured. Normal and atherosclerotic coronary arteries showed peak reductions in flow rate of 22% and 92% respectively, while the times to peak reduction of flow averaged 6 and 4 min and the times to 50% relaxation averaged 13 and 24 min. Ultrasound imaging showed that heavily atherosclerotic regions with extensive focal plaque maintained the induced spasm for a longer period than regions with less disease within the same vessel. Silver nitrate staining showed that these heavily atherosclerotic regions were devoid of endothelium. Thus, atherosclerotic human coronary arteries show a larger magnitude of spasm which persists for a longer period of time as compared to normal coronaries.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3225133

Morcos, N C; Purdy, R E; Henry, W L

1988-01-01

57

Practice Parameter: Medical Treatment of Infantile Spasms  

PubMed Central

Objective To determine the current best practice for treatment of infantile spasms in children. Methods Database searches of MEDLINE from 1966 and EMBASE from 1980 and searches of reference lists of retrieved articles were performed. Inclusion criteria were the documented presence of infantile spasms and hypsarrhythmia. Outcome measures included complete cessation of spasms, resolution of hypsarrhythmia, relapse rate, developmental outcome, and presence or absence of epilepsy or an epileptiform EEG. One hundred fifty-nine articles were selected for detailed review. Recommendations were based on a four-tiered classification scheme. Results Adrenocorticotropic hormone (ACTH) is probably effective for the short-term treatment of infantile spasms, but there is insufficient evidence to recommend the optimum dosage and duration of treatment. There is insufficient evidence to determine whether oral corticosteroids are effective. Vigabatrin is possibly effective for the short-term treatment of infantile spasm and is possibly also effective for children with tuberous sclerosis. Concerns about retinal toxicity suggest that serial ophthalmologic screening is required in patients on vigabatrin; however, the data are insufficient to make recommendations regarding the frequency or type of screening. There is insufficient evidence to recommend any other treatment of infantile spasms. There is insufficient evidence to conclude that successful treatment of infantile spasms improves the long-term prognosis. Conclusions ACTH is probably an effective agent in the short-term treatment of infantile spasms. Vigabatrin is possibly effective. PMID:15159460

Mackay, M.T.; Weiss, S.K.; Adams-Webber, T.; Ashwal, S.; Stephens, D.; Ballaban-Gill, K.; Baram, T.Z.; Duchowny, M.; Hirtz, D.; Pellock, J.M.; Shields, W.D.; Shinnar, S.; Wyllie, E.; Snead, O.C.

2010-01-01

58

Muscle metaboreflex-induced coronary vasoconstriction functionally limits increases in ventricular contractility.  

PubMed

Muscle metaboreflex activation during dynamic exercise induces a substantial increase in cardiac work and oxygen demand via a significant increase in heart rate, ventricular contractility, and afterload. This increase in cardiac work should cause coronary metabolic vasodilation. However, little if any coronary vasodilation is observed due to concomitant sympathetically induced coronary vasoconstriction. The purpose of the present study is to determine whether the restraint of coronary vasodilation functionally limits increases in left ventricular contractility. Using chronically instrumented, conscious dogs (n = 9), we measured mean arterial pressure, cardiac output, and circumflex blood flow and calculated coronary vascular conductance, maximal derivative of ventricular pressure (dp/dt(max)), and preload recruitable stroke work (PRSW) at rest and during mild exercise (2 mph) before and during activation of the muscle metaboreflex. Experiments were repeated after systemic alpha(1)-adrenergic blockade ( approximately 50 microg/kg prazosin). During prazosin administration, we observed significantly greater increases in coronary vascular conductance (0.64 + or - 0.06 vs. 0.46 + or - 0.03 ml x min(-1) x mmHg(-1); P < 0.05), circumflex blood flow (77.9 + or - 6.6 vs. 63.0 + or - 4.5 ml/min; P < 0.05), cardiac output (7.38 + or - 0.52 vs. 6.02 + or - 0.42 l/min; P < 0.05), dP/dt(max) (5,449 + or - 339 vs. 3,888 + or - 243 mmHg/s; P < 0.05), and PRSW (160.1 + or - 10.3 vs. 183.8 + or - 9.2 erg.10(3)/ml; P < 0.05) with metaboreflex activation vs. those seen in control experiments. We conclude that the sympathetic restraint of coronary vasodilation functionally limits further reflex increases in left ventricular contractility. PMID:20413426

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

2010-08-01

59

Measurement of interstitial lactate during hypoxia-induced dilatation in isolated pressurised porcine coronary arteries  

PubMed Central

Lactate is formed in the coronary arterial wall and in the myocardium as a consequence of ischaemia and infarction. We combined direct measurement of coronary artery diameter and interstitial arterial wall lactate concentration ex vivo in order to ascertain the possible role of lactate in hypoxia-induced vasodilatation. The wall of porcine coronary arteries, precontracted during an intraluminal pressure of 40 mmHg by addition of prostaglandin F2?, was cannulated using a microdialysis catheter, and exposed to hypoxia for 60 min, followed by 45 min of reoxygenation. The exchange fraction of [14C]lactate over the microdialysis membrane increased from 0.38 ± 0.04 to 0.52 ± 0.05 (P < 0.001) during the study period. Coronary artery diameter increased by 15.5 ± 2.0 % (n = 20) during hypoxia (P < 0.001, compared to normoxic controls) and interstitial lactate concentration rose from 1.07 ± 0.21 to 2.50 ± 0.40 mmol l?1 during hypoxia (P < 0.01) and was unchanged in controls. The increase in coronary artery diameter correlated with the increase in interstitial lactate concentration in the period between 30 and 60 min of hypoxia (r = 0.62; P = 0.02). Dichloroacetate (10?5m), an agent that reduces lactate generation by activating pyruvate dehydrogenase, abolished hypoxia-induced lactate production, but caused a further increase in coronary arterial diameter (30.2 ± 4.4 %, n = 9; P < 0.001 vs. hypoxia and no dichloroacetate). Under control conditions, the addition of l-lactate (10?3-10?2m) increased dose-dependently coronary arterial diameter by 22.0 ± 4.2 % (n = 5) and interstitial lactate concentration from 0.52 ± 0.04 to 5.70 ± 0.66 mmol l?1 (P < 0.001). There was a correlation between the increase in coronary artery diameter and interstitial lactate concentration (r = 0.60; P = 0.02). The present observations represent the first direct measurements of metabolites by microdialysis in a blood vessel wall. The lactate concentration may affect, but is not essential for, hypoxia-induced vasodilatation in porcine coronary arteries. PMID:11850519

Frřbert, Ole; Mikkelsen, Erich O; Bagger, Jens P; Gravholt, Claus H

2002-01-01

60

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. PMID:22674721

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

2012-01-01

61

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

PubMed

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 gp91(phox) protein. Higher endothelium-dependent vasodilatation by ACh or leptin was abolished with incubation of NOS inhibitor N(G)-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. PMID:22674721

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

2012-09-01

62

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. PMID:23185498

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

2012-01-01

63

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

PubMed

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

2012-01-01

64

Cellular and Pharmacological Targets to Induce Coronary Arteriogenesis  

PubMed Central

The formation of collateral vessels (arteriogenesis) to sustain perfusion in ischemic tissue is native to the body and can compensate for coronary stenosis. However, arteriogenesis is a complex process and is dependent on many different factors. Although animal studies on collateral formation and stimulation show promising data, clinical trials have failed to replicate these results. Further research to the exact mechanisms is needed in order to develop a pharmalogical stimulant. This review gives an overview of recent data in the field of arteriogenesis. PMID:23638831

Hollander, Maurits R.; Horrevoets, Anton J.G.; van Royen, Niels

2014-01-01

65

Genetic and biologic classification of infantile spasms.  

PubMed

Infantile spasms constitute an age-dependent epilepsy, highly associated with cognitive impairment, autism, and movement disorders. Previous classification systems focused on a distinction between symptomatic and cryptogenic etiologies, and have not kept pace with recent discoveries of mutations in genes in key pathways of central nervous system development in patients with infantile spasms. Children with certain genetic syndromes are much likelier to manifest infantile spasms, and we review the literature to propose a genetic classification of these disorders. Children demonstrating genetic associations with infantile spasms also manifest phenotypes beyond epilepsy that may be explained by recent advances in the understanding of underlying biological mechanisms. Therefore we propose a biologic classification of genes highly associated with infantile spasms, and articulate models for infantile spasms pathogenesis based on those data. The two best described pathways of pathogenesis involve abnormalities in the gene regulatory network of gamma-aminobutyric acidergic forebrain development and abnormalities in molecules expressed at the synapse. These genetic and biologic classifications are flexible, and they should encourage much needed progress in syndrome recognition, clinical genetic testing, and the development of new therapies targeting specific pathways of pathogenesis. PMID:22114996

Paciorkowski, Alex R; Thio, Liu Lin; Dobyns, William B

2011-12-01

66

Catheter-induced intimal injury during routine coronary catheterization in dogs.  

PubMed

The location and progression of changes in arterial permeability and structure were studied in nine dogs over a 13-week period following left coronary catheterization with standard coronary catheters. Changes in arterial permeability were analyzed by quantitating Evans blue dye (EBD) uptake over the aortic luminal surface (blue areas). Structural changes were assessed by light and electron microscopy. In the catheterized animals, compared to uncatheterized controls, we observed a significant increase in aortic luminal EBD uptake that was maximal 4 hours after the procedure but still present up to 13 weeks later. Microscopic analysis of "blue areas" shortly after the procedure revealed widespread endothelial denudation, platelet and leukocyte adherence, with occasional intimal avulsions, disruption of the internal elastica, and thrombi. The EBD uptake patterns in association with the electron microscopic findings in these animals suggested that 67-89% of the aortic endothelium was removed by the catheter during the procedure. The proliferative response that occurred following this catheter-induced injury produced fibrocellular intimal thickening in the aortas and left main coronary arteries of animals studied 10 to 92 days after the procedure. In the aortic root, such thickening was associated with incomplete re-endothelialization, thrombogenicity, and grossly abnormal permeability patterns. We conclude that significant catheter-induced intimal injury can occur during coronary angiography. In the canine model, such injury is associated with widespread fibrocellular intimal thickening and abnormal permeability that persists for at least 13 weeks after the procedure. PMID:3815517

Pap, J M

1987-01-01

67

Percutaneous transluminal coronary angioplasty for unstable angina: Predictors of outcome in a multicenter study  

Microsoft Academic Search

Background: Angiographic and clinical studies have demonstrated that coronary artery plaque rupture with thrombus formation, spasm, or both are frequently responsible for the syndrome of unstable angina. Percutaneous transluminal coronary angioplasty (PTCA) is commonly used in the treatment of patients with coronary artery disease and unstable angina. A number of studies have shown, however, that intracoronary thrombus increases the risk

Eric D. Grassman; Ferdinand Leya; Sarah A. Johnson; Bruce E. Lewis; Mark W. Wolfe; John T. Strony; Burt Adelman; John A. Bittl

1994-01-01

68

Hemifacial Spasm and Neurovascular Compression  

PubMed Central

Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve. PMID:25405219

Lu, Alex Y.; Yeung, Jacky T.; Gerrard, Jason L.; Michaelides, Elias M.; Sekula, Raymond F.; Bulsara, Ketan R.

2014-01-01

69

Hemifacial spasm and neurovascular compression.  

PubMed

Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve. PMID:25405219

Lu, Alex Y; Yeung, Jacky T; Gerrard, Jason L; Michaelides, Elias M; Sekula, Raymond F; Bulsara, Ketan R

2014-01-01

70

Exercise left ventricular performance in patients with chest pain, ischemic-appearing exercise electrocardiograms, and angiographically normal coronary arteries  

SciTech Connect

Left ventricular performance was evaluated using first-pass radionuclide angiocardiography in 31 patients with chest pain, an ischemic-appearing exercise electrocardiogram, and angiographically normal coronary arteries at rest and during maximal upright bicycle exercise. /sup 201/Tl imaging was done in all patients after treadmill exercise and in selected patients after ergonovine provocation. Resting left ventricular performance was normal in all patients. An abnormal ejection fraction response to exercise was detected in 12 of 31 patients. Regional dysfunction was present during exercise in four patients, all of whom also had abnormal global responses. Three of these 12 patients and two additional patients had exercise-induced /sup 201/Tl perfusion defects. In all nine patients who underwent ergonovine testing, there was no suggestion of coronary arterial spasm. Thus, left ventricular dysfunction during exercise, in the presence of normal resting performance, was found in a substantial number of patients with chest pain, an ischemic-appearing exercise electrocardiogram, and normal coronary arteries.

Berger, H.J.; Sands, M.J.; Davies, R.A.; Wackers, F.J.; Alexander, J.; Lachman, A.S.; Williams, B.W.; Zaret, B.L.

1981-02-01

71

Argatroban Therapy in Patients with Coronary Artery Disease and Heparin-Induced Thrombocytopenia  

Microsoft Academic Search

The efficacy of the direct thrombin inhibitor argatroban was investigated in patients who developed heparin-induced thrombocytopenia following heparin therapy for coronary artery disease. The outcome of 121 patients treated with argatroban was compared with that of 26 patients in a historical control (i.e. patients who did not receive direct thrombin inhibition therapy). Argatroban, compared with controls, significantly reduced the 37-day

Ik-Kyung Jang; Marcie J. Hursting; David McCollum

2008-01-01

72

Neonatal estradiol stimulation prevents epilepsy in Arx model of X-linked infantile spasms syndrome.  

PubMed

Infantile spasms are a catastrophic form of pediatric epilepsy with inadequate treatment. In patients, mutation of ARX, a transcription factor selectively expressed in neuronal precursors and adult inhibitory interneurons, impairs cell migration and causes a major inherited subtype of the disease X-linked infantile spasms syndrome. Using an animal model, the Arx((GCG)10+7) mouse, we determined that brief estradiol (E2) administration during early postnatal development prevented spasms in infancy and seizures in adult mutants. E2 was ineffective when delivered after puberty or 30 days after birth. Early E2 treatment altered mRNA levels of three downstream targets of Arx (Shox2, Ebf3, and Lgi1) and restored depleted interneuron populations without increasing GABAergic synaptic density. Postnatal E2 treatment may induce lasting transcriptional changes that lead to enduring disease modification and could potentially serve as a therapy for inherited interneuronopathies. PMID:24452264

Olivetti, Pedro R; Maheshwari, Atul; Noebels, Jeffrey L

2014-01-22

73

Neonatal Estradiol Stimulation Prevents Epilepsy in Arx Model of X-Linked Infantile Spasms Syndrome  

PubMed Central

Infantile spasms are a catastrophic form of pediatric epilepsy with inadequate treatment. In patients, mutation of ARX, a transcription factor selectively expressed in neuronal precursors and adult inhibitory interneurons, impairs cell migration and causes a major inherited subtype of the disease X-linked infantile spasms syndrome. Using an animal model, the Arx(GCG)10+7 mouse, we determined that brief estradiol (E2) administration during early postnatal development prevented spasms in infancy and seizures in adult mutants. E2 was ineffective when delivered after puberty or 30 days after birth. Early E2 treatment altered mRNA levels of three downstream targets of Arx (Shox2, Ebf3, and Lgi1) and restored depleted interneuron populations without increasing GABAergic synaptic density. Postnatal E2 treatment may induce lasting transcriptional changes that lead to enduring disease modification and could potentially serve as a therapy for inherited interneuronopathies. PMID:24452264

Olivetti, Pedro R.; Maheshwari, Atul; Noebels, Jeffrey L.

2014-01-01

74

The relationship of coronary flow reserve (CFR) to stress thallium-201 myocardial perfusion (T1) and radionuclide ventriculography (RNV)  

SciTech Connect

Coronary arteriography (CA) can be used to delineate the abnormal anatomy in coronary artery disease (CAD), but the degree of the impairment of coronary blood flow (CBF) cannot be predicted precisely by CA. As a reduction in maximal hyperemic blood flow (MHBF) characterizes a functionally significant coronary lesion, the ratio of contrast-induced MHBF to basal CBF: the coronary flow reserve (CFR) reflects the physiologic significance of a coronary lesion. Recent developments in digital coronary angiography allow CFR to be measured at CA. To assess the relationship of CFR to other noninvasive tests of myocardial perfusion and function the results of stress T1 and RNV were compared to those of CA and CFR for the distribution of 48 arteries in 20 patients. Seven patients had normal CA without spasm: 3 with abnormal CFR had a discrete T1 defect or global RNV dysfunction. The remaining 4 had normal CFR, T1 and RNV. Thirteen had CAD without prior infarction. Segmental T1 and RNV were compared to CA and CFR. Normal CFR was seen in patients with both normal T1 and RNV; while T1 was best associated with abnormal CFR in CAD and may be the preferable noninvasive modality to identify physiologically significant, abnormal CBF in suspected cases of CAD.

Le Grand, V.; Vogel, R.; Gross, M.D.; Mancini, J.

1984-01-01

75

Celiprolol induces ?(3)-adrenoceptors-dependent relaxation in isolated porcine coronary arteries.  

PubMed

In porcine coronary arteries (PCAs), celiprolol, a selective ?(1)-adrenoceptors antagonist, induces vasodilatation by an endothelium- and nitric oxide (NO)-dependent pathway. However, the mechanisms of that vascular effect have not been precisely established. ?(3)-Adrenoceptors have been shown to be involved in the relaxation per se of various vascular beds, including coronary vessels. Thus, we evaluated (i) the presence of ?(3)-adrenoceptors in the PCA and (ii) their role in celiprolol-induced vasodilatation. PCA rings were placed in organ baths and preconstricted with KCl. All experiments were performed in the presence of nadolol (a ?(1)/?(2)-adrenoceptor antagonist). Cumulative concentration-response curves to SR 58611A and ICI 215001 (2 ?(3)-adrenoceptor agonists) and to celiprolol were constructed. We also used semiquantitative reverse transcription - polymerase chain reaction, which clearly showed the presence of ?(3)-adrenoceptor transcripts. SR 58611A, ICI 215001, and celiprolol induced concentration-dependent relaxations in PCA rings. SR 58611A-induced relaxation was almost abolished after removal of endothelium or pretreatment with L-NAME (a NO synthase inhibitor). The vasorelaxations induced by SR 58611A and celiprolol were inhibited in the presence of SR 59230A and L-748337 (2 selective ?(3)-adrenoceptor antagonists). We showed (i) that PCAs possess functional ?(3)-adrenoceptors mediating endothelium- and NO-dependent relaxation, and (ii) that celiprolol exerts a ?(3)-adrenoceptor agonistic activity in this vascular bed. PMID:24144049

Abdelkrim, Mohammed Amine; Martignat, Lionel; Gogny, Marc; Desfontis, Jean-Claude; Noireaud, Jacques; Mallem, Mohamed Yassine

2013-10-01

76

Contrast between innovator drug- and generic drug-induced renal dysfunction on coronary angiography (CONTRAST study).  

PubMed

Contrast-induced nephropathy (CIN) has gained increasing attention in clinical practice, particularly during coronary angiography (CAG). However, some "bioequivalent" generic (GE) drugs are less effective than the innovator (IN) drug. Therefore, the aim of this study was to compare contrast media (IN drug)-induced renal dysfunction with contrast media (GE drug)-induced dysfunction. We enrolled 44 patients who underwent elective CAG or percutaneous coronary intervention (PCI) and randomly divided them into two groups that received contrast media (Iohexol, nonionic and low-osmolality contrast agent) containing either IN drug (Omnipaque) or GE drug (Iopaque). Blood and urine sampling were performed before and after (24 and 48 h) CAG or PCI. Biochemical parameters in blood (serum creatinine, cystatin C, high-sensitivity C-reactive protein, and pentraxin-3) and urine (urinary albumin/Cr and liver-type fatty acid binding protein/Cr) were measured. There were no significant differences in the biochemical parameters at baseline between the groups. In addition, there were no differences in changes in biochemical parameters in blood and urine before and after CAG or PCI between the groups, although one patient in the GE group had CIN. The degree of contrast in Iopaque-induced renal dysfunction was comparable with that in Omnipaque-induced dysfunction. PMID:24072136

Nakamura, Ayumi; Miura, Shin-Ichiro; Sugihara, Makoto; Miyase, Yuiko; Norimatsu, Kenji; Shiga, Yuhei; Nishikawa, Hiroaki; Saku, Keijiro

2014-09-01

77

Thrombolytic efficacy of recombinant human microplasmin in a canine model of copper coil-induced coronary artery thrombosis  

Microsoft Academic Search

We investigated the in vitro fibrinolytic properties of microplasmin, the isolated proteinase domain of plasmin, and its thrombolytic\\u000a efficacy in a coronary artery thrombosis model in dogs. The amidolytic and fibrinolytic activity of recombinant microplasmin\\u000a was compared with natural human plasmin. The thrombolytic efficacy of microplasmin was studied in a canine model of copper\\u000a coil induced coronary artery thrombosis. Animals

Christophe Dommke; Oliver Turschner; Jean-Marie Stassen; Frans Van de Werf; H. Roger Lijnen; Peter Verhamme

2010-01-01

78

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))

1990-11-01

79

Serotonin, atherosclerosis, and collateral vessel spasm  

NASA Technical Reports Server (NTRS)

Studies on animal models demonstrate that platelet products contribute to vascular spasm in ischemic syndromes and that this is reversible with administration of ketanserin and thromboxane synthesis inhibitors. Laboratory animals (dogs, rabbits, and rats) that had femoral artery ligations exhibited supersensitivity to serotonin within days in their collateral blood vessels. This supersensitivity lasted at least 6 months. The response to serotonin was reversed by ketanserin, but not by 5HT-1 antagonists. Supersensitivity does not extend to norepinephrine, and alpha blockers do not influence the response to serotonin. It appears that platelet activation by endothelial injury contributes to ischemia through blood vessel occlusion and vascular spasm. When platelet activation occurs in vivo, blood vessel occlusion and vascular spasm are reversible in part by using ketanserin or agents that block thromboxane synthesis or its action. Combining both classes of agents reverses spasm completely. These findings support existing evidence that platelet products contribute to vascular disease, and provide an approach to improved management with currently available pharmacologic agents.

Hollenberg, N.

1988-01-01

80

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

1971-01-01

81

Enhanced cAMP-induced nitric oxide-dependent coronary dilation during myocardial stunning in conscious pigs.  

PubMed

The goal of the current study was to determine the effects of cAMP-mediated coronary reactivity in conscious pigs with stunned myocardium induced by 1.5 h coronary stenosis (CS) and 12 h coronary artery reperfusion (CAR). Domestic swine (n = 5) were chronically instrumented with a coronary artery blood flow (CBF) probe, hydraulic occluder, left ventricular pressure gauge, wall-thickening crystals in the ischemic and nonischemic zones, and a coronary sinus catheter. The hydraulic occluder was inflated to induce a CS with a stable 38 +/- 1% reduction in CBF for 1.5 h. Before flow reduction and during CAR, cAMP-induced coronary vasodilation was investigated by forskolin (20 nmol. kg(-1). min(-1)). Enhanced CBF responses [+62 +/- 9%, P < 0.05, compared with pre-CS (+37 +/- 3%)] were observed for forskolin at 12 h after CAR as well as for bradykinin and reactive hyperemia. With the use of a similar protocol during systemic nitric oxide (NO) synthase inhibition with N(omega)-nitro-L-arginine (30 mg. kg(-1). day(-1) for 3 days), the enhanced CBF responses to forskolin, bradykinin, and reactive hyperemia were not observed after CS. Isolated microvessel preparations from pigs (n = 8) also demonstrated enhanced NO production to direct stimulation of adenylyl cyclase with forskolin (+71 +/- 12%) or NKH-477 (+60 +/- 10%) and administration of 8-bromo-cAMP (+74 +/- 13%), which were abolished by protein kinase A or NO synthase inhibition. These data indicate that cAMP stimulation elicits direct coronary vasodilation and that this action is amplified in the presence of sustained myocardial stunning after recovery from CS. This enhanced cAMP coronary vasodilation is mediated by an NO mechanism that may be involved in myocardial protection from ischemic injury. PMID:11087254

Kudej, R K; Zhang, X P; Ghaleh, B; Huang, C H; Jackson, J B; Kudej, A B; Sato, N; Sato, S; Vatner, D E; Hintze, T H; Vatner, S F

2000-12-01

82

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/min.mm Hg in the group with ST depression compared with 1,179 +/- 1,417 beats/min.mm 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.

1988-07-01

83

Stereoselective inhibition of thromboxane-induced coronary vasoconstriction by 1,4-dihydropyridine calcium channel antagonists  

SciTech Connect

The biological activity of the (+)-S- and (-)-R-enantiomers of niguldipine, of the (-)-S- and (+)-R-enantiomers of felodipine and nitrendipine, and of rac-nisoldipine and rac-nimodipine was investigated in vitro and in vivo. Inhibition of coronary vasoconstriction due to the thromboxane A2 (TxA2)-mimetic U-46619 in guinea pig Langendorff hearts, displacement of (+)-({sup 3}H)isradipine from calcium channel binding sites of guinea pig skeletal muscle T-tubule membranes, and blood pressure reduction in spontaneously hypertensive rats were determined. The enantiomers were obtained by stereoselective synthesis. Cross-contamination was less than 0.5% for both S- and R-enantiomers of niguldipine and nitrendipine and less than 1% for those of felodipine. From the doses necessary for a 50% inhibition of coronary vasoconstriction, stereoselectivity ratios for (+)-(S)-/(-)-(R)-niguldipine, (-)-(S)-/(+)-(R)-felodipine, and (-)-(S)-/(+)-(R)-nitrendipine of 28, 13, and 7, respectively, were calculated. The potency ratio rac-nisoldipine/rac-nimodipine was 3.5. Ratios obtained from binding experiments and antihypertensive activity were (+)-(S)-/(-)-(R)-niguldipine = 45 and 35, (-)-(S)-/(+)-(R)-felodipine = 12 and 13, (-)-(S)-/(+)-(R)-nitrendipine = 8 and 8, and rac-nisoldipine/rac-nimodipine = 8 and 7, respectively. Highly significant correlations were found between the in vitro potency of the substances to prevent U-46619-induced coronary vasoconstriction and their affinity for calcium channel binding sites as well as their antihypertensive activity.

Eltze, M.; Boer, R.; Sanders, K.H.; Boss, H.; Ulrich, W.R.; Flockerzi, D. (Byk Gulden Pharmaceuticals, Konstanz (Germany F.R.))

1990-01-01

84

Greater collagen-induced platelet aggregation following cyclooxygenase 1 inhibition predicts incident acute coronary syndromes.  

PubMed

Greater ex vivo platelet aggregation to agonists may identify individuals at risk of acute coronary syndromes (ACS). However, increased aggregation to a specific agonist may be masked by inherent variability in other activation pathways. In this study, we inhibited the cyclooxygenase-1 (COX1) pathway with 2-week aspirin therapy and measured residual aggregation to collagen and ADP to determine whether increased aggregation in a non-COX1 pathway is associated with incident ACS. We assessed ex vivo whole blood platelet aggregation in 1,699 healthy individuals with a family history of early-onset coronary artery disease followed for 6±1.2 years. Incident ACS events were observed in 22 subjects. Baseline aggregation was not associated with ACS. After COX1 pathway inhibition, collagen-induced aggregation was significantly greater in participants with ACS compared with those without (29.0 vs. 23.6 ohms, p < 0.001). In Cox proportional hazards models, this association remained significant after adjusting for traditional cardiovascular risk factors (HR = 1.10, 95%CI = 1.06-1.15; p < 0.001). In contrast, ADP-induced aggregation after COX1 inhibition was not associated with ACS. After COX1 pathway inhibition, subjects with greater collagen-induced platelet aggregation demonstrated a significant excess risk of incident ACS. These data suggest that platelet activation related to collagen may play an important role in the risk of ACS. PMID:25066685

Qayyum, Rehan; Becker, Diane M; Yanek, Lisa R; Faraday, Nauder; Vaidya, Dhananjay; Mathias, Rasika; Kral, Brian G; Becker, Lewis C

2015-02-01

85

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

SciTech Connect

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 angiography under basal conditions, during spontaneous or ergonovine-induced ischemia, and after resolution of the ischemic attack. Myocardial perfusion was assessed by thallium 201 scintigraphy in 21 patients of this series during superimposable ischemic episodes. In group 1, ischemia caused RV (14 of 15 patients) and LV (13 of 15 patients) regional dysfunction with significant reduction in RV and LV ejection fractions. The interventricular spetum was involved in six of 15 patients, causing a more pronounced LV impairment. In group 2, all patients showed septal dyssynergies associated with a reduction of LV ejection fraction; absent or trivial RV involvement was observed. In both groups, LV perfusion defects were present in all patients with LV wall motion abnormalities during ischemia, matching the site of regional dyssynergies. Thus, in a group of patients with variant angina and single-vessel disease, transient occlusion of the right coronary artery directly caused RV and LV impairment; in these patients, the extent of LV but not RV dysfunction appeared related to the presence of septal ischemia. Vasospasm of the left anterior descending coronary artery consistently caused LV dysfunction not associated with secondary effects on RV systolic function.

Neglia, D.; Parodi, O.; Marzullo, P.; Sambuceti, G.; Marcassa, C.; Michelassi, C.; L'Abbate, A. (CNR Institute of Clinical Physiology, Pisa (Italy))

1990-02-01

86

Coronary artery manifestations of fibromuscular dysplasia.  

PubMed

Fibromuscular dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic "string of beads" that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramural hematoma, spasm, or tortuosity. Importantly, FMD must be identified in at least one other noncoronary arterial territory to attribute any coronary findings to FMD. Although there is limited evidence to guide treatment, many lesions heal spontaneously; thus, a conservative approach is generally preferred. The etiology is poorly understood, but there are ongoing efforts to better characterize FMD and define its genetic and molecular basis. This report reviews the clinical course of FMD involving the coronary arteries and provides guidance for diagnosis and treatment strategies. PMID:25190240

Michelis, Katherine C; Olin, Jeffrey W; Kadian-Dodov, Daniella; d'Escamard, Valentina; Kovacic, Jason C

2014-09-01

87

Infantile Spasms: Little Seizures, BIG Consequences  

PubMed Central

Infantile spasms is one of the “catastrophic childhood epilepsies” because of the difficulty in controlling seizures and the association with mental retardation. However, early recognition, a careful diagnostic evaluation, and proper treatment may allow some children to attain seizure control and to achieve a normal, or at least much improved, level of development. Thus, there is the opportunity to have an important impact in the lives of these unfortunate children and their families. PMID:16761063

Shields, W Donald

2006-01-01

88

Treatment of infantile spasms: an evidence-based approach.  

PubMed

The object of this work was to subject established empirical medical treatment regimens for infantile spasms to evidence-based medicine analysis in order to determine the current best practice for the treatment of infantile spasms in children. Clinical studies of infantile spasms reported during the presteroid era were reviewed critically to define the natural history of the disorder. Treatment trials of infantile spasms conducted since 1958 were rigorously assessed using MEDLINE and hand searches of the English language literature. Inclusion criteria were the documented presence of infantile spasms and hypsarrhythmia. Outcome measures included complete cessation of spasms, resolution of hypsarrhythmia, relapse rate, developmental outcome, the presence or absence of epilepsy, and/or an epileptiform electroencephalogram. Evidence was defined as class I, II, or III, and practice parameter recommendations were made using the framework devised by the American Academy of Neurology. Class I and III evidence support a standard of practice recommendation for the use of vigabatrin in the treatment of infantile spasms in children with tuberous sclerosis. Class I and III evidence support a guidelines recommendation for the use of either ACTH or vigabatrin in infantile spasms in nontuberous sclerosis patients. There is no strong evidence that successful treatment of infantile spasms improves the long-term prognosis for cognitive outcome or decreases the incidence of later epilepsy. A practice option recommendation for the use of oral corticosteroids in the treatment of infantile spasms is supported by limited and inconclusive class I and III data. Based on the evidence, no recommendation can be made for the use of pyridoxine, benzodiazepines, or the newer antiepileptic drugs in the treatment of infantile spasms. ACTH and vigabatrin are the most effective agents in the treatment of infantile spasms, but concerns remain about the risk/benefit profiles of these drugs. PMID:12040891

Mackay, Mark; Weiss, Shelly; Snead, O Carter

2002-01-01

89

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.

1987-01-01

90

Behind the facial twitch: depressive symptoms in hemifacial spasm  

Microsoft Academic Search

BackgroundDepression impairs psychosocial and occupational functioning and contributes to significant morbidity and mortality. Hemifacial spasm (HFS) causes social embarrassment and visual and verbal disability.

Eng-King Tan; Sau-Ying Lum; S. Fook-Chong; Ling-Ling Chan; Christopher Gabriel; Leslie Lim

2005-01-01

91

Cocaine-Induced Vasoconstriction in the Human Coronary Microcirculation: New Evidence from Myocardial Contrast Echocardiography  

PubMed Central

Background Cocaine is a major cause of acute coronary syndrome (ACS), especially in young adults; however, the mechanistic underpinning of cocaine-induced ACS remains limited. Previous studies in animals and in patients undergoing cardiac catheterization suggest that cocaine constricts coronary microvessels, yet direct evidence is lacking. Methods and Results We used myocardial contrast echocardiography (MCE) to test the hypothesis that cocaine causes vasoconstriction in the human coronary microcirculation. Measurements were performed at baseline and after a low non-intoxicating dose of intranasal cocaine (2 mg/kg) in 10 healthy cocaine-naďve young men (median age 32 years). Post-destruction time-intensity MCE kinetic data were fit to the equation: y = A(1-e- ? t) to quantify functional capillary blood volume (A), microvascular flow velocity (?), and myocardial perfusion (A × ?). Heart rate (HR), mean arterial pressure (MAP), and LV work (two-dimensional echocardiography) were measured before and 45 minutes after cocaine. Cocaine increased MAP (+14±2 mmHg; mean ± SE), HR (+8±3 beats/min), and LV work (+50±18 mmHg·mL-1·bpm-1). Despite increasing these determinants of myocardial oxygen demand, myocardial perfusion decreased by 30% (103.7±9.8 to 75.9±10.8 a.u/s, p<0.01) due mainly to decreased capillary blood volume (133.9±5.1 to 111.7±7.7 a.u., p<.05) with no significant change in microvascular flow velocity (0.8±0.1 to 0.7±0.1 a.u.). Conclusions In healthy cocaine-naďve young adults, a low-dose cocaine challenge evokes a sizeable decrease in myocardial perfusion. Moreover, the predominant effect is to decrease myocardial capillary blood volume rather than microvascular flow velocity, suggesting a specific action of cocaine to constrict terminal feed arteries. PMID:23812179

Gurudevan, Swaminatha V.; Nelson, Michael D.; Rader, Florian; Tang, Xiu; Lewis, Joshua; Johannes, Jimmy; Belcik, J. Todd; Elashoff, Robert M.; Lindner, Jonathan R.; Victor, Ronald G.

2013-01-01

92

Efficacy and tolerability of the Galanin Analog NAX 5055 in the multiple-hit rat model of symptomatic infantile spasms  

PubMed Central

Infantile spasms are seizures manifesting in infantile epileptic encephalopathies that are associated with poor epilepsy and cognitive outcomes. The current therapies are not always effective or are associated with serious side effects. Early cessation of spasms has been proposed to improve long-term outcomes. To identify new therapies for infantile spasms with rapid suppression of spasms, we are using the multiple-hit rat model of infantile spasms, which is a model of refractory infantile spasms. Here, we are testing the efficacy and tolerability of a single dose of the galanin receptor 1 preferring analog, NAX 5055, in the multiple-hit model of spasms. To induce the model, postnatal day 3 (PN3) male Sprague-Dawley rats underwent right intracerebral infusions of doxorubicin and lipopolysaccharide; p-chlorophenylalanine was then injected intraperitoneally (i.p.) at PN5. After the onset of spasms at PN4, 11–14 rats/group were injected i.p. with either NAX 5055 (0.5, 1, 2, or 4 mg/kg) or vehicle. Video monitoring for spasms included a 1hour pre-injection period, followed by 5 hours of recording post-injection, and two 2 hour sessions on PN5. The study was conducted in a randomized, blinded manner. Neurodevelopmental reflexes were assessed daily as well as at 2 hours after injection. Respiratory function, heart rate, pulse distension, oximetry and blood glucose were measured 4 hours after injection. The relative expression of GalR1 and GalR2 mRNA over ?-actin in the cerebral cortex and hippocampus was determined with real time reverse transcription polymerase chain reaction. There was no acute effect of NAX 5055 on spasm frequency after the single dose of NAX 5055 (n=11–13 rats/group, following exclusions). Neurodevelopmental reflexes, vital signs, blood glucose measured 4 hours post-injection, and survival were not affected. A reduction in pulse and breath distention of unclear clinical significance was observed with the 7mg/kg NAX 5055 dose. GalR1 mRNA was present in the cerebral cortex and hippocampus of PN4 and adult rats. The hippocampal –but not the cortical- GalR1 mRNA expression was significantly lower in PN4 pups than in adults. GalR1 mRNA was also at least 20 times less abundant in the PN4 cortex than GalR2 mRNA. In conclusion, a single dose of NAX 5055 has no acute efficacy on spasms or toxicity in the multiple hit rat model of medically refractory infantile spasms. Our findings cannot exclude the possibility that repetitive NAX 5055 administration may show efficacy on spasms. The higher expression of GalR2 in the PN4 cortex suggests that GalR2-preferring analogs may be of interest to test for efficacy on spasms. PMID:24252685

Gygax, Marine Jequier; Klein, Brian D.; White, H. Steve; Kim, Mimi; Galanopoulou, Aristea S.

2013-01-01

93

Role of K+ channels in EDHF-dependent relaxation induced by acetylcholine in canine coronary artery.  

PubMed

To identify the K+ channels responsible for endothelium-derived hyperpolarizing factor (EDHF)-dependent relaxation, we studied the effects of various K+ channel blockers on acetylcholine-induced relaxation, which persists even in the presence of both an inhibitor of nitric oxide synthase and that of cyclooxygenase, in canine coronary artery rings. A nonselective K+ channel blocker, tetrabutylammonium (TBA), a large and intermediate conductance Ca2+-activated K+ channel blocker, charybdotoxin (CTX), and a voltage-dependent K+ channel blocker, 4-aminopyridine (4-AP), significantly inhibited this residual relaxation. A combined treatment with CTX and 4-AP almost completely blocked the relaxation. Neither a large (iberiotoxin) nor a small (apamin) conductance Ca2+-activated K+ channel blocker blocked the relaxation. We also investigated effects of K+ channel blockers on basal tone to determine whether or not EDHF is involved in regulating basal tone. TBA and CTX substantially raised basal tone to a greater degree in endothelium-intact preparations than in endothelium-denuded preparations. These results indicate that EDHF may exert its relaxing action through intermediate conductance Ca2+-activated and voltage-dependent K+ channels in canine coronary arteries. In addition, EDHF may play a role in maintaining basal vascular tone. PMID:9860196

Nakashima, Y; Toki, Y; Fukami, Y; Hibino, M; Okumura, K; Ito, T

1997-01-01

94

Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography  

PubMed Central

Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short- and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography. PMID:22655164

Hung, Yao-Min; Lin, Shoa-Lin; Hung, Shih-Yuan; Huang, Wei-Chun; Wang, Paul Yung-Pou

2012-01-01

95

Is a metallic microcoil really a permanent embolic agent for the management of distal guidewire-induced coronary artery perforation?  

PubMed

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. PMID:21949533

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

2011-08-01

96

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 Patanč; Filippo Marte; Giuseppe Dattilo; Rosario Grassi; Francesco Patanč

2010-01-01

97

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

2007-01-01

98

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

2011-01-01

99

Botulinum toxin treatment in patients with hemifacial spasm  

Microsoft Academic Search

Hemifacial spasm is nearly always a unilateral disease of the facial musculature and is characterized by involuntary tonic or clonic cramps that considerably reduce the affected patient's quality of life. In the past, a number of different conservative and operative therapeutic procedures have been applied for the treatment of hemifacial spasm. In many cases these attempts failed to control the

R. Laskawi; M. Ellies; C. Drobik; A. Bätz

1994-01-01

100

Botulinum Toxin Injections: A Treatment for Muscle Spasms  

MedlinePLUS

... considering botulinum toxin injections to treat certain muscle spasms on your face or eyelids. The injections can also be used for some eye movement disorders, such as a lazy eye (also called strabismus). ... torticollis, a muscle spasm that causes the head and neck to pull ...

101

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

1998-01-01

102

Diastolic Timed Vibrator: Noninvasive Pre-Hospitalization Treatment of Acute Coronary Ischemia.  

PubMed

The speed of intervention is one of the major factors in increasing the survival rate of patients suffering from acute coronary ischemia. The two principal techniques currently in use: pharmacological and interventional, can be employed to re-canalize coronary arteries, but the former is slow acting and often leads to incomplete reperfusion, while the latter requires specialized personnel in a hospital with a cardiac catheterization laboratory. In this paper, we introduce a novel method intended for pre-hospitalization treatment of patients with acute coronary ischemia that can be safely applied by a minimally trained individual prior to or during patient transportation to hospital. It consists in applying low frequency mechanical vibrations to the left intercostal space of patient's chest during diastole of the heart cycle, to induce vibrations of the heart and thus of the coronary arteries. Mechanical vibrations stimulate mixing of blood which improves drug delivery to the occlusion site, applies mechanical force on the clot leading to its faster dissolution and finally acts as a strong vasodilator in case of spasms. We introduce the principle of operation and the architecture of the Diastolic Timed Vibrator (DTV), including a custom ECG processing algorithm, vibration pattern generator and active braking methods. Experimental results demonstrate the functionality of the DTV device and pave way for in-vivo tests necessary for clinical confirmation of the proposed method. PMID:23934670

Marzencki, Marcin; Kajbafzadeh, Behrad; Khosrow-Khavar, Farzad; Tavakolian, Kouhyar; Kaminska, Bozena; Menon, Carlo

2013-08-01

103

Le spasme du sanglot chez les nourrissons  

PubMed Central

Résumé Question Des enfants qui fréquentent ma clinique ont des épisodes semblables ŕ des convulsions pendant lesquels ils pleurent et retiennent leur souffle au point de faire survenir une cyanose et de perdre conscience. Les résultats ŕ l’examen ou aux investigations sont normaux et les pédiatres consultés ne font pas d’autres investigations. Les spasmes du sanglot sont-ils communs et quels genres d’investigations faut-il faire? Réponse Le spasme du sanglot est un trouble non épileptique paroxysmal bénin qui se produit chez les enfants en santé de six ŕ 48 mois. Les épisodes commencent par une provocation, comme un bouleversement émotionnel ou une blessure mineure, et peuvent progresser en une retenue de la respiration, une cyanose et une syncope. Les épisodes sont extręmement effrayants ŕ regarder mais ont des conséquences bénignes. Une fois le diagnostic clinique posé, on recommande de faire passer un électrocardiogramme et d’exclure la possibilité d’une anémie, mais aucune autre investigation ou demande de consultation n’est nécessaire.

Goldman, Ran D.

2015-01-01

104

Tocotrienols-induced inhibition of platelet thrombus formation and platelet aggregation in stenosed canine coronary arteries  

PubMed Central

Background Dietary supplementation with tocotrienols has been shown to decrease the risk of coronary artery disease. Tocotrienols are plant-derived forms of vitamin E, which have potent anti-inflammatory, antioxidant, anticancer, hypocholesterolemic, and neuroprotective properties. Our objective in this study was to determine the extent to which tocotrienols inhibit platelet aggregation and reduce coronary thrombosis, a major risk factor for stroke in humans. The present study was carried out to determine the comparative effects of ?-tocopherol, ?-tocotrienol, or tocotrienol rich fraction (TRF; a mixture of ?- + ?- + ?-tocotrienols) on in vivo platelet thrombosis and ex vivo platelet aggregation (PA) after intravenous injection in anesthetized dogs, by using a mechanically stenosed circumflex coronary artery model (Folts' cyclic flow model). Results Collagen-induced platelet aggregation (PA) in platelet rich plasma (PRP) was decreased markedly after treatment with ?-tocotrienol (59%; P < 0.001) and TRF (92%; P < 0.001). ?-Tocopherol treatment was less effective, producing only a 22% (P < 0.05) decrease in PA. Adenosine diphosphate-induced (ADP) PA was also decreased after treatment with ?-tocotrienol (34%; P < 0.05) and TRF (42%; P < 0.025). These results also indicate that intravenously administered tocotrienols were significantly better than tocopherols in inhibiting cyclic flow reductions (CFRs), a measure of the acute platelet-mediated thrombus formation. Tocotrienols (TRF) given intravenously (10 mg/kg), abolished CFRs after a mean of 68 min (range 22 -130 min), and this abolition of CFRs was sustained throughout the monitoring period (50 - 160 min). Next, pharmacokinetic studies were carried out and tocol levels in canine plasma and platelets were measured. As expected, ?-Tocopherol treatment increased levels of total tocopherols in post- vs pre-treatment specimens (57 vs 18 ?g/mL in plasma, and 42 vs 10 ?g/mL in platelets). However, treatment with ?-tocopherol resulted in slightly decreased levels of tocotrienols in post- vs pre-treatment samples (1.4 vs 2.9 ?g/mL in plasma and 2.3 vs 2.8 ?g/mL in platelets). ?-Tocotrienol treatment increased levels of both tocopherols and tocotrienols in post- vs pre-treatment samples (tocopherols, 45 vs 10 ?g/mL in plasma and 28 vs 5 ?g/mL in platelets; tocotrienols, 2.8 vs 0.9 ?g/mL in plasma and 1.28 vs 1.02 ?g/mL in platelets). Treatment with tocotrienols (TRF) also increased levels of tocopherols and tocotrienols in post- vs pre-treatment samples (tocopherols, 68 vs 20 ?g/mL in plasma and 31.4 vs 7.9 ?g/mL in platelets; tocotrienols, 8.6 vs 1.7 ?g/mL in plasma and 3.8 vs 3.9 ?g/mL in platelets). Conclusions The present results indicate that intravenously administered tocotrienols inhibited acute platelet-mediated thrombus formation, and collagen and ADP-induced platelet aggregation. ?-Tocotrienols treatment induced increases in ?-tocopherol levels of 4-fold and 6-fold in plasma and platelets, respectively. Interestingly, tocotrienols (TRF) treatment induced a less pronounced increase in the levels of tocotrienols in plasma and platelets, suggesting that intravenously administered tocotrienols may be converted to tocopherols. Tocotrienols, given intravenously, could potentially prevent pathological platelet thrombus formation and thus provide a therapeutic benefit in conditions such as stroke and myocardial infarction. PMID:21489303

2011-01-01

105

Trimetazidine in the prevention of contrast?induced nephropathy after coronary procedures  

PubMed Central

Objective To evaluate the efficacy of trimetazidine (TMZ) in the prevention of contrast?induced nephropathy (CIN) in patients with high serum creatinine levels undergoing coronary angiography/angioplasty. Methods TMZ (20?mg thrice daily) was administered orally for 72?h starting 48?h before the procedure. All patients were given intravenous saline (0.9%) at a rate of 1?ml/kg of body weight per hour for 24?h starting 12?h beforehand. Serum creatinine levels were measured before the procedure, 48?h and 7?days after the procedure. Increase in serum creatinine level exceeding 0.5?mg/day or one quarter of the basal value is considered as CIN. Venous blood samples for serum total antioxidant capacity (TAC) measurement were drawn before and after coronary angiography. Results Basal serum creatinine levels and TAC were similar in TMZ and control groups. Serum creatinine levels in the control group increased significantly 2?days after the procedure, and returned to the baseline values on the seventh day. However, it did not change significantly on the second day, and even significantly decreased on the seventh day in the TMZ group. CIN developed in 2.5% (1/40) of patients in the TMZ group and in 16.6% (7/42) of patients in the control group (p<0.05). TAC values were not different between treatment groups. Conclusion TMZ along with isotonic saline infusion is more effective than isotonic saline alone in reducing the risk of CIN in patients with pre?existing renal dysfunction. PMID:17065180

Onbasili, Alper O; Yeniceriglu, Yavuz; Agaoglu, P?nar; Karul, Asl?han; Tekten, Tarkan; Akar, Harun; Discigil, Guzel

2007-01-01

106

Effect of High Dose Rosuvastatin Loading before Percutaneous Coronary Intervention on Contrast-Induced Nephropathy  

PubMed Central

Background and Objectives Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality. This observational, non-randomized study evaluated the effect of rosuvastatin loading before percutaneous coronary intervention (PCI) on the incidence of CIN in patients with acute coronary syndrome (ACS). Subjects and Methods A total of 824 patients who underwent PCI for ACS were studied (408 patients in the statin group=40 mg rosuvastatin loading before PCI; 416 patients of control group=no statin pretreatment). Serum creatinine concentrations were measured before and 24 and 48 hours after PCI. The primary endpoint was development of CIN defined as an increase in serum creatinine concentration of ?0.5 mg/dL or ?25% above baseline within 72 hours after PCI. Results The incidence of CIN was significantly lower in the statin group than that in the control group (18.8% vs. 13.5%, p=0.040). The maximum percent changes in serum creatinine and estimated glomerular filtration rate in the statin group within 48 hours were significantly lower than those in the control group (5.84±22.59% vs. 2.43±24.49%, p=0.038; -11.44±14.00 vs. -9.51±13.89, p=0.048, respectively). The effect of rosuvastatin on preventing CIN was greater in the subgroups of patients with diabetes, high-dose contrast medium, multivessel stents, high baseline C-reactive protein, and myocardial infarction. A multivariate analysis revealed that rosuvastatin loading was independently associated with a decreased risk for CIN (odds ratio, 0.64; 95% confidence interval, 0.43-0.95, p=0.026). Conclusion High-dose rosuvastatin loading before PCI was associated with a significantly lower incidence of CIN in patients with ACS. PMID:25278982

Lim, Jae Hong; Hwang, Kyo Bum; Woo, Sun Ho; Jeong, Jin Woo; Kim, Yong Cheol; Joe, Dai-Yeol; Ko, Jum Suk; Rhee, Sang Jae; Lee, Eun Mi; Oh, Seok Kyu

2014-01-01

107

Distension of urinary bladder induces exaggerated coronary constriction in smokers with early atherosclerosis.  

PubMed

Distension of the urinary bladder causes an increase in efferent sympathetic activity, which can precipitate myocardial ischemia. Smoking has been shown to modulate activities of afferent nerves from the distended urinary bladder and to impair endothelial function in response to sympathetic activation. To assess the effect of bladder distension on coronary dynamics in smokers, we measured epicardial and microvascular responses in 24 patients with early atherosclerosis (< 50% diameter stenosis). Patients were classified into habitual smokers (group 1, n = 14) and nonsmokers (group 2, n = 10). Habitual smokers were randomized into two subgroups on the basis of the use of doxazosin, as follows: subgroup 1A (n = 7), without administration of doxazosin before catheterization; subgroup 1B (n = 7), with dosing doxazosin. In response to bladder distension (mean intravesical pressure 21.5 mmHg), bladder distension significantly decreased coronary diameter at the stenotic segments, coronary blood flow, and increased coronary resistance compared with baseline values, in subgroup 1A patients. In subgroup 1B patients during bladder distension, coronary diameter, coronary blood flow, and coronary resistance did not show significant changes compared with baseline values. There were significant differences of coronary diameter at the stenotic segments, coronary blood flow, and of changes of coronary vascular resistance between subgroup 1A and group 2 during bladder distension, despite similar changes in rate-pressure product. The present study showed that urinary bladder distension caused an abnormal vasomotor response of epicardial vasoconstriction and a concomitant increased coronary resistance, which leads to reduction in coronary blood flow in patients with early atherosclerosis. Smoking may further impair the response, implying that smoking has exaggerated response to sympathetic stimulation of conduit and resistance vessels. The abnormal response was abolished by pretreated administration of doxazosin, suggesting that the involved mechanisms are related to alpha(1)-adrenoceptors. PMID:11087239

Lee, T M; Su, S F; Suo, W Y; Lee, C Y; Chen, M F; Lee, Y T; Tsai, C H

2000-12-01

108

Interneuron, Interrupted: Molecular Pathogenesis of ARX Mutations and X-linked Infantile Spasms  

PubMed Central

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.

2012-01-01

109

MT2 Receptors Mediate the Inhibitory Effects of Melatonin on Nitric Oxide-Induced Relaxation of Porcine Isolated Coronary Arteries  

PubMed Central

Previous studies from our laboratory demonstrated that melatonin inhibits nitric oxide (NO)-induced relaxation in porcine coronary arteries. The present study was designed to further characterize the mechanisms underlying this inhibitory effect of melatonin. Western immunoblot studies identified the presence of melatonin type 2 (MT2) receptors, but not MT1 or MT3 receptors, in porcine coronary arteries. Immunohistochemical analysis revealed that MT2 receptors colocalized with ?-actin in the smooth muscle cell layer. In coronary arterial rings suspended in organ chambers for isometric tension recording, melatonin (10?7 M) inhibited relaxations induced by the exogenous NO donor sodium nitroprusside (SNP; 10?9 to 10?5 M) and by the ?2-adrenoceptor agonist 5-bromo-6-[2-imidazolin-2-yl-amino]-quinoxaline (UK14,304; 10?9 to 10?5 M), an endothelium-dependent vasodilator. The inhibitory effect of melatonin on SNP- and UK14,304-induced relaxations was abolished in the presence of the selective MT2 receptor antagonists 4-phenyl-2-propionamidotetralin (4P-PDOT; 10?7 M) and luzindole (10?7 M). In contrast to melatonin, the selective MT3 receptor agonist 5-methoxycarbonylamino-N-acetyltryptamine (5-MCA-NAT; 10?7 M) had no effect on the concentration-response curves to either SNP or UK14,304. Melatonin (10?7 M) had no effect on coronary artery relaxation induced by 8-bromoguanosine 3?,5?-cyclic monophosphate, but it significantly attenuated the increase in intracellular cyclic GMP levels in response to SNP (10?5 M). This effect of melatonin was abolished in the presence of 4P-PDOT (10?7 M). Taken together, these data support the view that melatonin acts on MT2 receptors in coronary vascular smooth muscle cells to inhibit NO-induced increases in cyclic GMP and coronary arterial relaxation, thus demonstrating a novel function for MT2 receptors in the vasculature. PMID:20959363

Tunstall, Radhika R.; Shukla, Praveen; Grazul-Bilska, Anna; Sun, Chengwen

2011-01-01

110

Intracoronary Versus Intravenous Adenosine-Induced Maximal Coronary Hyperemia for Fractional Flow Reserve Measurements  

PubMed Central

BACKGROUND Maximal hyperemia is the critical prerequisite for fractional flow reserve (FFR) assessment. Despite intravenous (IV) adenosine currently being the recommended approach, intracoronary (IC) administration of adenosine constitutes a valuable alternative in everyday practice. However, it is surprisingly unclear which IC strategy allows the achievement of FFR values that are comparable to IV adenosine. OBJECTIVES This study sought to compare increasing doses of IC adenosine versus IV adenosine for FFR. METHODS 30 intermediate coronary stenoses undergoing FFR measurement were prospectively and consecutively enrolled. Hyperemia was sequentially induced by bolus of IC adenosine (ADN; 150 ?g) followed by IV adenosine (IVADN) infusion over 3 minutes at dose of (140 ?g/kg/min). FFR values, symptoms, and development of atrioventricular block were recorded. RESULTS 150 ?g doses of IC adenosine were well tolerated and associated with fewer symptoms than IV adenosine. Intracoronary adenosine doses induced a significant decrease of FFR compared with baseline levels (P < 0.01). Among the 6 patients with FFR values less than 0.80 identified by IVADN, 4 were correctly identified also by 150 ?g bolus IC adenosine. Larger randomized studies with cross-over design are necessary to verify the results. CONCLUSIONS This small pilot study suggests that IC adenosine might be an alternative to IV adenosine. Larger randomized studies with a cross-over design are necessary. PMID:24558302

Khashaba, Ahmed; Mortada, Ayman; Omran, Azza

2014-01-01

111

Compound Danshen Dripping Pill Pretreatment to Prevent Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention  

PubMed Central

Background. Contrast-induced nephropathy (CIN) limits the outcome of percutaneous coronary intervention (PCI). Objective. To investigate whether pretreatment with Compound Danshen Dripping Pills (CDDP) will decrease the incidence of CIN after PCI. Methods. A total of 229 patients with acute coronary syndrome (ACS) undergoing PCI were divided into the control group (n = 114) and the CDDP (containing salvia miltiorrhiza and sanqi) group (n = 115; given 20 CDDP pills, three times daily before PCI). Serum creatinine, creatinine clearance (CrCl), high-sensitivity C-reactive protein (hsCRP), P-selectin, and intercellular adhesion molecule-1 (ICAM-1) were measured at admission and 24 and 48?h after PCI. Results. CrCl decreased after PCI but recovered after 48 h. In the CDDP group, CrCl recovered more rapidly (P < 0.05). The procedure increased the hsCRP, P-selectin, and ICAM-1 levels, but these levels were less in the CDDP group (P < 0.05). Conclusions. Pretreatment with CDDP can decrease the occurrence of CIN in patients undergoing PCI, suggesting that the early use of CDDP is an appropriate adjuvant pharmacological therapy before PCI. PMID:25386219

Yang, Rong; Chang, Liang; Guo, Bing-yan; Wang, Yan-wei; Wang, Ya-ling; Jin, Xin; Liu, Su-yun; Li, Yong-jun

2014-01-01

112

Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis  

SciTech Connect

The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P?induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

Lee, Cheng-Hung [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China); Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Jhong, Guan-Heng [Graduate Institute of Medical Mechatronics, Chang Gung University, Tao-Yuan, Taiwan (China); Hsu, Ming-Yi; Wang, Chao-Jan [Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan (China); Liu, Shih-Jung, E-mail: shihjung@mail.cgu.edu.tw [Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Hung, Kuo-Chun [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China)

2014-05-28

113

Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis  

NASA Astrophysics Data System (ADS)

The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P < 0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70° than at angle ?70° (P < 0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P < 0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.

Lee, Cheng-Hung; Jhong, Guan-Heng; Hsu, Ming-Yi; Liu, Shih-Jung; Wang, Chao-Jan; Hung, Kuo-Chun

2014-05-01

114

Coronary Arteries  

MedlinePLUS

... and animations for grades K-6. The Coronary Arteries | Share Coronary Circulation The heart muscle, like every ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...

115

ACTH therapy in infantile spasms: side effects.  

PubMed Central

162 children with infantile spasms were treated with ACTH at the Children's Hospital, Helsinki, and at the Aurora Hospital, Helsinki, during 1960--76. In a large proportion (37%) of the children the treatment caused pronounced side effects, and the mortality was 4.9%. The most common complications were infections: septic infections, pneumonias, and urinary and gastrointestinal infections. Other side effects were arterial hypertension (11), osteoporosis (2), hypokalaemic alkalosis (2), and other marked electrolyte disturbances (10). In children necropsy showed fresh intracerebral haemorrhages. Four children developed oliguria and hyperkalaemia during and after withdrawal of ACTH. One of them had tubular necrosis confirmed by renal biopsy. Infections were significantly more common with large doses (120 units) of ACTH than with small ones (40 units). It is concluded that side effects, even severe ones, are more common during treatment than had been assumed. Careful watch is important before and after treatment. The benefit of very high dosages should also be reconsidered. PMID:6254450

Riikonen, R; Donner, M

1980-01-01

116

Association of Serum Bilirubin with Contrast-Induced Nephropathy and Future Cardiovascular Events in Patients Undergoing Coronary Intervention  

PubMed Central

Objectives Enhanced reactive oxygen species formation within the kidney following the administration of contrast media may play a key role in the development of contrast-induced nephropathy (CIN). Bilirubin has emerged as an important endogenous antioxidant molecule. This study was undertaken to determine whether bilirubin is associated with CIN and future cardiovascular events in patients undergoing coronary intervention. Methods Totally, 544 consecutive patients received coronary intervention were enrolled. All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was CIN, defined as a rise in serum creatinine (SCr) of 0.5 mg/dl or a 25% increase from the baseline value within 48 hours after the procedure. The secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal myocardial infarction, and ischemic stroke. Results Overall, CIN occurred in 85 (15.6%) patients. All patients were stratified into 3 groups (low/normal/high) according to the serum bilirubin levels. In a multivariate logistic analysis, the odds ratio for CIN with low-bilirubin levels relative to high-bilirubin levels was 11.82 (95% CI, 3.25–43.03). By Cox regression analysis, serum bilirubin levels was an independent predictor of MACE in patients undergoing coronary intervention (low vs. high hazard ratio 2.26; 95% CI, 1.05–4.90). Conclusions CIN is a serious complication of coronary intervention. Higher serum bilirubin concentrations were associated with lower risk of CIN and fewer cardiovascular events. The development of interventions that promote bilirubin levels may be a potential target to reduce CIN and future MACE in patients undergoing coronary intervention. PMID:22880046

Huang, Shao-Sung; Huang, Po-Hsun; Wu, Tao-Cheng; Chen, Jaw-Wen; Lin, Shing-Jong

2012-01-01

117

Botulinum toxin treatment in patients with hemifacial spasm.  

PubMed

Hemifacial spasm is nearly always a unilateral disease of the facial musculature and is characterized by involuntary tonic or clonic cramps that considerably reduce the affected patient's quality of life. In the past, a number of different conservative and operative therapeutic procedures have been applied for the treatment of hemifacial spasm. In many cases these attempts failed to control the disease permanently or resulted in unwanted, sometimes strong, side effects. We report our own experiences with botulinum therapy in 29 patients with hemifacial spasm (78 therapeutic sessions). In our patients the mean duration of an effect after treatment with botulinum toxin was 18.2 weeks. Side effects were rare. Our results since 1990 at the University of Göttingen demonstrate that subcutaneous application of toxin from Clostridium botulinum to involved facial muscles represents a reliable method for successful treatment of hemifacial spasm. PMID:7986498

Laskawi, R; Ellies, M; Drobik, C; Bätz, A

1994-01-01

118

Glimepiride induces nitric oxide production in human coronary artery endothelial cells via a PI3-kinase-Akt dependent pathway.  

PubMed

Diabetes mellitus is one of the major risk factors for coronary artery disease (CAD). A recent study reported that glimepiride, a new third-generation sulfonylurea, inhibited the formation of atheromatous plaques in high-cholesterol fed rabbits. However, the mechanism by which glimepiride induces atheroprotection remains unknown. In the present study, we tested the hypothesis that glimepiride may stimulate NO production in vascular endothelial cells. Human coronary artery endothelial cells (HCAECs) were treated with glimepiride, glibenclamide or vehicle, and NO release was measured. Akt phosphorylation was evaluated by Western blot. The effects of LY294002, a specific PI3-kinase inhibitor, and antisense oligonucleotides directed to Akt, on glimepiride-induced NO production were examined. Glimepiride (0.1-10 microM), but not glibenclamide, induced NO production, significantly increasing it by 1.8-fold (n=6, p<0.05). LY294002 inhibited glimepiride-induced NO production by 68%. Akt was rapidly phosphorylated by glimepiride and antisense oligonucleotides directed to Akt completely inhibited glimepiride-induced NO production. These data demonstrate that glimepiride induces NO production in HCAECs by activating PI3-kinase and Akt, and also suggest that use of glimepiride in type 2 diabetes may show promise for preventing CAD in addition to lowering glucose levels. PMID:16216590

Ueba, Hiroto; Kuroki, Masatoshi; Hashimoto, Shigemasa; Umemoto, Tomio; Yasu, Takanori; Ishikawa, San-e; Saito, Muneyasu; Kawakami, Masanobu

2005-11-01

119

Cerebellopontine angle endodermal cyst presenting with hemifacial spasm  

Microsoft Academic Search

Intracranial endodermal cysts presenting with hemifacial spasm (HFS) are extremely rare. We report a right cerebellopontine\\u000a angle (CPA) endodermal cyst in a 56-year-old man who presented with a 6-month history of right-sided hemifacial spasm. Computed\\u000a tomography revealed a homogenous, well-demarcated, hyperdense lesion extending from prepontine cistern to right CPA. Magnetic\\u000a resonance imaging demonstrated a right CPA extra-axial cystic lesion protruding

Prasanna Karki; Manoj Bohara; Hajime Yonezawa; Hiroshi Tokimura; Hirofumi Hirano; Ryosuke Hanaya; Kazunori Arita

120

The effect of long-term streptozotocin-induced diabetes on contractile and relaxation responses of coronary arteries: selective attenuation of CGRP-induced relaxations  

PubMed Central

This study investigates the effect of partially metabolic controlled long-term (34 weeks) streptozotocin (STZ)-induced diabetes on relaxation and contractile responses of isolated coronary arteries to seven different vasoactive agents. The average fasting and non-fasting blood glucose concentrations (mM) were significantly elevated in STZ-induced diabetic rats (P<0.0001; 10.4±0.4 and 16.6±1.1, n=15) compared to those (4.3±0.03 and 4.7±0.18, n=11) in age-matched controls. The level of glycated haemoglobin (HbA1) was also significantly (P<0.0001) increased in STZ-induced diabetic rats. In STZ-induced diabetic rats, the HbA1 levels were significantly correlated with the non-fasting blood glucose concentrations (r=0.76; P=0.003; n=13). In both groups, there was no significant correlation between the HbA1 levels and maximal responses or sensitivities to the vasoactive agents. The maximal relaxation induced by rat-?calcitonin gene-related peptide (rat-?CGRP) was significantly attenuated in the coronary arteries of STZ-induced diabetic rats (P<0.05; 40±7%, n=15) compared to that in age-matched controls (63±3%, n=11). However, there was no significant difference in the sensitivity to rat-?CGRP between the two groups. There was no significant difference in either maximal response or sensitivity to any of the six other vasoactive agents between STZ- induced diabetic rats (n=15) and age-matched controls (n=11). Our results show that partially metabolic controlled long-term (34 weeks) STZ-induced diabetes causes a selective depression of rat-?CGRP-induced relaxation in the intramural coronary arteries of Wistar rats. PMID:10725270

Sheykhzade, Majid; Dalsgaard, Grethe T; Johansen, Tue; Nyborg, Niels C Berg

2000-01-01

121

Relation of coronary blood flow and reactive hyperemia to regional dysfunction induced by dopamine infusion in dogs: limitations in detecting subcritical coronary stenoses.  

PubMed

Sympathomimetic agents have been used clinically to elicit regional dysfunction or heterogeneity of coronary blood flow to detect coronary artery lesions. However, the usefulness of this procedure in detecting mild to moderate coronary stenoses has not been defined previously. This was investigated in 10 open chest anesthetized dogs using subendocardial ultrasonic crystals to measure segment lengths. An electromagnetic flow probe was placed on the proximal left anterior descending artery, and graded coronary stenoses were created using a cuff occluder. In the first phase of the study, subcritical coronary stenoses were created which impaired maximal postocclusion reactive hyperemia, but not coronary blood flow at rest. A constant infusion of dopamine (average 15 micrograms/kg per min) was then administered. Regional dysfunction during dopamine infusion was not consistently observed despite production of coronary stenoses resulting in total loss of reactive hyperemia at rest. Regional function during dopamine treatment was, however, critically related to the actual changes in coronary blood flow during the infusion. In the second phase of the study, regional function during dopamine challenge was investigated during progressive impairments of coronary blood flow. Regional function was maintained until coronary blood flow during the infusion was reduced to near rest levels below which regional function deteriorated rapidly.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3973264

Hodgson, J M; Mancini, G B

1985-03-01

122

A genetic and biologic classification of infantile spasms  

PubMed Central

Infantile spasms are an age-dependent epilepsy that are highly associated with cognitive impairment, autism, and movement disorders. Previous classification systems have focused on a distinction between symptomatic and cryptogenic etiologies, and have not kept pace with the recent discoveries of mutations in genes in key pathways of central nervous system development in patients with infantile spasms. Children with certain genetic syndromes are much more likely to have infantile spasms, and we review the literature to propose a genetic classification of these disorders. Children with these genetic associations with infantile spasms also have phenotypes beyond epilepsy that may be explained by recent advances in the understanding of underlying biological mechanisms. We therefore also propose a biologic classification of the genes highly associated with infantile spasms, and articulate models for infantile spasms pathogenesis based on that data. The two best described pathways of pathogenesis are abnormalities in the gene regulatory network of GABAergic forebrain development, and abnormalities in molecules expressed at the synapse. We intend for these genetic and biologic classifications to be flexible, and hope that they will encourage much needed progress in syndrome recognition, clinical genetic testing, and ultimately the development of new therapies that target specific pathways of pathogenesis. PMID:22114996

Paciorkowski, Alex R.; Thio, Liu Lin; Dobyns, William B.

2011-01-01

123

Cortical involvement in focal epilepsies with epileptic spasms.  

PubMed

The pathophysiological mechanisms of epileptic spasms are still poorly understood. The role of subcortical structures has been suggested on the basis of non-localized EEG features and from experimental data. The description of asymmetric spasms associated with lateralized EEG patterns has challenged this view and raises the possibility of a cortical origin. This study investigated the cortical organization of partial seizures associated with epileptic spasms in children undergoing intracerebral EEG recordings for presurgical evaluation. Eleven children with drug resistant epileptic spasms and for whom depth electrode recordings were performed were retrospectively studied. In all children several features suggested a focal origin. Cortical involvement was studied using the "Epileptogenicity Index" (EI). A focal origin was finally demonstrated in 10/11 patients. Seven patients demonstrated pre-ictal changes in the seizure onset zone area. EI analysis showed maximal values in the temporal (n=5), parietal (n=1) or frontal (n=5) cortices. EEG changes were also observed in the premotor cortex during spasms in patients with frontal or parietal seizures and in 3/5 patients with temporal lobe seizures. Good surgical outcome (class I or II) was obtained in 7/10 patients. Seizures associated with epileptic spasms may originate from various cortical regions. Premotor/motor cortices are probably involved in determining ictal clinical changes. PMID:25212728

de la Vaissičre, Sabine; Milh, Mathieu; Scavarda, Didier; Carron, Romain; Lépine, Anne; Trébuchon, Agnes; Gavaret, Martine; Hewett, Russell; Laguitton, Virginie; Daquin, Géraldine; Villeneuve, Nathalie; Bartolomei, Fabrice

2014-11-01

124

Adenovirus-Mediated Transfer of Dominant-Negative Rho-Kinase Induces a Regression of Coronary Arteriosclerosis in Pigs In Vivo  

Microsoft Academic Search

Small GTPase Rho and its target Rho-kinase\\/ROK\\/ROCK play an important role in various cellular functions, including smooth muscle contraction, actin cytoskeleton organization, and cell adhesion and migration, all of which may be involved in the pathogenesis of arteriosclerosis. Here, we show that adenovirus-mediated transfer of dominant- negative Rho-kinase (DNRhoK) induces a marked regression of coronary constrictive remodeling and abolishes coronary

Kunio Morishige; Hiroaki Shimokawa; Yasuhiro Eto; Tadashi Kandabashi; Kenji Miyata; Yasuharu Matsumoto; Masahiko Hoshijima; Kozo Kaibuchi; Akira Takeshita

2010-01-01

125

Comparative study of coronary flow reserve, coronary anatomy and results of radionuclide exercise tests in patients with coronary artery disease  

Microsoft Academic Search

A comparative assessment of regional coronary flow reserve, quantitative percent diameter coronary stenosis and exercise-induced perfusion and wall motion abnormalities was performed in 39 patients with coronary artery disease. Coronary flow reserve was determined by a digital angiographic technique utilizing contrast medium as the hyperemic agent. Percent diameter stenosis was calculated by an automated quantification program applied to orthogonal cineangiograms.

Victor Legrand; G. B. John Mancini; Eric R. Bates; John Mc B. Hodgson; Milton D. Gross; Robert A. Vogel

1986-01-01

126

Depressive Symptoms and Mental Stress Induced Myocardial Ischemia in Patients with Coronary Heart Disease  

PubMed Central

Objectives The primary focus of this study was to examine associations between depressive symptoms and mental stress induced myocardial ischemia (MSIMI) in patients with coronary heart disease (CHD). Methods Adult patients with documented CHD were recruited for baseline mental stress and exercise stress screening testing as a part of the enrollment process of the REMIT trial. Patients were administered the Beck Depression Inventory II (BDI-II) and the Center for Epidemiologic Studies Depression Scale (CESD). Following a 24-48-hour Beta-blocker withdrawal, consented patients completed three mental stress tests followed by a treadmill exercise test. Ischemia was defined as 1) any development or worsening of any wall motion abnormality (WMA), 2) reduction of left ventricular ejection fraction (LVEF) ? 8% by transthoracic echocardiography, and/or ischemic ST-segment change by electrocardiography during stress testing. MSIMI was considered present when ischemia occurred in at least one mental test. Data were analyzed using logistic regression adjusting for age, gender, and resting left ventricular ejection fraction. Results One hundred twenty five (44.2 %) of 283 patients were found to have MSIMI and 93 (32.9%) had ESIMI. Unadjusted analysis showed that BDI-II scores were positively associated with the probability of MSIMI (OR = .1.30: 95% CI 1.06 – 1.60, p = .013) and number of MSIMI positive tasks (all p < .005). These associations were still significant after adjustment for covariates (ps ? .05). Conclusions In CHD patients, depressive symptoms were associated with a higher probability of MSIMI. These observations may enhance our understanding of the mechanisms contributing to the association of depressive symptoms to future cardiovascular events. PMID:24163385

Boyle, Stephen; Samad, Zainab; Becker, Richard C.; Williams, Redford; Kuhn, Cynthia; Ortel, Thomas L.; Kuchibhatla, Maragatha; Prybol, Kevin; Rogers, Joseph; O’Connor, Christopher; Velazquez, Eric J.; Jiang, Wei

2015-01-01

127

Pioglitazone inhibits high glucose-induced expression of receptor for advanced glycation end products in coronary artery smooth muscle cells  

PubMed Central

Receptor for advanced glycation end products (RAGE) is critical in inflammatory diseases, including diabetes and atherosclerosis. The mechanism underlying the effect of peroxisome proliferator-activated receptor ? (PPAR?) agonist pioglitazone (PIO) on RAGE expression in coronary artery smooth muscle cells (SMCs) stimulated by high glucose concentrations remains to be elucidated. In the present study, the effect and mechanism of action of PIO on RAGE expression in SMCs was investigated following treatment with high glucose concentrations. Rat coronary artery SMCs were pretreated with PIO alone, PIO and GW9662 (a PPAR? antagonist), diphenyleneiodonium (DPI; a nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor) or the antioxidant pyrrolidine dithiocarbamate (PDTC; a nuclear factor-?B (NF-?B) inhibitor), followed by treatment with high glucose. RAGE mRNA and protein expression, reactive oxygen species (ROS) production and NF-?B nuclear translocation were investigated. Glucose induced RAGE expression in a dose-dependent manner, with maximal effect at a concentration of 25 mmol/l following treatment for 48 h. PIO, DPI and PDTC reduced high glucose-induced increases in RAGE protein and mRNA expression. PIO prominently downregulated RAGE expression and inhibited high glucose-induced increases in ROS production and NF-?B activation (P<0.05). Pretreatment with PIO and GW9662 did not exhibit this inhibitory effect. High glucose may stimulate RAGE expression in coronary artery SMCs through NADPH oxidase-mediated ROS generation and NF-?B activation. PIO downregulated RAGE expression and inhibited ROS production and NF-?B activation via PPAR? activation, which may prevent the inflammatory effect of AGE/RAGE system in diabetes. PMID:25523934

DI, BEI-BING; LI, HONG-WEI; LI, WEI-PING; SHEN, XU-HUA; SUN, ZHI-JUN; WU, XING

2015-01-01

128

Recent advances in the pharmacotherapy of infantile spasms.  

PubMed

Adrenocorticotrophic hormone (ACTH), oral corticosteroids and vigabatrin are now first-line treatments for infantile spasms in the US and Europe. There is now increased knowledge regarding the role of ACTH, corticosteroids and vigabatrin (e.g. efficacy, doses, side effects, treatment in specific aetiological subtypes of infantile spasms), and other antiepileptic drugs (i.e. topiramate, valproate, zonisamide, sulthiame, levetiracetam, lamotrigine, pyridoxine, ganaxolone), as well as adjunctive flunarizine and novel drugs not yet in clinical use for infantile spasms (i.e. pulse rapamycin and melanocortin receptor agonists). The existence of a latent period, weeks to months following a precipitating brain insult, raises the possibility of preventive interventions. Recent experimental data emerging from animal models of infantile spasms have provided optimism that new and innovative treatments can be developed, and knowledge that drug treatment can affect long-term cognitive outcome is increasing. The aim of this article is to review recent developments in the pharmacotherapy of infantile spasms and to highlight the practical implications of the latest research. PMID:24504827

Riikonen, Raili

2014-04-01

129

Relation of pacing-induced coronary resistance vessel dilation to total serum cholesterol and heart rate-blood pressure product  

Microsoft Academic Search

Coronary risk factors adversely affect coronary resistance vessel dilation to acetylcholine, but little is known about the effect of risk factors on coronary blood flow (CBF) responses to physiologic stimuli. CBF was derived from Doppler flow velocity (0.018-inch Doppler wire) and coronary diameter (quantitative angiography) in response to rapid atrial pacing in 50 patients (mean age 52 ± 12 years).

Todd J. Anderson; David M. Goodhart; Mouhiedin Traboulsi; Merril L. Knudtson

1997-01-01

130

Cinnamaldehyde and cinnamaldehyde-containing micelles induce relaxation of isolated porcine coronary arteries: role of nitric oxide and calcium  

PubMed Central

Background and purpose Cinnamaldehyde, a major component of cinnamon, induces the generation of reactive oxygen species and exerts vasodilator and anticancer effects, but its short half-life limits its clinical use. The present experiments were designed to compare the acute relaxing properties of cinnamaldehyde with those of self-assembling polymer micelles either loaded with cinnamaldehyde or consisting of a polymeric prodrug [poly(cinnamaldehyde)] that incorporates the compound in its backbone. Methods Rings of porcine coronary arteries were contracted with the thromboxane A2 receptor agonist U46619 or 40 mM KCl, and changes in isometric tension were recorded. Results Cinnamaldehyde induced concentration-dependent but endothelium-independent, nitric oxide synthase (NOS)-independent, cyclooxygenase-independent, soluble guanylyl cyclase (sGC)-independent, calcium-activated potassium-independent, and TRPA1 channel-independent relaxations. Cinnamaldehyde also inhibited the contractions induced by 40 mM KCl Ca2+ reintroduction in 40 mM KCl Ca2+-free solution or by the Ca2+ channel opener Bay K8644. Cinnamaldehyde-loaded control micelles induced complete, partly endothelium-dependent relaxations sensitive to catalase and inhibitors of NOS or sGC, but not cyclooxygenase or TRPA1, channels. Cinnamaldehyde-loaded micelles also inhibited contractions induced by 40 mM KCl Ca2+ reintroduction or Bay K8644. Poly(cinnamaldehyde) micelles induced only partial, endothelium-dependent relaxations that were reduced by inhibitors of NOS or sGC and by catalase and the antioxidant tiron, but not by indomethacin or TRPA1 channel blockers. Conclusion The present findings demonstrate that cinnamaldehyde-loaded and poly(cinnamaldehyde) micelles possess vasodilator properties, but that the mechanism underlying the relaxation that they cause differs from that of cinnamaldehyde, and thus could be used both to relieve coronary vasospasm and for therapeutic drug delivery. PMID:24904214

Raffai, Gábor; Kim, Byungkuk; Park, Sanga; Khang, Gilson; Lee, Dongwon; Vanhoutte, Paul M

2014-01-01

131

Vigabatrin retinal toxicity in children with infantile spasms  

PubMed Central

Objectives: To determine time to vigabatrin (VGB, Sabril; Lundbeck, Deerfield, IL) induced retinal damage in children with infantile spasms (IS) and to identify risk factors for VGB-induced retinal damage (VGB-RD). Methods: Observational cohort study including 146 participants (68 female, 81 male) with IS, an age-specific epilepsy syndrome of early infancy, treated with VGB. Participants ranged from 3 to 34.9 months of age (median 7.6 months). The median duration of VGB treatment was 16 months (range 4.6–78.5 months). Electroretinograms (ERGs) were performed according to the Standards of the International Society for Clinical Electrophysiology of Vision. Inclusion required baseline (pre-VGB or within 4 weeks of starting VGB treatment) and at least 2 follow-up ERGs. Significant reduction from baseline of the 30-Hz ERG flicker amplitude on 2 consecutive visits identified VGB-RD. Kaplan-Meier survival analyses depicted the effect of duration of VGB on VGB-RD. Results: These data represent the largest survival analysis of children treated with VGB who did not succumb to retinal toxicity during the study. Thirty of the 146 participants (21%) showed VGB-RD. The ERG amplitude reduced with duration of VGB treatment (p = 0.0004) with no recovery after VGB cessation. With 6 and 12 months of VGB treatment, 5.3% and 13.3%, respectively, developed VGB-RD. There was neither effect of age of initiation of VGB treatment nor sex of the child on survival statistics and no significant effect of cumulative dosage on the occurrence of VGB-RD. Conclusions: Minimizing VGB treatment to 6 months will reduce the prevalence of VGB-RD in patients with IS. PMID:25381295

Wright, Tom; Cortese, Filomeno; Kumarappah, Ananthavalli; Snead, O. Carter; Buncic, Joseph R.

2014-01-01

132

Nonatherosclerotic causes of acute coronary syndrome: recognition and management.  

PubMed

Acute coronary syndromes (ACS) frequently result from the rupture or erosion of a vulnerable coronary plaque, with associated intracoronary thrombosis. ACS also may occur in patients with angiographically normal coronary arteries. Some of these patients, however, still have angiographically silent underlying coronary artery disease. In this setting, subtle atherosclerotic changes frequently associated with unstable morphologic features or residual intracoronary thrombus may be detected with intracoronary imaging techniques. Nevertheless, other patients develop ACS as a result of nonatherosclerotic coronary artery disease (NA-CAD). ACS in patients with NA-CAD may be the consequence of coronary spasm or transient coronary embolic phenomena. In these patients, after the initial ischemic insult, late coronary angiography usually reveals normal epicardial coronary vessels. Kounis syndrome is a type of ACS generated by allergic reactions. Takotsubo cardiomyopathy is characterized by normal coronary arteries with a distinct pattern of transient left ventricular wall motion abnormalities. ACS also may occur in young patients following illicit drug use. Finally, spontaneous coronary artery dissection and intramural hematoma represent other etiologies of NA-CAD. In this review, we discuss current evidence regarding diagnostic and treatment strategies in patients presenting with ACS as a result of NA-CAD. PMID:25308305

Bastante, Teresa; Rivero, Fernando; Cuesta, Javier; Benedicto, Amparo; Restrepo, Jorge; Alfonso, Fernando

2014-11-01

133

Simultaneous onset of infantile spasms in monozygotic twins.  

PubMed

The clinical, electroencephalographic, and genetic findings are reported for three pairs of monozygotic twins who developed infantile spasms in their first year. In all three pairs, the spasms started on the same day in each member of the pair. Neither sequencing of the ARX and CDKL5 (alias STK9) genes nor array comparative genomic hybridization assessment revealed any abnormalities. The long-term outcome was poor in all twins, although with different severity in individual pairs. These findings suggest that genes other than those currently known likely play a role in predisposition to infantile spasms, and that genetic susceptibility is linked to a variable phenotypic expression, ranging from quite benign to very severe, in monozygotic twins with no other apparent risk factors. PMID:20610124

Coppola, Giangennaro; Grosso, Salvatore; Verrotti, Alberto; D'Aniello, Alfredo; Pascotto, Antonio

2010-08-01

134

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

2010-01-01

135

The Other Babinski Sign in Hemifacial Spasm William Stamey, MD, Joseph Jankovic, MD  

E-print Network

by contraction of the frontalis muscle ipsilateral to the facial spasm. METHODSMETHODS REFERENCESREFERENCES 1The Other Babinski Sign in Hemifacial Spasm William Stamey, MD, Joseph Jankovic, MD Parkinson with hemifacial spasm (HFS), which he first described in 1905. This "other Babinski sign"1 is manifested

Lichtarge, Olivier

136

Sympathetic denervation in association with coronary artery grafting in patients with Prinzmetals' angina.  

PubMed

Myocardial revascularization in patients with Prinzmetal's angina has yielded variable results. Two patients are presented who underwent partial cardiac sympathectomy in combination with coronary artery grafting for typical variant angina associated with severe organic obstructive coronary artery disease. Late results 12 and 18 months postoperatively have been excellent in both instances as shown by clinical and angiographic evaluation. Although the exact mechanism responsible for Prinzmetal's angina is not known, it is believed that spasm through increased activity of vasomotor tone or of the autonomic nervous system plays a major role. Since this variant form of angina encompasses a whole spectrum at angiography, ranging from normal arteries to severely narrowed ones, including those with spasm, it is suggested that surgical treatment be planned accordingly. Thus, in patients who have organic stenoses with and without spasm, operative treatment may consist of removal of the preaortic or pretracheal plexus in association with conventional coronary artery grafting. In patients who have intractable episodes of ventricular arrhythmia or angina and who angiogram is normal or shows isolated spasm, coronary artery grafting should be abandoned, in view of the poor results reported in the literature in these circumstances, and cervicothoracic sympathectomy should be considered. PMID:300006

Grondin, C M; Limet, R

1977-02-01

137

Epidermoid cyst causing hemifacial spasm epidermoid cyst in cerebellopontine angle presenting with hemifacial spasm  

PubMed Central

Hemifacial Spasm (HS) occurs idiopathically or secondary to the lesions compressing the root exit zone of the facial nerve symptomatically. Symptomatic HS is generally due to vascular compression. We report on a 23-year-old male with right sided HS for a month. Magnetic resonance imaging (MRI) of the brain revealed a well-demarcated epidermoid cyst in the right cerebellopontine cistern. It was hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging without contrast enhancement, hyperintense on DWI, and slightly hypointense on ADC relative to the brain. Although it caused shifting of the pons and medulla to the left side and compression of the right cerebellar peduncles and fourth ventricle, the sole symptom of the patient was HS. Clinicians are advised to request MRI/scan for brainstem lesions from the patients with HS. Epidermoid cysts in cerebellopontine cistern may present with HS as the sole symptom. PMID:23188990

Alemdar, Murat

2012-01-01

138

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

2001-01-01

139

Myocardial perfusion imaging study of CO(2)-induced panic attack.  

PubMed

Chest pain is often seen alongside with panic attacks. Moreover, panic disorder has been suggested as a risk factor for cardiovascular disease and even a trigger for acute coronary syndrome. Patients with coronary artery disease may have myocardial ischemia in response to mental stress, in which panic attack is a strong component, by an increase in coronary vasomotor tone or sympathetic hyperactivity setting off an increase in myocardial oxygen consumption. Indeed, coronary artery spasm was presumed to be present in cases of cardiac ischemia linked to panic disorder. These findings correlating panic disorder with coronary artery disease lead us to raise questions about the favorable prognosis of chest pain in panic attack. To investigate whether myocardial ischemia is the genesis of chest pain in panic attacks, we developed a myocardial perfusion study through research by myocardial scintigraphy in patients with panic attacks induced in the laboratory by inhalation of 35% carbon dioxide. In conclusion, from the data obtained, some hypotheses are discussed from the viewpoint of endothelial dysfunction and microvascular disease present in mental stress response. PMID:24188891

Soares-Filho, Gastăo L F; Machado, Sergio; Arias-Carrión, Oscar; Santulli, Gaetano; Mesquita, Claudio T; Cosci, Fiammetta; Silva, Adriana C; Nardi, Antonio E

2014-01-15

140

Periorbital pain associated with hemifacial spasms that responded to botulinum toxin treatment and microvascular decompression surgery: a case report  

Microsoft Academic Search

Periorbital pain is unusual in patients with blepharospasms. We report a patient with hemifacial spasms who presented with severe ipsilateral periorbital aching pain. After treatment with botulinum toxin type A, the left hemifacial spasms and left periorbital pain improved temporarily. Microvascular decompression surgery was then performed for the facial spasms. The patient's left hemifacial spasms disappeared immediately after the operation,

Hiroki Iida; Kazuyuki Sumi; Motoyasu Takenaka; Toshio Asano; Shigemi Matsumoto; Toru Iwama; Shuji Dohi

2005-01-01

141

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

2011-01-01

142

[Treatment of hemifacial spasm with botulinum A toxin].  

PubMed

The authors present the method of hemifacial spasm treatment with botulinum toxin discussing the results of the treatment, injection method, side effects and complications of this treatment on the basis of literature review and their own experience. Clinical features, aetiology and pathophysiology of this condition are described. Other treatment methods are briefly mentioned. PMID:9608555

Duzy?ski, W; S?awek, J

1998-01-01

143

Computerized tomography of brain in infantile spasms (West syndrome)  

Microsoft Academic Search

Computerized tomographic scanning of the brain was performed in 26 infants with Infantile spasms. Majority of the patients, 18 (69%) had some abnormality. Changes noted were cerebral atrophy in 12, calcifications in 5 and dysgenesis of the corpus callosum in 3 patients. One infant each had porencephaly, hydrocephalus and cavum septum pellucidum. Five patients had more than one abnormality simultaneously.

A. H. Mahdi; M. D. Yohannan; P. J. Patel; T. M. Malabarey; T. M. Kolawole

1990-01-01

144

Current-density estimation of exercise-induced ischemia in patients with multivessel coronary artery disease  

Microsoft Academic Search

Magnetocardiographic and body surface potential mapping data measured in 6 patients with multivessel coronary artery disease were used in equivalent current-density estimation (CDE). Patient-specific boundary-element torso models were acquired from magnetic resonance images. Positron emission tomography data registrated with anatomical magnetic resonance imaging data provided the gold standard. Discrete current-density estimation values were computed on the epicardial surface of the

Jukka Nenonen; Katja Pesola; Kirsi Lauerma; Panu Takala; Juhani Knuuti; Lauri Toivonen; Toivo Katila

2001-01-01

145

Potentiation of phorbol ester-induced coronary vasoconstriction in dogs following endothelium disruption  

SciTech Connect

In the present study, the effect of phorbol ester, 12-0-tetradecanoylphorbol 13-acetate (TPA), activation of protein kinase C on coronary vascular reactivity was studied in isolated dog coronary arteries. Addition of TPA (10-100 nM) produced a slow, time- and dose-dependent contraction reaching a maximum at approx 2-3 hrs and was essentially irreversible upon washing. Disruption of the endothelium(EC) greatly accelerated the development as well as increase the magnitude of TPA contraction (50-100%). Prior treatment of vessels with phentolamine (1..mu..M), cyproheptadine (1..mu..H) and ibuprofen (1..mu..g/ml) did not alter the TPA contraction. Furthermore, in contrast to previously reported calcium-dependence of TPA contraction in other vessels, complete removal of extracellular calcium (Ca/sub 0/) or addition of 1..mu..M nimodipine after TPA(30nM) resulted in only 32 +/- 4% and 25 +/- 3% reversal of TPA contraction, respectively. Addition of amiloride (10..mu..M to 1mM), however, resulted in a dose-dependent reversal of TPA contraction. The results of the present study indicate that a similar activation of protein kinase C by TPA leads to potent coronary vasoconstriction, which is not completely dependent on Ca/sub 0/. More importantly, these results further support their hypothesis that EC also functions as an inhibitory barrier to prevent circulating vasoconstrictors from exerting their deleterious constrictory effects.

Roberts, R.B.; Ku, D.D.

1986-03-05

146

Comparison of contrast-induced nephrotoxicity of iodixanol and iopromide in patients with renal insufficiency undergoing coronary angiography.  

PubMed

This prospective, randomized, double-blind study was performed to compare the incidence of contrast-induced nephropathy (CIN) after the administration of the iso-osmolar contrast medium iodixanol to the low-osmolar contrast medium iopromide during coronary angiography in patients with impaired renal function. Patients with creatinine clearance (CrCl) <60 ml/min who underwent coronary angiography and/or percutaneous coronary intervention were randomized to receive either iodixanol (n = 215) or iopromide (n = 205). The primary study end point was the incidence of CIN, which was defined as an absolute increase in serum creatinine (SCr) ?0.5 mg/dl (44.2 mol/L) or a relative increase ?25% compared to baseline SCr. The secondary end points were the proportion of patients with increases in SCr ?0.5 mg/dl, the proportion with SCr increases ?1.0 mg/dl (88.4 mol/L), and the peak increase in SCr. Age, the presence of diabetes mellitus, mean baseline SCr, CrCl, the use of N-acetylcysteine, contrast volume, and the predicted risk score for CIN were similar in the 2 groups. CIN developed in 39 patients (9.3%); there was no significant difference between the iodixanol and iopromide groups (10.7% and 7.8%, respectively; absolute difference 2.9%, 95% confidence interval -3.1% to 8.9%, p = 0.394). The proportions of patients with SCr increases ?0.5 mg/dl (6.5% vs 6.3%) and ?1.0 mg/dl (2.8% vs 2.9%) were similar in the 2 groups. There was a tendency for more patients with relative increases ?25% (10.2% vs 6.8%) and greater peak increases in SCr (0.037 ± 0.375 vs 0.029 ± 0.351 mg/dl) to be in the iodixanol group, but these differences were not statistically significant. In conclusion, the incidences of CIN after coronary angiography did not significantly differ between the iodixanol and iopromide groups in patients with impaired renal function. PMID:21545991

Shin, Dong-Ho; Choi, Dong-Ju; Youn, Tae-Jin; Yoon, Chang-Hwan; Suh, Jung-Won; Kim, Kwang-Il; Cho, Young-Seok; Cho, Goo-Yeong; Chae, In-Ho; Kim, Cheol-Ho

2011-07-15

147

The effects of ablations in the central nervous system on arrhythmias induced by coronary occlusion in the rat.  

PubMed Central

The role of the central nervous system (CNS) in arrhythmogenesis in the 4 h period following occlusion of a coronary artery was investigated in rats by use of CNS ablations and other procedures. Ablations in the CNS included pithing, spinalization and decerebration combined with acute and chronic surgical preparation and noradrenaline/adrenaline infusions. All procedures involving acute surgery reduced the incidence and severity of the arrhythmias induced by occlusion. Such reductions were most marked in the second (0.5-4 h post-occlusion) arrhythmic period. The observed reductions in arrhythmias could not be explained in terms of involvement of the CNS or adrenoceptor activation. When circulating leucocytes, platelets and serum potassium were measured in a group of pithed rats before and after occlusion, reduced levels (20-50%) of both leucocytes and platelets occurred while serum potassium levels rose by 50-100%. Arrhythmias following coronary occlusion may depend in part on factors in the blood such as leucocytes, platelets and serum potassium and these factors may be altered by acute surgery. PMID:4063585

Curtis, M. J.; Macleod, B. A.; Walker, M. J.

1985-01-01

148

Encephalopathy in an infant with infantile spasms: possible role of valproate toxicity.  

PubMed

An infant presented with global developmental delay and infantile spasms. EEG was suggestive of hypsarrhythmia. She was started on sodium valproate, clonazepam and adrenocorticotropic hormone injection. After an initial improvement the child developed vomiting, altered sensorium and increase in frequency of seizures suggestive of encephalopathy. Valproate-induced hyperammonaemia or hepatic encephalopathy was considered and the drug was withheld following which there was a dramatic improvement. Paradoxically, the liver function tests and serum ammonia were normal. However, a complete reversal of encephalopathy, on withdrawal of the drug, strongly suggested an adverse drug reaction (ADR) due to valproic acid. Marginal elevation of serum valproic acid prompted us to use the Naranjo ADR probability score to confirm the diagnosis. This case highlights the fact that valproate toxicity can manifest with normal liver function and serum ammonia levels. This is the youngest reported case with this rare form of valproate-induced encephalopathy. PMID:24810446

Sivathanu, Shobhana; Sampath, Sowmya; Veerasamy, Madhubala; Sunderkumar, Satheeshkumar

2014-01-01

149

The clinical significance and management of patients with incomplete coronary angiography and the value of additional computed tomography coronary angiography.  

PubMed

To assess the anatomical background and significance of incomplete invasive coronary angiography (ICA) and to evaluate the value of coronary computed tomography angiography (CTA) in this scenario. The current study is an analysis of high volume center experience with prospective registry of coronary CTA and ICA. The target population was identified through a review of the electronic database. We included consecutive patients referred for coronary CTA after ICA, which did not visualize at least one native coronary artery or by-pass graft. Between January 2009 and April 2013, 13,603 diagnostic ICA were performed. There were 45 (0.3 %) patients referred for coronary CTA after incomplete ICA. Patients were divided into 3 groups: angina symptoms without previous coronary artery by-pass grafting (CABG) (n = 11,212), angina symptoms with previous CABG (n = 986), and patients prior to valvular surgery (n = 925). ICA did not identify by-pass grafts in 21 (2.2 %) patients and in 24 (0.2 %) cases of native arteries. The explanations for an incomplete ICA included: 11 ostium anomalies, 2 left main spasms, 5 access site problems, 5 ascending aorta aneurysms, and 2 tortuous take-off of a subclavian artery. However, in 20 (44 %) patients no specific reason for the incomplete ICA was identified. After coronary CTA revascularization was performed in 11 (24 %) patients: 6 successful repeat ICA and percutaneous intervention and 5 CABG. Incomplete ICA constitutes rare, but a significant clinical problem. Coronary CTA provides adequate clinical information in these patients. PMID:24623270

Pregowski, Jerzy; Kepka, Cezary; Kruk, Mariusz; Mintz, Gary S; Kalinczuk, Lukasz; Ciszewski, Michal; Kochanowski, Lukasz; Wolny, Rafal; Chmielak, Zbigniew; Jastrz?bski, Jan; Klopotowski, Mariusz; Zalewska, Joanna; Demkow, Marcin; Karcz, Maciej; Witkowski, Adam

2014-04-01

150

Papaverine: The ideal coronary vasodilator for investigating coronary flow reserve? A study of timing, magnitude, reproducibility, and safety of the coronary hyperemic response after intracoronary papaverine  

Microsoft Academic Search

A potent, short-acting vasodilator that induces a maximal hyperemic response of the coronary vascular bed is needed to determine coronary flow reserve. In 12 patients, we measured coronary sinus blood flow by thermodilution over a period of 2 min during which a bolus of 10 mg papaverine was given into the left main coronary artery. This was repeated after 5

F. Zijlstra; P. W. J. C. Serruys; P. G. Hugenholtz

1986-01-01

151

Hemifacial spasm: clinical characteristics of 321 Indian patients.  

PubMed

Hemifacial spasm (HFS) is a common neurological disorder characterized by involuntary tonic and clonic contractions of the muscles innervated by the facial nerve. We aimed to describe clinical features, common antecedents, triggers and relieving factors in patients with hemifacial spasm to study the correlation of hypertension and HFS, and to compare clinical features of primary and secondary cases of HFS. The data for the study were collected prospectively on a predesigned and pre-tested format at the first attendance in all consecutive HFS patients attending the movement disorders clinic of a tertiary teaching hospital in India. The demographic profile, HFS symptoms, antecedent illnesses and neurological examination were recorded and analyzed. Muscle power in individual muscles innervated by the facial nerve was tested carefully before botulinum toxin injection. Hemifacial spasm occurred in 7.14% (n = 582) of 8,151 cases registered at the movement disorders clinic from 1993 to 2010. Data of 321 patients were complete and were included in the study. Females constituted 49.22% (n = 158). The mean age the patients was 46.02 ± 11.82 years; ipsilateral ear clicking was observed in 22.74% cases. The most common aggravating factor was stress (44.86%), while the most common relieving factor was sleep (44.24%). Two hundred fifty-two patients (78.5%) had primary HFS. The severity of spasm correlated significantly with disease duration (p < 0.001) and weakness of facial muscles (p < 0.001). We did not observe any correlation between HFS on the left side and hypertension, as has been reported earlier. This is one of the largest studies of HFS patients and the only one that prospectively assesses patients with HFS clinically on their first visit. Interesting observations of this study are lack of female preponderance, presence of clicking in the ipsilateral ear and facial weakness even prior to botulinum toxin injection. PMID:22222858

Batla, Amit; Goyal, Chanchal; Shukla, Garima; Goyal, Vinay; Srivastava, Achal; Behari, Madhuri

2012-08-01

152

Adrenocorticotropic hormone versus prednisolone in the treatment of infantile spasms post vigabatrin failure.  

PubMed

The Child Neurology Society/American Academy of Neurology practice parameter has recommended adrenocorticotropic hormone or vigabatrin in the short-term treatment of infantile spasms. When vigabatrin is unavailable or ineffective and adrenocorticotropic hormone is not a treatment option because of the prohibitive cost, other forms of corticosteroids have been considered in the treatment of infantile spasms. This retrospective study reviewed the Hospital for Sick Children's experience with the short-term effectiveness of prednisolone versus adrenocorticotropic hormone in patients with infantile spasms who have failed vigabatrin. The results showed that while adrenocorticotropic hormone was more likely to lead to short-term spasm freedom, there was no difference in the likelihood of longer-term spasm resolution without relapse. These findings can guide clinicians in the treatment of infantile spasms post vigabatrin failure. PMID:24965788

Jones, Kevin; Snead, O Carter; Boyd, Jennifer; Go, Cristina

2015-04-01

153

Effect of contrast-induced nephropathy on cardiac outcomes after use of nonionic isosmolar contrast media during coronary procedure.  

PubMed

Contrast-induced nephropathy (CIN) has been increasing and seems to be associated with clinical outcomes in ischemic heart disease. This study aimed to assess the incidence, predictors, and cardiac outcomes of CIN when nonionic isosmolar contrast media (iodixanol, Visipaque(®), GE Healthcare, Cork, Ireland) was used. Between January 2005 and July 2008, 510 patients (69.2 ± 9.0 years of age, 384 men) undergoing diagnostic coronary angiography (CAG) or percutaneous coronary intervention (PCI) were divided into two groups according to the development of CIN (CIN group: n=74; non-CIN group: n=436). CIN developed in 74 patients (14.5%). They were more likely to have diabetes (55.4% vs. 42.9%, p=0.045), decreased left ventricular ejection fraction (LVEF) (50.1 ± 12.6% vs. 57.7 ± 13.9%, p<0.001), and lower baseline hematocrit level (32.4 ± 5.3% vs. 36.6 ± 5.5%, p<0.001). Multiple logistic regression analysis revealed baseline hematocrit (odds ratio 0.900, 95% confidence interval 0.851-0.952, p<0.001), decreased LVEF (odds ratio 0.967, 95% confidence interval 0.949-0.986, p=0.001), and baseline creatinine level (odds ratio 2.317, 95% confidence interval 1.252-4.286, p=0.007) as independent predictors of CIN. At 1-year follow-up, patients with CIN were found to have more adverse outcomes than without CIN in Cox proportional hazards analysis (hazard ratio 13.068, 95% confidence interval 2.425-70.434, p=0.003). CIN was mostly associated with baseline creatinine level rather than CM amount using nonionic isosmolar CM. We found that patients with CIN had worse event-free survival than patients without CIN after multifactorial adjustment. PMID:20708903

Cho, Jae Yeong; Jeong, Myung Ho; Hwan Park, Su; Kim, In Soo; Park, Keun Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Park, Hyung Wook; Hong, Young Joon; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

2010-11-01

154

Infantile spasms are associated with abnormal copy number variations.  

PubMed

The authors tested the hypothesis that de novo copy number variations (CNVs) implicated in known genomic disorders ("pathogenic CNVs") are significant predisposing factors of infantile spasms. The authors performed a genome-wide analysis of single-nucleotide polymorphism genotyping microarray data to identify the role of de novo/known pathogenic large CNVs in 13 trios of children affected by infantile spasms. A rare, large (4.8 Mb) de novo duplication was detected in the 15q11-13 region of 1 patient. In addition, 3 known pathogenic CNVs (present in the patient as well as 1 of the parents) were detected in total. In 1 patient, a known pathogenic deletion was detected in the region of 2q32.3. Similarly, in 1 other patient, 2 known pathogenic deletions in the regions of 16p11.2 and Xp22.13 (containing CDKL5) were detected. These findings suggest that some specific pathogenic CNVs predispose to infantile spasms and may be associated with different phenotypes. PMID:22914377

Tiwari, Vijay N; Sundaram, Senthil K; Chugani, Harry T; Huq, A H M M

2013-10-01

155

Delayed Dural Arteriovenous Fistula after Microvascular Decompression for Hemifacial Spasm  

PubMed Central

Dural arteriovenous fistula (AVF) is very rare, acquired lesion that may present with intracranial hemorrhage or neurological deficits. The etiology is not completely understood but dural AVF often has been associated with thrombosis of the involved dural sinuses. To our knowledge, this is the first well documented intracranial hemorrhage case caused by dural AVF following microvascular decompression for hemifacial spasm. A 49-year-old male patient had left microvascular decompression of anterior inferior cerebellar artery via retrosigmoid suboccipital craniotomy. The patient was in good condition without any residual spasm or surgery-related complications. However, after 10 months, he suffered sudden onset of amnesia and dysarthria. Computed tomography and magnetic resonance imaging revealed the presence of dural AVF around the left transverse-sigmoid sinus. The dural AVF was treated with Onyx® (ev3) embolization. At the one-year follow up visit, there were no evidence of recurrence and morbidity related to dural AVF and its treatment. This case confirms that the acquired etiology of dural AVF may be associated with retrosigmoid suboccipital craniotomy for hemifacial spasm, even though it is an extremely consequence of this procedure. PMID:25328659

Kim, Sung Han; Chang, Won Seok; Jung, Hyun Ho

2014-01-01

156

Percutaneous coronary rotary ablation.  

PubMed

The rotablator is a high-speed rotating ablative system developed to grind obstructing atheromatous material into fine particles. It consists of a rotating burr attached to a long, flexible driving shaft with a central flexible guidewire. The device rotates with a speed of 190,000 r.p.m. In this study, after appropriate pretreatment, the atherectomy system was positioned over the guidewire, the steerable guidewire advanced to beyond the stenosis, the abrasive burr positioned at the stenosis and the rotation commenced. The abrasive burr was advanced until a resistance was experienced and then, with back and forth motion, further advanced until passage of the stenosis was achieved. The procedure was repeated six to eight times until no further mechanical resistance was encountered. Patients were maintained on aspirin and nifedipine. With a burr size between 1.5 and 2 mm, in 32 patients in the right coronary artery, twelve patients in the left anterior descending artery and eight patients in the circumflex artery, an average increase in diameter from 0.52 +/- 0.28 mm to 1.27 +/- 0.37 mm was achieved with respective reduction in the stenosis from 80 +/- 11% to 47 +/- 17%. Balloon dilatation was subsequently carried out in 19 patients in 15 of whom residual significant stenosis was due to the use of an inadequately large burr. There were no deaths. During ablation, in six patients evanescent (of few seconds in duration), spontaneously-reversible AV-block developed probably due to embolization of particles into the sinus node artery. Two patients developed coronary spasm, three had acute occlusion with subsequent myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2146203

Bertrand, M E; Lablanche, J M; Fourrier, J L; Bauters, C; Leroy, F

1990-10-01

157

Automatic Identification and Classification of Muscle Spasms in Long-Term EMG Recordings.  

PubMed

Spinal cord injured (SCI) individuals may be afflicted by spasticity, a condition in which involuntary muscle spasms are common. EMG recordings can be analyzed to quantify this symptom of spasticity but manual identification and classification of spasms are time consuming. Here, an algorithm was created to find and classify spasm events automatically within 24-h recordings of EMG. The algorithm used expert rules and time-frequency techniques to classify spasm events as tonic, unit, or clonus spasms. A companion graphical user interface (GUI) program was also built to verify and correct the results of the automatic algorithm or manually defined events. Eight channel EMG recordings were made from seven different SCI subjects. The algorithm was able to correctly identify an average (±SD) of 94.5 ± 3.6% spasm events and correctly classify 91.6 ± 1.9% of spasm events, with an accuracy of 61.7 ± 16.2%. The accuracy improved to 85.5 ± 5.9% and the false positive rate decreased to 7.1 ± 7.3%, respectively, if noise events between spasms were removed. On average, the algorithm was more than 11 times faster than manual analysis. Use of both the algorithm and the GUI program provide a powerful tool for characterizing muscle spasms in 24-h EMG recordings, information which is important for clinical management of spasticity. PMID:24801733

Winslow, Jeffrey; Martinez, Adriana; Thomas, Christine K

2015-03-01

158

Modification of the ischaemic-induced contraction in the sheep circumflex coronary artery by various pharmacological antagonists.  

PubMed Central

1. Sheep isolated circumflex coronary artery rings were exposed to simulated ischaemia (increased K+ reduced pH, hypoxia, reduced glucose and addition of lactate). Simulated ischaemia caused a transient relaxation lasting approximately 5 min followed by a sustained contraction that was reversible on washing with oxygenated Krebs solution. 2. Haemolysate caused a rise in baseline tension and augmented the ischaemic contraction. 3. The ischaemic contraction was abolished by BW 755C 5 microM and reduced by indomethacin 1 microM, quinacrine 50 microM or the thromboxane A2 antagonist BM 13177 10 microM. The leukotriene D4 antagonist, ICI 198615, had no effect. 4. The ischaemic-induced contraction was enhanced by propranolol 1 microM, methiothepin 1 microM and reduced by ketanserin 1 microM. 5. The ischaemic contraction was markedly inhibited by trypsin (1 mu ml-1) and by verapamil, cromakalim or sodium nitroprusside. 6. The following had no or little effect on the ischaemic contraction: Sar1-Thr8-angiotensin II, mepyramine, atropine, the spin trapping agent PBN or the free radical scavenger dimethylsulphoxide. Superoxide dismutase caused a slight enhancement. 7. The ischaemic-induced contraction was abolished by the simultaneous administration, at subthreshold concentrations, either of two vasodilators (iloprost and adenosine) or of a vasodilator and a vasoconstrictor (iloprost and U46619). 8. The ischaemic relaxation phase was reduced by propranolol and indomethacin, abolished by haemolysate and enhanced by quinacrine or cromakalim. 9. It is concluded that the ischaemic-induced contraction is caused by mediators released from the endothelium including a product of the lipoxygenase pathway. There is also evidence that simulated ischaemia causes the release of noradrenaline and 5-hydroxytryptamine. PMID:2390668

Kwan, Y. W.; Wadsworth, R. M.; Kane, K. A.

1990-01-01

159

Structural changes in the CNS of patients with hemifacial spasm.  

PubMed

Hemifacial spasm (HFS) is a peripheral nerve disorder which impacts the living quality of patients both psychologically and physically. Whether HFS has structural changes under these specific stressors including psychological and physiological conditions in the CNS remains largely unknown. In the current study, voxel-based morphometry (VBM) was used to evaluate changes in gray matter (GM) by using T1-weighted imaging in 25 HFS patients and 25 demographically similar healthy volunteers. The severity of the spasm was assessed using a Cohen evaluation scale. Hamilton anxiety (HAMA) and Hamilton depression (HAMD) rating scales were used to evaluate the affective conditions of subjects. 3D-FIESTA and 3D-TOF sequences were applied to evaluate the neurovascular compression (NVC) rating in each subject. In our results, we found that HFS patients had higher NVC rating scores than those of healthy volunteers, and the spasm severity rating was positively correlated with the NVC rating (r=0.736, p<0.001). HFS patients had higher scores on the HAMA and HAMD compared with healthy volunteers. For the GM comparison, reductions were found in the thalamus, putamen, pallidum, dorsolateral prefrontal cortex, amygdala and parahippocampal gyrus in patients with HFS compared with healthy volunteers. Additionally, the GM volume changes in the amygdala did not exhibit any significant between-group differences with HAMA and HAMD scores as covariates. Our results suggested that HFS probably led to GM volume abnormalities of the CNS. We indicated that the GM volume changes of the amygdala may be highly related to emotional factors. PMID:25595976

Bao, F; Wang, Y; Liu, J; Mao, C; Ma, S; Guo, C; Ding, H; Zhang, M

2015-03-19

160

Synkinesis in hemifacial spasm: results of recording intracranially from the facial nerve  

Microsoft Academic Search

Summary We show evidence that the motonucleus of the facial nerve is involved in producing the synkinesis in patients with hemifacial spasm. These results were obtained by recording from the intracranial portion of the facial nerve and from the orbicularis oculi muscle in patients operated upon for hemifacial spasm during electrical stimulation of the mandibular branch of the facial nerve.

A. R. Mřller; P. J. Jannetta

1985-01-01

161

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

162

Warm water irrigation for dealing with spasm during colonoscopy: Simple, inexpensive, and effective  

Microsoft Academic Search

Background: Colonic spasm can interfere with colonoscopy by hindering insertion of the colonoscope and by making polypectomy difficult, painful, and dangerous. Methods for dealing with colonic spasm include waiting for it to subside and administration of antispasmodic agents such as glucagon or hyoscyamine. Glucagon is expensive and hyoscyamine has side effects. This study evaluated an inexpensive technique, warm water irrigation,

James M. Church

2002-01-01

163

Six Cases of Hemifacial Spasm Treated with Electro?Acupuncture Therapy  

Microsoft Academic Search

Patients with hemifacial spasm (HFS sometimes visit acupuncture practitioners for treatment. We can find descriptions of acupuncture procedures and methods for treating facial spasm in textbooks of clinical acupuncture. However there is almost to literature that presents data on the actual responses of HFS patients to acupuncture. Therefore we cannot judge satisfactorily whether acupuncture is suitable for treating of HFS

Hiroshi TSUKAYAMA; Motoaki YOSHIDA; Kazushi NISHIJO

164

Young onset Hemifacial Spasm in patients with Chiari type I malformation  

Microsoft Academic Search

Hemifacial spasm (HFS) resulting from Chiari type I malformation (CIM) is rare. We retrospectively evaluated five patients with CIM and HFS among a series of 103 subjects. The frequency of HFS associated to CIM was of 4.85%. The clinical profile did not differ from the classical primary cases except for young-onset development of facial spasms in patients with CIM. Three

Andre Carvalho Felício; Clecio de Godeiro Jr; Vanderci Borges; Sonia Maria de Azevedo Silva; Henrique Ballalai Ferraz

2008-01-01

165

Clinical assessment of patients with primary and postparalytic hemifacial spasm: a retrospective study  

Microsoft Academic Search

Objective: To compared the clinical features of 373 patients with primary and postparalytic hemifacial spasm (HFS). Method: Data analyzed were gender, ethnicity, age at symptom onset, disease duration, affected side, distribution of facial spasm at onset, hypertension, family history of HFS, previous history of facial palsy and latency between facial palsy and HFS. Results: The prevalence of patients with Asian

Andre Carvalho Felicio; Clecio de Oliveira Godeiro-Junior; Vanderci Borges; Sonia Maria de Azevedo Silva; Henrique Ballalai Ferraz

2007-01-01

166

The female urethral syndrome: external sphincter spasm as etiology.  

PubMed

Many women suffer a constellation of urinary and pelvic symptoms commonly referred to as the urethral syndrome. Numerous medical, surgical and psychological treatment modalities have been used to alleviate the symptoms. Urodynamic techniques were used to study a group of women with the urethral syndrome. Based on the findings of external urethral sphincter spasm and/or pelvic floor hyperactivity the institution of diazepam therapy not only has provided clinical relief but also sphincter synergy as demonstrated by post-treaatment urodynamics. PMID:7411719

Kaplan, W E; Firlit, C F; Schoenberg, H W

1980-07-01

167

G protein-coupled receptors mediate coronary flow- and agonist-induced responses via lectin-oligosaccharide interactions.  

PubMed

Blood flow acts parallel to the coronary luminal endothelial surface layer (LESL) and modulates multiple parenchymal functions via the release of paracrine agents. Evidence indicates that the LESL may be a flow-sensing organelle and that perhaps through flow-induced lectin (L)·oligosaccharide (O) complex formation (L·O) participates in this process. LESL integrins and selectins are both lectinic and flow sensitive, but the L properties of flow-sensitive G protein-coupled receptors (GPCRs) are unknown. Therefore, we investigated the presence of L in the LESL and hypothesized that if flow-sensitive GPCRs are L, flow and O will determine their response to receptor activation. The LESL protein fraction isolated from guinea pig hearts was passed through an affinity chromatography column made of three sugars, mannose, galactose, and N-acetylglucosamine, and the lectinic fraction was eluted. Immune dot blot was used to identify L proteins in the LESL fraction. Our results indicate the following. 1) Two-dimensional SDS-PAGE (2D-SDS-PAGE) of the LESL lectinic fraction revealed at least 167 Ls. 2) Among these Ls, we identified three selectins and the GPCRs: angiotensin II, bradykinin (B2-R), adenosine A1 and A2, prolactin, endothelin, ?1-adrenergic (?1A-R), thromboxane A2, ?1-adrenergic, ?3-adrenergic, and insulin receptors; the first six GPCRs are known to be flow sensitive. 3) The amplitude of receptor-induced vascular responses by ?1A-R and B2-R activation (phenylephrine or bradykinin, respectively) was a function of flow and O (hyaluronidate). Our results support a novel mechanism of GPCR-mediated responses to flow via L·O interaction. PMID:24363307

Perez-Aguilar, Sandra; Torres-Tirado, David; Martell-Gallegos, Guadalupe; Velarde-Salcedo, Jimena; Barba-de la Rosa, Ana Paulina; Knabb, Maureen; Rubio, Rafael

2014-03-01

168

Clinical Review of the Effects of Hominis Placental Pharmacopuncture in the Treatment of Facial Spasm Patients  

PubMed Central

Objectives: The main purpose of this research is to investigate the effect of treatment with Hominis Placental pharmacopuncture (HPP) for 32 patients with hemifacial spasm. Methods: We treated facial spasm patients with acupuncture and HPP at Sabaek (ST2), Seung-eup (ST1), Gwallyeo (SI18), Chanjuk (BL2), Sajukgong (TE23), Hagwan (ST7), Hyeopgeo (ST6), Jichang (ST4), Wan-gol (SI4) and Yepung (TE17), and we investigated the effect by using Scott’s scale. The data were analyzed by using the SPSS/10.0 for windows program with descriptive statistics, the paired t-test, and the Shapiro-Wilk normality test. Results: After treatment, the grade of the spasm’s intensity based on Scott’s description were decreased significantly. About 72% of the patients felt that the combination treatment had produced excellent results. Conclusion: These data suggested that HPP can be useful for treating facial spasm patients.

Jo, Na-Young; Kim, Jeong-Hyun; Roh, Jeong-Du

2013-01-01

169

Cholinergic induced coronary vasospasm: Treatment of organophosphate toxicity. Final report, 1 May 1988-31 October 1991  

SciTech Connect

To evaluate the mechanism of organophosphate's possible acetylcholine (ACh) mediated vasospasm, studies were conducted on sixteen, Yorkshire swine. In one group of eight pigs, a dose of two LD-50s of soman (4.6 Kg/kg 205 JIG) was given at 102.5 microgram/second in the femoral vein. These experiments demonstrated that following soman injection coronary blood flow decreased, with an increase in acetylcholine levels and coronary vascular resistance. The fall in coronary blood flow was accompanied by concomitant decreases in acetyl-cholinesterase levels, hemodynamic function, S-T segment elevation and ventricular fibrillation. In eight additional pigs intracoronary saline or ACh (1.05 + or - 0.39 micrometers) infusions tested coronary vasoactivity in the resting condition. Following the sedentary experiments the same pigs underwent six treadmill exercise studies:(1) Exer. Cont., 1 ml/min saline, i.c.;(2) Exer.+ 0.10 + or - 0.02 micrometers ACh, i.c.; (3) Exer. + 0.52 + or - 0.20 micrometers ACh, i.c.; (4) Exer. + 1.05 + or - 0.39 micrometers ACh, i.c.; (5) Exer.+ ACh-atropine, 1.05 + or - 0.39 micrometers ACh, i.c., atropine 28 microgram/kg, i.v.; or (6) Atropine, 1 ml/min saline, i.c., atropine 28 microgram/kg i.v. At rest ACh decreased coronary blood flow by 28%. Exercise increased coronary blood flow by 77% while exercise plus ACh infusions reduced coronary blood flow by 19%, 261/, and 31% for Exer.+0.10, Exer.+0.5, and Ex+1.05 JIM ACh, respectively. In addition, ACh infusion during exercise decreased the lactate consumption and at Exer.+1.05 micrometer ACh there was a lactate production with a reduction in Mv02. These data support ACh mediated coronary vasospasm in the swine.

McKenzie, J.E.; Bellamy, R.F.

1993-05-13

170

Myeloperoxidase Is Not Useful for Detecting Stress Inducible Myocardial Ischemia but May Be Indicative of the Severity of Coronary Artery Disease  

PubMed Central

Background and Objectives Elevated levels of myeloperoxidase (MPO) have been found in patients in different stages of coronary artery disease (CAD). The aim of this study was to assess whether the MPO liberation is increased by stress inducible myocardial ischemia and could be used to improve the diagnostic accuracy of non-invasive evaluation for myocardial ischemia. Subjects and Methods Seventy-six patients with suspected myocardial ischemia who underwent stress myocardial perfusion scintigraphy (MPS) were enrolled. 59 patients with an acute coronary syndrome (ACS) who received a percutaneous coronary intervention along with 12 healthy volunteers were also included in the study. In every subject the MPO plasma levels were assessed by enzyme linked immunosorbent assay. In patients undergoing MPS, the MPO levels were measured serially before and after the stress testing. Results Of the 76 patients undergoing MPS, 38 were diagnosed with a stress inducible myocardial ischemia. The patients with a stress induced ischemia had significantly higher basal MPO levels than those without it (32±3 ng/mL vs. 24±4 ng/mL, p=0.03). However, there was no relevant change in the MPO levels after the stress test compared to the baseline. The patients with ACS showed significantly higher MPO levels than the patients undergoing MPS (131±14 ng/mL vs. 28±2 ng/mL, p<0.01) and the healthy subjects (131±14 ng/mL vs. 26±2 ng/mL, p<0.01). Conclusion Since the MPO plasma levels did not increase after the stress MPS, MPO appears not to be a useful biomarker for detecting a stress inducible myocardial ischemia. Yet, the MPO levels correlate with the different stages of CAD and may hold significance as an indicator for its clinical severity. PMID:24497884

Schuhmann, Christoph G.; Hacker, Marcus; Jung, Philip; Krötz, Florian

2014-01-01

171

Role of mitochondrial dysfunction in hyperglycaemia-induced coronary microvascular dysfunction: Protective role of resveratrol.  

PubMed

Microvascular complications are now recognized to play a major role in diabetic complications, and understanding the mechanisms is critical. Endothelial dysfunction occurs early in the course of the development of complications; the precise mechanisms remain poorly understood. Mitochondrial dysfunction may occur in a diabetic rat heart and may act as a source of the oxidative stress. However, the role of endothelial cell-specific mitochondrial dysfunction in diabetic vascular complications is poorly studied. Here, we studied the role of diabetes-induced abnormal endothelial mitochondrial function and the resultant endothelial dysfunction. Understanding the role of endothelial mitochondrial dysfunction in diabetic vasculature is critical in order to develop new therapies. We demonstrate that hyperglycaemia leads to mitochondrial dysfunction in microvascular endothelial cells, and that mitochondrial inhibition induces endothelial dysfunction. Additionally, we show that resveratrol acts as a protective agent; resveratrol-mediated mitochondrial protection may be used to prevent long-term diabetic cardiovascular complications. PMID:25767181

Joshi, Mandar S; Williams, David; Horlock, Duncan; Samarasinghe, Thilini; Andrews, Karen L; Jefferis, Ann-Maree; Berger, Philip J; Chin-Dusting, Jaye P; Kaye, David M

2015-05-01

172

Aronia melanocarpa juice, a rich source of polyphenols, induces endothelium-dependent relaxations in porcine coronary arteries via the redox-sensitive activation of endothelial nitric oxide synthase.  

PubMed

This study examined the ability of Aronia melanocarpa (chokeberry) juice, a rich source of polyphenols, to cause NO-mediated endothelium-dependent relaxations of isolated coronary arteries and, if so, to determine the underlying mechanism and the active polyphenols. A. melanocarpa juice caused potent endothelium-dependent relaxations in porcine coronary artery rings. Relaxations to A. melanocarpa juice were minimally affected by inhibition of the formation of vasoactive prostanoids and endothelium-derived hyperpolarizing factor-mediated responses, and markedly reduced by N(?)-nitro-l-arginine (endothelial NO synthase (eNOS) inhibitor), membrane permeant analogs of superoxide dismutase and catalase, PP2 (Src kinase inhibitor), and wortmannin (PI3-kinase inhibitor). In cultured endothelial cells, A. melanocarpa juice increased the formation of NO as assessed by electron paramagnetic resonance spectroscopy using the spin trap iron(II)diethyldithiocarbamate, and reactive oxygen species using dihydroethidium. These responses were associated with the redox-sensitive phosphorylation of Src, Akt and eNOS. A. melanocarpa juice-derived fractions containing conjugated cyanidins and chlorogenic acids induced the phosphorylation of Akt and eNOS. The present findings indicate that A. melanocarpa juice is a potent stimulator of the endothelial formation of NO in coronary arteries; this effect involves the phosphorylation of eNOS via the redox-sensitive activation of the Src/PI3-kinase/Akt pathway mostly by conjugated cyanidins and chlorogenic acids. PMID:23973200

Kim, Jong Hun; Auger, Cyril; Kurita, Ikuko; Anselm, Eric; Rivoarilala, Lalainasoa Odile; Lee, Hyong Joo; Lee, Ki Won; Schini-Kerth, Valérie B

2013-11-30

173

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.

1988-01-01

174

Water-soluble jack-knife prawn extract inhibits 5-hydroxytryptamine-induced vasoconstriction and platelet aggregation in humans.  

PubMed

Coronary artery spasm plays an important role in the pathogenesis of various ischemic heart diseases or serious arrhythmia. The aim of this study is to look for functional foods which have physiologically active substances preventing 5-hydroxytryptamine (5-HT)-related vasospastic diseases including peri- and postoperative ischemic complications of coronary artery bypass grafting (CABG) from ocean resources in Japanese coastal waters. First, we evaluated the effect of water-soluble ocean resource extracts on the response to 5-HT in HEK293 cells which have forcibly expressed cyan fluorescent protein-fused 5-HT2A receptors (5-HT2A-CFP). Among 5 different water-soluble extracts of ocean resources, the crude water-soluble jack-knife prawn extract (WJPE) significantly reduced maximal Ca(2+) influx induced by 0.1 ?M 5-HT in a concentration-dependent manner. The Crude WJPE significantly inhibited, in a concentration-dependent manner, 5-HT-induced constriction of human saphenous vein. 5-HT released from activated platelets plays a crucial roles in the constriction of coronary artery. Next the WJPE was purified for applying the experiment of 5-HT-induced human platelet aggregation. The purified WJPE significantly inhibited 5-HT-induced human platelet aggregation also in a concentration-dependent manner. Based on our findings, jack-knife prawn could be one of a functional food with health-promoting benefits for most people with vasospastic diseases including patients who have gone CABG. PMID:25464143

Gamoh, Shuji; Kanai, Tasuku; Tanaka-Totoribe, Naoko; Ohkura, Masamichi; Kuwabara, Masachika; Nakamura, Eisaku; Yokota, Atsuko; Yamasaki, Tetsuo; Watanabe, Akiko; Hayashi, Masahiro; Fujimoto, Shouichi; Yamamoto, Ryuichi

2015-02-11

175

Effect of CT scan protocols on x-ray-induced DNA double-strand breaks in blood lymphocytes of patients undergoing coronary CT angiography  

Microsoft Academic Search

Aims  To compare in vivo DNA lesions induced during helical and sequential coronary computed tomography angiography (CTA) and to\\u000a evaluate the effect of CT parameters on double-strand break (DSB) levels.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Thirty-six patients were examined with various CT protocols and modes (helical scan, n?=?27; sequential scan, n?=?9) either using a 64-slice dual-source or a 128-slice CT system. Blood samples were obtained before

M. A. Kuefner; S. Grudzenski; J. Hamann; S. Achenbach; Michael Lell; K. Anders; S. A. Schwab; L. Häberle; M. Löbrich; M. Uder

2010-01-01

176

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

SciTech Connect

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 lipoproteins has been lowered to ideal levels (serum cholesterol 202 +/- 31 mg/dl, low-density lipoproteins 130 +/- 30 mg/dl, very low-density lipoproteins 22 +/- 15 mg/dl, serum triglycerides 105 (69 to 304) mg/dl) and physical work capacity was improved by 21% (p less than .01). No significant effect was noted on high-density lipoproteins, probably as a result of the low-fat/high-carbohydrate diet. Stress-induced myocardial ischemia, as assessed by thallium-201 scintigraphy, was decreased by 54% (p less than .05) despite higher myocardial oxygen consumption. Eighteen patients matched for age and severity of coronary artery disease served as a control group and ''usual medical care'' was rendered by their private physicians. No significant changes with respect to serum lipoproteins, physical work capacity, maximal rate-pressure product, or stress-induced myocardial ischemia were observed in this group. These data indicate that regular physical exercise at high intensity, lowered body weight, and normalization of serum lipoproteins may alleviate compromised myocardial perfusion during stress.

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

1988-01-01

177

Coronary heart disease  

MedlinePLUS

Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. Coronary ...

178

Coronary Heart Disease  

MedlinePLUS

... from the NHLBI on Twitter. What Is Coronary Heart Disease? Espańol Coronary heart disease (CHD) is a disease ... Coronary Heart Disease, visit www.clinicaltrials.gov . Coronary Heart Disease in the News November 18, 2014 NHLBI Media ...

179

Coronary Calcium Scan  

MedlinePLUS

... 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 ...

180

Coronary angiography  

MedlinePLUS

... for coronary artery disease Heart failure Recent heart attack ... when compared with other heart tests. However, the test is very safe when ... associated with any type of catheterization include ...

181

Delayed relief of hemifacial spasm after microvascular decompression.  

PubMed

Microvascular decompression (MVD) has been accepted worldwide as a reasonable treatment for hemifacial spasm (HFS); however, resolution of the HFS is often gradual. To conclude the delayed relief rate of the MVD for the treatment of HFS, we conducted a systematic review. Using the keywords delayed relief, hemifacial spasm, or microvascular decompression, articles published in English-language journals and indexed in PubMed between June 1, 1994 and June 1, 2014 on the treatment of HFS with emphasis on delayed relief were considered for this study. Twelve articles with 2727 patients with HFS were finally enrolled in this review. Among all the patients, the ratio of male versus female was 1:2.7, and left versus right was 1:1.6. The average age at surgery was 52.5 years (49.1-55.9 y), with HFS symptom duration of 68.4 months (38.4-98.4 mo) before the surgery. The average follow-up duration was 49 months (6.4-121.6 mo). After examining all the patients, we obtained a mean postoperative success rate of 85.1% (76.5%-93.5%), but the success rate after the MVD immediately is only 71.8% (59.5%-84%). The mean rate of delayed relief was 25.4% (18.8%-37.1%). Approximately 13.1% (5.9%-19.7%) of the patients with symptom recurrence resorted to repeated MVD during the follow-up period. Accordingly, MVD is the most effective treatment for patients with HFS, but some of the patients may experienced delayed relief, which could be avoided if a thorough decompression of the facial nerve root had been obtained. PMID:25668113

Xia, Lei; Zhong, Jun; Zhu, Jin; Dou, Ning-Ning; Liu, Ming-Xing; Li, Shi-Ting

2015-03-01

182

Parry-Romberg syndrome with hemimasticatory spasm in pregnancy; A dystonia mimic  

PubMed Central

Parry-Romberg syndrome (PRS) with hemimasticatory spasm (HMS) is quite an uncommon overlapping phenomenon which very often mimics jaw closing dystonia. A previously healthy 35-year-old female, during her 5th month of pregnancy started developing intermittent unilateral painful spasms of jaw while conversation, clinching of teeth, or eating, which led to frequent tongue bites. The spasms were worsened during pregnancy. She used to do certain manoeuvre like sensory tricks in form of touching involved side of the face to relieve the symptoms. Apart from this, she developed progressive hemifacial and hemitongue atrophy. Other medical and neurological examinations were normal. Laboratory investigations as well as neuroimaging were noncontributory. The spasm responded to carbamazepine but hemifacial atrophy persists. To our best knowledge, onset and worsening of this syndrome in pregnancy has not been described earlier which might be correlated either with some hormonal imbalance or some unknown mechanisms. PMID:24966565

Panda, Akhila Kumar; Gopinath, Godhavarma; Singh, Shaily

2014-01-01

183

Parry-Romberg syndrome with hemimasticatory spasm in pregnancy; A dystonia mimic.  

PubMed

Parry-Romberg syndrome (PRS) with hemimasticatory spasm (HMS) is quite an uncommon overlapping phenomenon which very often mimics jaw closing dystonia. A previously healthy 35-year-old female, during her 5(th) month of pregnancy started developing intermittent unilateral painful spasms of jaw while conversation, clinching of teeth, or eating, which led to frequent tongue bites. The spasms were worsened during pregnancy. She used to do certain manoeuvre like sensory tricks in form of touching involved side of the face to relieve the symptoms. Apart from this, she developed progressive hemifacial and hemitongue atrophy. Other medical and neurological examinations were normal. Laboratory investigations as well as neuroimaging were noncontributory. The spasm responded to carbamazepine but hemifacial atrophy persists. To our best knowledge, onset and worsening of this syndrome in pregnancy has not been described earlier which might be correlated either with some hormonal imbalance or some unknown mechanisms. PMID:24966565

Panda, Akhila Kumar; Gopinath, Godhavarma; Singh, Shaily

2014-04-01

184

The effects of ATP-dependent potassium channel opener; pinacidil, and blocker; glibenclamide, on the ischemia induced arrhythmia in partial and complete ligation of coronary artery in rats  

PubMed Central

Objective(s): Electrical inhomogeneity between ischemic and non ischemic myocardium is the basis of arrhythmia which occurs following coronary artery occlusion. The leakage of potassium from the ischemic region to the non ischemic region is very effective in the generation of these arrhythmias. The aim of this study is to research the effect of ATP-dependent potassium (KATP) channel blocker (glibenclamide) and opener (pinacidil) on ischemia induced arrhythmia in the presence of small and large infarct sizes. Materials and Methods: In this study Sprague-Dawley male rats of 8-9 months of age were used. Ischemia was produced by the partial ligation of left coronary artery ramus descending (PL) for smaller infarct and complete ligation of this artery (CL) for larger infarct for 30 min. The arrhythmia score which was calculated from the duration and type of arrhythmia was significantly higher in animals which had a larger infarct area than the animals which had a smaller infarct. Results: Glibenclamide increased the rate of arrhythmia in animals having smaller infarct but not in animals having larger infarct. Pinacidil did not affect the occurrence of arrhythmia in either group. There was a significant difference in the infarct size and risk of infarct zone between animals which had small and large infarct sizes. The effect of glibenclamide and pinacidil on the arrhythmias differed depend on decrease of infarct size. Conclusion: Glibenclamide is not effective to decrease ischemia induced arrhythmia in the presence of small and pinacidil in large ischemic zone. PMID:25810894

Ya?ar, Selçuk; Bozdo?an, Ömer; Kaya, Salih Tunç; Orallar, Hayriye Soytürk

2015-01-01

185

First description of the effect of a non-sulfonylurea compound, tetramethylpyrazine, on coronary response to desoxyglucose-induced ischemia.  

PubMed

The compound 2,3,5,6-Tetramethylpyrazine (TMP; Ligustrazine), a flavouring component and sweetness enhancer for beverages constitutes a commonly used food additive. Now we studied the effect of TMP on coronary artery dilation during ischemia: In our experiments we used isolated, Langendorff-perfused guinea pig hearts, arrested with K(+)-rich Normal Tyrode solution (in mM: NaCl 129.5, KCl 15, MgCl2 0.8, CaCl2 1.0, glucose 10), buffered with 10 mM HEPES to pH 7.4 at 37 degrees C, equilibrated with 100% O2. Ischemia was simulated by equimolar replacement of glucose by 2-deoxyglucose (DOG), an inhibitor of oxydative phosphorylation. We found that coronary perfusion pressure (CPP) decreased by 20 +/- 1.2 cm H2O (from initially 90 cm H2O; n = 6, +/- SEM) within 15 min from the onset of DOG. In the presence of 1 mM TMP the decrease in CPP was largely attenuated and CPP declined by 1.4 +/- 1.0 cm H2O (n = 6, +/- SEM; p < 0.01). In 2 out of the 6 TMP experiments even as light increase in CPP (< 2 cm H2O) could be seen. We conclude that TMP, a blocker of ATP-dependent K(+)-channels in pancreatic beta-cells and possibly in arterial smooth muscle cells, prevents coronary dilation in response to ischemia. The possible suppression of this vital mobilization of coronary reserve during ischemia in patients with coronary artery disease certainly merits further attention and may question the use of this compound as a food additive. PMID:9576020

Grisold, M; Köppel, H; Gasser, R

1998-01-01

186

UTP induces vascular responses in the isolated and perfused canine epicardial coronary artery via UTP-preferring P2Y receptors  

PubMed Central

Vasoconstrictor responses of the isolated and perfused canine epicardial coronary artery to uridine 5?-triphosphate (UTP) were analysed pharmacologically. At basal perfusion pressure, UTP induced vasoconstriction in a dose-related manner and the vasoconstriction was sometimes followed by a slight vasodilatation at large doses (more than 10?nmol). The rank order of potency for vasoconstriction was UTP=UDP>ATP>TTP?ITP>> UMP. At raised perfusion pressure by 20?mM KCl, the vasoconstriction was not changed and a small vasodilatation was induced at large doses. The rank order of potency for vasodilatation was induced at large doses. The rank order of potency for vasodilatation was ATP>>ITP?UDP>UTP?TTP. The maximal vasodilator response to UTP was much less than that to ATP. UMP did not induce vasodilatation. The P2X receptor agonist and desensitizing agent ?,?-methylene ATP (1??M) and the P2 receptor antagonist suramin (100??M) inhibited the vasoconstrictor responses to ATP but not those to UTP and UDP. The P2 receptor antagonist reactive blue 2 (30??M) did not inhibit the vascular responses to UTP. UTP (200??M) desensitized the vasoconstrictor responses to UTP, but not either the vasodilator responses to UTP or the vasoconstrictor responses to ATP and UDP. UDP (200??M) did not desensitize the vascular responses to UTP. Preincubating the UDP stock solution and arterial preparation with hexokinase (10 and 1?uml?1, respectively) did not change the vasoconstrictor responses to UDP. The Ca channel blocker diltiazem (1??M) inhibited the vasoconstrictor responses to UTP but not those to ATP and UDP. Incubation in a Ca2+-free solution containing 1?mM EGTA inhibited the vascular responses to ATP, UTP and UDP. Removal of the endothelium by an intraluminal injection of saponin (1?mg) inhibited the vasodilator responses to UTP. Indomethacin, a cyclo-oxygenase inhibitor (1??M), inhibited the vasodilator responses to UTP, but NG-nitro-L-arginine, a nitric oxide synthase inhibitor (300??M), did not have an inhibitory effect. The results suggest that (1) UTP induces vasoconstriction via UTP-preferring P2Y receptors on the smooth muscle and vasodilatation via receptors different from those mediating the vasoconstriction induced by UTP and mediating the vasodilatation by ATP on the endothelium, through mainly the release of prostacyclin in the canine epicardial coronary artery; (2) UDP induces vasoconstriction via UDP-preferring P2Y receptors; and (3) L-type Ca ion channels are involved in the vasoconstriction induced by UTP, but not in that induced by UDP. PMID:9422807

Matsumoto, Takako; Nakane, Tokio; Chiba, Shigetoshi

1997-01-01

187

Coronary angioscopy.  

PubMed Central

Coronary angioscopy will not replace angiography as the gold standard for imaging atherosclerotic coronary arteries. However, there may well be a clinical niche for a technology that gives accurate information regarding a specific lesion, if that information can be used to improve the acute or chronic outcome of an interventional procedure. Our experience demonstrates that angioscopy indeed provides this information. Using angioscopy, we now have access to information regarding arterial wall disease that heretofore has been available only at necropsy. In addition, whereas angiography has provided only a 2-dimensional, gray-scale image of the coronary vessels, angioscopy offers a full-color, 3-dimensional perspective of the intracoronary surface morphology. These important lesion-specific details, not reliably available from angiography alone, may ultimately be used to improve patient outcome and to assess risk. Images PMID:7787466

White, C J; Ramee, S R; Collins, T J; Murgo, J P

1995-01-01

188

Thyroid Hormone Promotes Remodeling of Coronary Resistance Vessels  

Microsoft Academic Search

Low thyroid hormone (TH) function has been linked to impaired coronary blood flow, reduced density of small arterioles, and heart failure. Nonetheless, little is known about the mechanisms by which THs regulate coronary microvascular remodeling. The current study examined the initial cellular events associated with coronary remodeling induced by triiodothyronine (T3) in hypothyroid rats. Rats with established hypothyroidism, eight weeks

Olga V. Savinova; Yingheng Liu; Garth A. Aasen; Kai Mao; Nathan Y. Weltman; Brett L. Nedich; Qiangrong Liang; A. Martin Gerdes; Piero Anversa

2011-01-01

189

Calcium channel blocking activity of Mentha longifolia L. explains its medicinal use in diarrhoea and gut spasm.  

PubMed

Mentha longifolia has a reputation in traditional medicine in the indications of diarrhoea and gut spasm. This study was carried out to provide a possible pharmacological basis for its medicinal use in hyperactive gut disorders. In a castor oil induced diarrhoeal model, the crude extract of Mentha longifolia (Ml.Cr), at doses of 100-1000 mg/kg, provided 31-80% protection, similar to loperamide. In isolated rabbit jejunum preparations, Ml.Cr caused inhibition of spontaneous and high K(+)-induced contractions, with respective EC50 values of 1.80 (1.34-2.24; n = 6-8) and 0.60 mg/mL (0.37-0.85; n = 6-8), which suggests spasmolytic activity, mediated possibly through calcium channel blockade (CCB). The CCB activity was further confirmed when pretreatment of the tissue with Ml.Cr (0.3-1 mg/mL) caused a rightward shift in the Ca(++) concentration-response curves (CRCs), similar to verapamil. Loperamide also inhibited spontaneous and high K(+)-induced contractions and shifted the Ca(++) CRCs to the right. Activity-directed fractionation revealed that the petroleum spirit fraction was more potent than the parent crude extract and aqueous fraction. These data indicate that the antidiarrhoeal and spasmolytic effects of the crude extract of Mentha longifolia are mediated through the presence of CCB-like constituent(s), concentrated in the petroleum spirit fraction and this study provides indirect evidence for its medicinal use in diarrhoea and spasm. PMID:20669262

Shah, Abdul Jabbar; Bhulani, Nizar Noorali; Khan, Sara Haroon; Ur Rehman, Najeeb; Gilani, Anwarul Hassan

2010-09-01

190

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.

1983-08-01

191

Activation of group IVC phospholipase A 2 by polycyclic aromatic hydrocarbons induces apoptosis of human coronary artery endothelial cells  

Microsoft Academic Search

Exposure to environmental pollutants, such as polycyclic aromatic hydrocarbons (PAHs) found in coal tar mixtures and tobacco\\u000a sources, is considered a significant risk factor for the development of heart disease in humans. The goal of this study was\\u000a to determine the influence of PAHs present at a Superfund site on human coronary artery endothelial cell (HCAEC) phospholipase\\u000a A2 (PLA2) activity

Patricia K. TithofSean; Sean M. Richards; Mona A. Elgayyar; Fu-Minn Menn; Vijay M. Vulava; Larry McKay; John Sanseverino; Gary Sayler; Dawn E. Tucker; Christina C. Leslie; Kim P. Lu; Kenneth S. Ramos

2011-01-01

192

Acute effects of nicotine content in cigarettes on coronary flow velocity and coronary flow reserve in men  

Microsoft Academic Search

Smoking a cigarette with a high nicotine content induced an abrupt reduction in coronary flow reserve. This reduction may have been mediated by nicotine or some other unknown substance influenced by smoking. Smoking a cigarette with a high nicotine content may lower the ischemic threshold by reducing the coronary vasodilatory capacity in patients with coronary artery disease.

Takahiro Tanaka; Yukiko Oka; Ineko Tawara; Toshikatu Sada; Yuji Kira

1998-01-01

193

Furosemide with Saline Hydration for Prevention of Contrast-Induced Nephropathy in Patients undergoing Coronary Angiography: A Meta-Analysis of Randomized Controlled Trials  

PubMed Central

Background The clinical efficacy of furosemide administration in preventing contrast-induced nephropathy (CIN) remains uncertain. This meta-analysis was designed to update data on the incidence of CIN with additional furosemide treatment beyond saline hydration in comparison with hydration alone in patients undergoing percutaneous coronary intervention (PCI). Material/Methods A computerized literature search of MEDLINE, EMBASE, and Cochrane databases was performed. Trials were eligible if they enrolled patients undergoing coronary angiography and randomly allocated participants to receive furosemide administration in addition to saline hydration or saline hydration alone. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for combinations of studies. Results Five trials involving 1294 patients (640 for additional furosemide treatment and 654 for hydration alone) were included in the meta-analysis. In the synthesis of data, additional furosemide administration had little impact on the incidence of CIN post-PCI compared with peri-procedural saline hydration alone (OR=0.96; 95% CI 0.33–2.84, p=0.95). Moreover, as for the subsequent need for dialysis, there was no statistical significant difference between the 2 groups (OR=1.01; 95% CI 0.38–2.67, p=0.99). Sensitivity analyses did not show any relevant influence on the overall results. There was no publication bias in the meta-analysis. Conclusions Furosemide administration did not achieve additional benefit beyond saline hydration in reducing the incidence of CIN in patients undergoing PCI. PMID:25613017

Duan, Nana; Zhao, Jiegang; Li, Zhuanzhen; Dong, Pingshuan; Wang, Shaoxin; Zhao, Yuwei; Wang, Liping; Wang, Hongyun

2015-01-01

194

High-sensitivity C-reactive protein and exercise-induced changes in subjects suspected of coronary artery disease  

PubMed Central

Background Inflammation plays a major role in the development of atherosclerosis. We wanted to investigate the effects of exercise on high-sensitivity (hs) C-reactive protein (CRP) in subjects who were suspected of having coronary artery disease (CAD). Methods Blood samples were obtained before, 5 minutes after, and 20 hours after an exercise test in 155 subjects who were suspected of CAD. Coronary anatomy was evaluated by computed tomography coronary angiography and/or coronary angiography. Results Median baseline hs-CRP was higher in subjects with ?50% coronary artery lumen diameter stenosis (n=41), compared with non-CAD-subjects (n=114), 2.93 mg/L (interquartile range 1.03–5.06 mg/L) and 1.30 mg/L (interquartile range 0.76–2.74 mg/L), respectively, P=0.007. In multivariate analyses testing conventional risk factors, hs-CRP proved borderline significant, odds ratio =2.32, P=0.065. Adding baseline hs-CRP to the results of the exercise test did not improve the diagnostic evaluation. Baseline natural logarithm (Ln) hs-CRP was positively associated with body mass index and baseline Ln-transformed hs troponin T levels, and negatively associated with the daily life activity level. An increase in hs-CRP of 0.13 mg/L (interquartile range 0.05–0.24 mg/L) from baseline to 5 minutes after peak exercise was found (P<0.0001), but the increase was not associated with presence of CAD. From baseline to 20 hours after exercise, no increase in hs-CRP was found. Conclusion In conclusion, hs-CRP was not independently associated with CAD. Hs-CRP increased immediately as a response to the exercise, and the increase was modest and not associated with CAD. The results indicate that exercise has potential to cause unwanted variations in hs-CRP and that exercise prior to hs-CRP measurements in subjects included in epidemiological studies, therefore, should be avoided. PMID:24715762

Mouridsen, Mette Rauhe; Nielsen, Olav Wendelboe; Carlsen, Christian Malchau; Mattsson, Nick; Ruwald, Martin H; Binici, Zeynep; Sajadieh, Ahmad

2014-01-01

195

SLCA/IP power alternative screening method (SPASM)  

SciTech Connect

This report describes the SLCA/IP Power Alternative Screening Method (SPASM), which was used to screen 784 possible combinations of electric power marketing alternatives and dam operational scenarios to provide a representative range for analysis in the Western Area Power Administration Salt Lake City Area Integrated Projects (SLCA/IP) Electric Power Marketing Environmental Impact Statement (EIS). Each combination consists of one energy and capacity commitment level and one operational scenario for each of the hydroelectric facilities at Glen Canyon Dam, Flaming Gorge Dam, and the Aspinall Unit. The total annual cost to the SLCA/IP firm power customers of each of the 784 combinations is estimated and included in a relative frequency distribution. A relative frequency distribution is also generated for each marketing alternative. The number of combinations is reduced to 12 by taking the mean value and endpoint value for each of four marketing alternatives. Some minor deviations from this procedure, which are made for political purposes, are explained. 9 figs., 14 tabs.

Palmer, S.C. [USDOE Western Area Power Administration, Salt Lake City, UT (United States). Salt Lake City Area Office]|[Argonne National Lab., IL (United States); Ancrile, J.D. [Argonne National Lab., IL (United States)

1995-03-01

196

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.

1982-12-01

197

Great heterogeneity of commercial fruit juices to induce endothelium-dependent relaxations in isolated porcine coronary arteries: role of the phenolic content and composition.  

PubMed

Since polyphenol-rich products such as red wine, grape juice, and grape extracts have been shown to induce potent endothelium-dependent relaxations, we have evaluated whether commercial fruit juices such as those from berries are also able to induce endothelium-dependent relaxations of isolated coronary arteries and, if so, to determine whether this effect is related to their phenolic content. Among the 51 fruit juices tested, 2/12 grape juices, 3/7 blackcurrant juices, 4/5 cranberry juices, 1/6 apple juices, 0/5 orange juices, 2/6 red fruit and berry juices, 3/6 blends of red fruit juices, and 0/4 non-red fruit juices were able to induce relaxations achieving more than 50% at a volume of 1%. The active fruit juices had phenolic contents ranging from 0.31 to 1.86?g GAE/L, which were similar to those of most of the less active juices with the exception of one active grape juice (2.14?g GAE/L) and one active blend of red fruit juices (3.48?g GAE/L). Altogether, these findings indicate that very few commercial fruit juices have the ability to induce potent endothelium-dependent relaxations, and that this effect is not related to their quantitative phenolic content, but rather to their qualitative phenolic composition. PMID:25009961

Auger, Cyril; Pollet, Brigitte; Arnold, Cécile; Marx, Céline; Schini-Kerth, Valérie B

2015-01-01

198

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 ...

199

Reperfusion?induced sustained ventricular tachycardia, leading to ventricular fibrillation, in chronically instrumented, intact, conscious mice  

PubMed Central

Abstract Reperfusion?induced lethal ventricular arrhythmias are observed during relief of coronary artery spasm, with unstable angina, exercise?induced ischemia, and silent ischemia. Accordingly, significant efforts are underway to understand the mechanisms responsible for reperfusion?induced lethal arrhythmias and mice have become increasingly important in these efforts. However, although reperfusion?induced sustained ventricular tachycardia leading to ventricular fibrillation (VF) has been recorded in many models, reports in mice are sparse and of limited success. Importantly, none of these studies were conducted in intact, conscious mice. Accordingly, a chronically instrumented, intact, conscious murine model of reperfusion?induced lethal arrhythmias has the potential to be of major importance for advancing the concepts and methods that drive cardiovascular therapies. Therefore, we describe, for the first time, the use of an intact, conscious, murine model of reperfusion?induced lethal arrhythmias. Male mice (n = 9) were instrumented to record cardiac output and the electrocardiogram. In addition, a snare was placed around the left main coronary artery. Following recovery, the susceptibility to sustained ventricular tachycardia produced by 3 min of occlusion and reperfusion of the left main coronary artery was determined in conscious mice by pulling on the snare. Reperfusion culminated in sustained ventricular tachycardia, leading to VF, in all nine conscious mice. The procedures conducted in conscious C57BL/6J mice, a strain commonly used in transgenic studies, can be utilized in genetically modified models to enhance our understanding of single gene defects on reperfusion?induced lethal ventricular arrhythmias in intact, conscious, and complex animals. PMID:24973331

Lujan, Heidi L.; DiCarlo, Stephen E.

2014-01-01

200

Late-onset epileptic spasms may be cured by focal cortical resective surgery.  

PubMed

We report the case of a child with isolated late-onset epileptic spasms who significantly improved after focal frontal cortectomy. Clusters of axial and limb tonic contractions with head nodding began at 2 years of age. They occurred only during sleep, lasting 15 to 20 minutes and were pharmacoresistant. The child suffered slight mental delay. Interictal EEG showed left frontal spikes in slow sleep. Ictal video-EEG showed patterns of asymmetric spasms. MRI revealed a distinct white matter abnormality in the left frontal superior gyrus, corresponding clearly to localised cortical hypometabolism on FDG-PET and PET-MRI co-recording. SEEG investigation showed that the first spasm of the clusters corresponded to a localised discharge of rapid rhythms from the electrodes placed within the area identified as a lesion by MRI. Discharges then became more diffuse across the left frontal and temporal electrodes throughout the duration of the cluster. A tailored focal frontal resection was performed at 16 years of age. Spasms were very rare during the following three years (Engel class II). This observation illustrates the fact that isolated epileptic spasms can be cured by focal cortical resection despite a lack of clearly localised EEG surface anomalies. PMID:22932687

Ricard-Mousnier, Brigitte; Dorfmuller, Georg; Fohlen, Martine; Jeanguillaume, Christine; Nguyen, Silvie; Delalande, Olivier; Bulteau, Christine

2012-09-01

201

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

PubMed

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 (ClinicalTrials.gov identifier: NCT01006811). PMID:21920781

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

2012-01-01

202

Screening of Inherited Metabolic Disorders in Infants with Infantile Spasms.  

PubMed

The objective of this study is to explore the incidence of inherited metabolic disorders (IMD) in infants with infantile spasms (IS), with an attempt to improve the early diagnosis and etiological and symptomatic treatment. Urine and blood samples were collected from 60 IS patients and analyzed for the quantification of amino acids, organic acids, and fatty acids by gas chromatography-mass spectrometry and tandem mass spectrum. Routine urine tests, hepatic function tests, blood biochemistry, brain imaging, as well as examinations of the brain stem auditory/visual evoked potentials were also examined. In addition to antiepileptic therapy, etiological and symptomatic treatments were also conducted in infants with confirmed IMD and the follow-up lasted for 6 months in these pediatric patients. Metabolic disorders were found in 28 (46.67 %) of 60 IS infants, among them 13 (21.67 %) were confirmed to be with IMD. Twelve of these 13 IS patients with definite IMD diagnoses (92.31 %) experienced varying degrees of delayed development of intelligence and motor function, 8 patients (61.54 %) had abnormal cranial CT or MRI findings, 11 patients (84.61 %) had abnormal brain stem evoked potentials, 4 patients (30.77 %) had abnormal hepatic functions, 3 patients (23.07 %) had abnormal blood biochemistry, 2 patients (15.38 %) had positive (+ to ++) results for routine urine ketones, and 2 patients (15.38 %) had skin lesions. After treatment in children who were diagnosed IMD, the well controlled epileptic seizures and the satisfactory developments in mental and motor were found in 4 cases of methylmalonic acidemia, 2 cases of classical phenylketonuria, and one case of biotin deficiency disease, glutaric acidemia type I, and 4-hydroxybutyric aciduria in each. IMD is a key biological cause in IS. Early screening for IMD is warranted in IS infants to facilitate the improvement for the prognosis and an early etiological treatment. PMID:25417060

Liu, Xiao-Ming; Li, Rui; Chen, Sheng-Zhi; Sang, Yan; Chen, Jiao; Fan, Cong-Hai

2014-11-23

203

Microvascular decompression for hemifacial spasm: focus on late reoperation.  

PubMed

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

2013-10-01

204

Late-onset epileptic spasms: clinical evidence and outcome in 34 patients.  

PubMed

To evaluate the diverse presentation and course of late-onset epileptic spasms in relation to etiology, we analyzed the clinical, electroencephalographic (EEG), and prognostic features in 34 patients. We divided the patient sample into cryptogenic or symptomatic based on etiology. An association emerged between symmetric spasms at onset and focal interictal EEG abnormalities in cryptogenic patients, and onset with focal or generalized seizures before displaying asymmetric spasms, and multifocal or diffuse EEG abnormalities, in the symptomatic group. Despite an overall poor prognosis, symptomatic patients starting with generalized seizures seem to have a relatively more favorable outcome. The high occurrence of intellectual disability, and sometimes psychomotor regression, confirmed this rare and poorly understood heterogeneous clinical condition as a severe form of epileptic encephalopathy that deserves further study. PMID:24907139

Ronzano, Nadia; Valvo, Giulia; Ferrari, Anna Rita; Guerrini, Renzo; Sicca, Federico

2015-02-01

205

Motor unit firing rates during spasms in thenar muscles of spinal cord injured subjects  

PubMed Central

Involuntary contractions of paralyzed muscles (spasms) commonly disrupt daily activities and rehabilitation after human spinal cord injury (SCI). Our aim was to examine the recruitment, firing rate modulation, and derecruitment of motor units that underlie spasms of thenar muscles after cervical SCI. Intramuscular electromyographic activity (EMG), surface EMG, and force were recorded during thenar muscle spasms that occurred spontaneously or that were triggered by movement of a shoulder or leg. Most spasms were submaximal (mean: 39%, SD: 33 of the force evoked by median nerve stimulation at 50 Hz) with strong relationships between EMG and force (R2 > 0.69). Unit recruitment occurred over a wide force range (0.2–103% of 50 Hz force). Significant unit rate modulation occurred during spasms (frequency at 25% maximal force: 8.8 Hz, 3.3 SD; at maximal force: 16.1 Hz, 4.1 SD). Mean recruitment frequency (7.1 Hz, 3.2 SD) was significantly higher than derecruitment frequency (5.4 Hz, 2.4 SD). Coactive unit pairs that fired for more than 4 s showed high (R2 > 0.7, n = 4) or low (R2:0.3–0.7, n = 12) rate-rate correlations, and derecruitment reversals (21 pairs, 29%). Later recruited units had higher or lower maximal firing rates than lower threshold units. These discrepant data show that coactive motoneurons are drive both by common inputs and by synaptic inputs from different sources during muscle spasms. Further, thenar motoneurons can still fire at high rates in response to various peripheral inputs after SCI, supporting the idea that low maximal voluntary firing rates and forces in thenar muscles result from reduced descending drive. PMID:25452723

Zijdewind, Inge; Bakels, Rob; Thomas, Christine K.

2014-01-01

206

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. PMID:22716997

2012-01-01

207

Infantile spasms and early immunization against whooping cough. Danish survey from 1970 to 1975  

Microsoft Academic Search

113 cases of infantile spasms were diagnosed in the period 1 April 1970 to 31 March 1975 after Denmark changed her immunization programme. Previously whooping cough vaccine was given as the triple combination at 5, 6, and 15 months of age. From 1 April 1970 it was given as a monovalent vaccine at 5 and 9 weeks of age and

J C Melchior

1977-01-01

208

Vaginal Spasm, Pain, and Behavior: An Empirical Investigation of the Diagnosis of Vaginismus  

Microsoft Academic Search

This study investigated the roles of vaginal spasm, pain, and behavior in vaginismus and the ability of psychologists, gynecologists, and physical therapists to agree on a diagnosis of vaginismus. Eighty-seven women, matched on age, relationship status, and parity, were assigned to one of three groups: vaginismus, dyspareunia resulting from vulvar vestibulitis syndrome (VVS), and no pain with intercourse. Diagnostic agreement

Elke D. Reissing; Yitzchak M. Binik; Samir Khalifé; Deborah Cohen; Rhonda Amsel

2004-01-01

209

Microvascular decompression of the facial nerve for hemifacial spasm in youth  

Microsoft Academic Search

Objects: The goal of this study was to investigate the differences between clinical findings in youth and in adulthood on microvascular decompression (MVD) of the facial nerve for the treatment of hemifacial spasm (HFS). Methods: We retrospectively evaluated 855 patients who underwent MVD from January 1985 to July 1999. In our series of 33 young HFS patients, all patients had

Jin Woo Chang; Jong Hee Chang; Yong Park; Sang Chung

2001-01-01

210

Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring  

Microsoft Academic Search

Summary 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

M. P. Sindou

2005-01-01

211

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

1986-01-01

212

Prenatal corticosteroids modify glutamatergic and GABAergic synapse genomic fabric: insights from a novel animal model of infantile spasms.  

PubMed

Prenatal exposure to corticosteroids has long-term postnatal somatic and neurodevelopmental consequences. Animal studies indicate that corticosteroid exposure-associated alterations in the nervous system include hypothalamic function. Infants with infantile spasms, a devastating epileptic syndrome of infancy with characteristic spastic seizures, chaotic irregular waves on interictal electroencephalogram (hypsarhythmia) and mental deterioration, have decreased concentrations of adrenocorticotrophic hormone (ACTH) and cortisol in cerebrospinal fluid, strongly suggesting hypothalamic dysfunction. We have exploited this feature to develop a model of human infantile spasms by using repeated prenatal exposure to betamethasone and a postnatal trigger of developmentally relevant spasms with NMDA. The spasms triggered in prenatally primed rats are more severe compared to prenatally saline-injected ones and respond to ACTH, a treatment of choice for infantile spasms in humans. Using autoradiography and immunohistochemistry, we have identified a link between the spasms in our model and the hypothalamus, especially the arcuate nucleus. Transcriptomic analysis of the arcuate nucleus after prenatal priming with betamethasone but before trigger of spasms indicates that prenatal betamethasone exposure down-regulates genes encoding several important proteins participating in glutamatergic and GABAergic transmission. Interestingly, there were significant sex-specific alterations after prenatal betamethasone in synapse-related gene expression but no such sex differences were found in prenatally saline-injected controls. A pairwise relevance analysis revealed that, although the synapse gene expression in controls was independent of sex, these genes form topologically distinct gene fabrics in males and females and these fabrics are altered by betamethasone in a sex-specific manner. These findings may explain the sex differences with respect to both normal behaviour and the occurrence and severity of infantile spasms. Changes in transcript expression and their coordination may contribute to a molecular substrate of permanent neurodevelopmental changes (including infantile spasms) found after prenatal exposure to corticosteroids. PMID:23763471

Iacobas, D A; Iacobas, S; Chachua, T; Goletiani, C; Sidyelyeva, G; Velíšková, J; Velíšek, L

2013-11-01

213

Prenatal corticosteroids modify glutamatergic and GABAergic synapse genomic fabric: Insights from a novel animal model of infantile spasms  

PubMed Central

Summary Prenatal exposure to corticosteroids has long-term postnatal somatic and neurodevelopmental consequences. Animal studies indicate that corticosteroid exposure-associated alterations in the nervous system include hypothalamic function. Infants with infantile spasms, a devastating epileptic syndrome of infancy with characteristic spastic seizures, chaotic irregular waves on interictal electroencephalogram (EEG; hypsarhythmia) and mental deterioration, have decreased concentrations of adrenocorticotropic hormone (ACTH) and cortisol in cerebrospinal fluid strongly suggesting hypothalamic dysfunction. We have exploited this feature to develop a model of human infantile spasms by using repeated prenatal exposure to betamethasone and postnatal trigger of developmentally relevant spasms with N-methyl-D-aspartic acid (NMDA). The spasms triggered in prenatally primed rats are more severe compared to prenatally saline-injected ones and respond to ACTH, a treatment of choice for infantile spasms in humans. Using autoradiography and immunohistochemistry, we have identified a link between the spasms in our model and hypothalamus, especially the arcuate nucleus. Transcriptomic analysis of the arcuate nucleus after prenatal priming with betamethasone but before trigger of spasms indicates that prenatal betamethasone exposure down-regulates genes encoding several important proteins participating in glutamatergic and GABAergic transmission. Interestingly, there were significant sex-specific alterations after prenatal betamethasone in synapse-related gene expression but no such sex differences were found in prenatally saline-injected controls. A pair-wise relevance analysis revealed that, although the synapse gene expression in controls was independent of sex, these genes form topologically distinct gene fabrics in males and females and these fabrics are altered by betamethasone in a sex-specific manner. These findings may explain the sex differences in both normal behaviour and occurrence and severity of infantile spasms. Changes in transcript expression and their coordination may contribute to a molecular substrate of permanent neurodevelopmental changes (including infantile spasms) found after prenatal exposure to corticosteroids. PMID:23763471

Iacobas, D.A.; Iacobas, S.; Chachua, T.; Goletiani, C.; Sidyelyeva, G.; Velíšková, J.; Velíšek, L.

2013-01-01

214

Endotracheal tube cuff pressure assessment maneuver induces drop of expired tidal volume in the postoperative of coronary artery bypass grafting  

PubMed Central

Background Previous investigations reported that the cuff pressure (CP) can decrease secondary to the CP evaluation itself. However is not established in literature if this loss of CP is able to generate alterations on expired tidal volume (ETV). Therefore, the aim of this study was to evaluate the potential consequences of the endotracheal CP assessment maneuver on CP levels and ETV in the early postoperative of coronary artery bypass grafting (CABG). Methods A total of 488 patients were analyzed. After the operation, the lungs were ventilated in pressure-assist-control mode and the same ventilatory settings were adjusted for all patients. After intensive care unit arrival, the cuff was fully deflated and then progressively inflated by air injection, to promote a minimal volume to occlude the trachea. To assist the cuff inflation and the air leakage identification, the graphical monitoring of the volume-time curve was adopted. After 20 minutes a first cuff pressure evaluation was performed (P1) and a second measurement (P2) was taken after 20 minutes with an analog manometer. ETV was obtained always pre and post P1 measurement. Results The CP assessment maneuver promoted a significant drop of P2 in relation to P1 when the manometer was attached to the pilot balloon (p?

2012-01-01

215

A Solute Carrier Family 22 Member 3 Variant rs3088442 G?A Associated with Coronary Heart Disease Inhibits Lipopolysaccharide-induced Inflammatory Response.  

PubMed

Recent genome-wide association studies have identified single-nucleotide polymorphism (SNPs) within the SLC22A3 (solute carrier family 22 member 3) gene associated with coronary heart disease (CHD) in the Caucasian population. We performed molecular analysis to investigate the potential role of SLC22A3 variants in CHD. Our study showed that the common polymorphism rs3088442 G?A, which is localized in the 3' UTR of the SLC22A3 gene, was associated with a decreased risk of CHD in the Chinese population by a case control study. In silico analysis indicated that G?A substitution of SNP rs3088442 created a putative binding site for miR-147 in the SLC22A3 mRNA. By overexpressing miR-147 or inhibiting endogenous miR-147, we demonstrated that SNP rs3088442 G?A recruited miR-147 to inhibit SLC22A3 expression. Moreover, SLC22A3 deficiency significantly decreased LPS-induced monocytic inflammatory response by interrupting NF-?B and MAPK signaling cascades in a histamine-dependent manner. Notably, the expression of SLC22A3(A) was also suppressed by LPS stimulus. Our findings might indicate a negative feedback mechanism against inflammatory response by which SLC22A3 polymorphisms decreased the risk of CHD. PMID:25561729

Li, Lu; He, Meian; Zhou, Li; Miao, Xiaoping; Wu, Fangqing; Huang, Suli; Dai, Xiayun; Wang, Tian; Wu, Tangchun

2015-02-27

216

The role of nitric oxide in testosterone-induced vasodilation in pig coronary arteries and rat thoracic aorta  

E-print Network

Several studies have provided evidence that the administration of testosterone to vascular tissue causes vasodilation (Costarella, Yue). This study examines the role of nitric oxide (NO) as a potential mechanism of testosterone-induced vasodilation...

Piefer, Jason William

2013-02-22

217

Continuous myocloni and tonic spasms in a 2-month-old infant with enterovirus 71 brain stem encephalitis.  

PubMed

Brain stem encephalitis is a cardinal presentation of central nervous system involvement in enterovirus 71 infection, and manifests as myoclonus, ataxia, tremor, and autonomic dysfunction. A 2-month-old infant with enterovirus 71 brain stem encephalitis demonstrated continuous myocloni and tonic spasms. On admission, the patient's myoclonus, which mainly involved the shoulders and the arms, was considerably worse during wakefulness and occurred once or twice a minute. Several hours after admission, the myoclonic jerks steadily worsened, appeared ceaselessly every 1 to 2?seconds, and were intermixed with tonic spasms of all four extremities accompanied by crying. Video electroencephalography revealed a normal background without epileptiform discharges and no ictal electroencephalographic changes during the myoclonic jerks and tonic spasms. Complete remission was achieved without complications after completion of a 3-day immunoglobulin therapy. This case suggests that the brain stem may be a major origin site for not only myoclonus but also tonic spasm. PMID:25290724

Lee, Kyung Yeon; Yeh, Hye-Ryun

2015-02-01

218

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. PMID:21984538

Bowles, Douglas K.; Duncker, Dirk J.

2012-01-01

219

Coronary Artery Anomalies  

MedlinePLUS

... terms: CAA, anomalous coronary artery (ACA), sudden cardiac arrest, sudden cardiac death A coronary artery anomaly (CAA) ... exercise Sudden cardiac death (also called sudden cardiac arrest) is the most dangerous symptom of a CAA. ...

220

Counseling the Coronary Patient  

ERIC Educational Resources Information Center

The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)

Semmler, Caryl; Semmler, Maynard

1974-01-01

221

Efficacy of transvaginal biofeedback and electrical stimulation in women with urinary urgency and frequency and associated pelvic floor muscle spasm.  

PubMed

Women with urinary urgency and frequency may also have pelvic floor muscle spasm. Transvaginal biofeedback (TVBF) and electrical stimulation (EStim) is a treatment modality that has been used to treat vaginismus and chronic pelvic pain. In this study, TVBF/EStim was evaluated in women with pelvic floor muscle spasm associated with urinary symptoms. Fifty-two women underwent therapy with TVBF/EStim and reported a mean symptom improvement of 64.5%. PMID:19579410

Bendańa, Emma E; Belarmino, James M; Dinh, Jenny H; Cook, Cynthia L; Murray, Brian P; Feustel, Paul J; De, Elise J B

2009-01-01

222

Coronary Artery Stenting  

Microsoft Academic Search

\\u000a When Andreas Gruentzig performed the first percutaneous coronary angioplasty on an awake patient in 1977 (Zurich, Switzerland),\\u000a he created the nascent field of interventional cardiology and ushered in a new era of coronary revascularization. Percutaneous\\u000a coronary transluminal angioplasty (PTCA) was positioned to serve as an alternative and complement to coronary artery bypass\\u000a grafting (CABG) and optimal medical therapy. As in

Eric A. Heller; George D. Dangas

223

Bilateral coronary arteriovenous fistulas  

Microsoft Academic Search

A 14-year-old girl with bilateral coronary arteriovenous fistulas (CAVFs) draining into the right ventricle (RV) is presented. Selective coronary angiography revealed involvement of both right and left coronary arteries in the fistulous formation, but communication into the RV was single.

Joseph Joy; Thomas Titus; C. G. Venkitachalam; K. G. Balakrishnan

1990-01-01

224

Comparative study of coronary flow reserve, coronary anatomy and results of radionuclide exercise tests in patients with coronary artery disease  

SciTech Connect

A comparative assessment of regional coronary flow reserve, quantitative percent diameter coronary stenosis and exercise-induced perfusion and wall motion abnormalities was performed in 39 patients with coronary artery disease. Coronary flow reserve was determined by a digital angiographic technique utilizing contrast medium as the hyperemic agent. Percent diameter stenosis was calculated by an automated quantification program applied to orthogonal cineangiograms. Thallium-201 scintigraphy and radionuclide ventriculography were used to assess regional perfusion and wall motion abnormalities, respectively, at rest and during exercise. In Group A, 19 patients without transmural infarction or collateral vessels, coronary flow reserve was inversely related to percent diameter stenosis (r = -0.61, p less than 0.0001), and scintigraphic abnormalities occurred only in vascular distributions with a coronary flow reserve of less than 2.00. There was a strong relation among abnormal regional exercise results, stenoses greater than 50% and reactive hyperemia of less than 2.00. Patients with multivessel disease, however, often had normal exercise scintigrams in regions associated with greater than 50% stenosis and low coronary flow reserve when other regions had a lower coronary flow reserve or higher grade stenosis, or both. In Group B, 20 patients with angiographically visible collateral vessels, 12 of whom had prior myocardial infarction, coronary flow reserve correlated less well with percent diameter stenosis than in Group A (r = -0.47, p less than 0.004). As in Group A patients, there was a significant relation between abnormal exercise test results and stenoses greater than 50%. However, reactive hyperemia values were generally lower than in Group A, and positive exercise stress results were strongly correlated only with highly impaired flow reserves of 1.3 or less.

Legrand, V.; Mancini, G.B.; Bates, E.R.; Hodgson, J.M.; Gross, M.D.; Vogel, R.A.

1986-11-01

225

Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: can we diagnose and treat?  

PubMed

National Institutes of Health category III prostatitis, also known as chronic prostatitis/chronic pelvic pain syndrome, is a common condition with significant impact on quality of life. This clinically defined syndrome has a multifactorial etiology and seems to respond best to multimodal therapy. At least half of these patients have pelvic floor spasm. There are several approaches to therapy including biofeedback, acupuncture, and myofascial release physical therapy. However, the only multicenter study of pelvic floor physical therapy for pelvic floor spasm in men failed to show an advantage over conventional Western massage. We have proposed a clinical phenotyping system called UPOINT to classify patients with urologic chronic pelvic pain and subsequently direct appropriate therapy. Here, we review the current approach to category III prostatitis and describe how clinical phenotyping with UPOINT may improve therapy outcomes. PMID:20490725

Westesson, Karin E; Shoskes, Daniel A

2010-07-01

226

CDKL5/STK9 is mutated in Rett syndrome variant with infantile spasms  

PubMed Central

Background: Rett syndrome is a severe neurodevelopmental disorder, almost exclusively affecting females and characterised by a wide spectrum of clinical manifestations. Both the classic form and preserved speech variant of Rett syndrome are due to mutations in the MECP2 gene. Several other variants of Rett syndrome have been described. In 1985, Hanefeld described a variant with the early appearance of convulsions. In this variant, the normal perinatal period is soon followed by the appearance of seizures, usually infantile spasms. We have observed two patients with signs of Rett syndrome showing acquired microcephaly and stereotypic midline hand movements. The disease started with generalised convulsions and myoclonic fits at 1.5 months in the first patient and with spasms at 10 days in the other, suggesting a diagnosis of the Hanefeld variant. In these patients, MECP2 point mutations and gross rearrangements were excluded by denaturing high performance liquid chromatography and real time quantitative PCR. The ARX and CDKL5 genes have been associated with West syndrome (infantile spasms, hypsarrhythmia, and mental retardation). Methods: Based on the clinical overlap between the Hanefeld variant and West syndrome, we analysed ARX and CDKL5 in the two girls. Results: We found frameshift deletions in CDKL5 in both patients; one in exon 5 (c.163_166delGAAA) and the other in exon 18 (c.2635_2636delCT). CDKL5 was then analysed in 19 classic Rett and 15 preserved speech variant patients, all MECP2 negative, but no mutations were found. Conclusion: Our results show that CDKL5 is responsible for a rare variant of Rett syndrome characterised by early development of convulsions, usually of the spasm type. PMID:15689447

Scala, E; Ariani, F; Mari, F; Caselli, R; Pescucci, C; Longo, I; Meloni, I; Giachino, D; Bruttini, M; Hayek, G; Zappella, M; Renieri, A

2005-01-01

227

Cerebellar gangliocytoma presenting with hemifacial spasms: clinical report, literature review and possible mechanisms  

Microsoft Academic Search

Summary  Cerebellar lesions have classically been considered not to cause epilepsy. However, previous reports have attributed seizures,\\u000a beginning as hemifacial spasms to lesions of the cerebellar peduncles. We report an example of paroxysmal facial contractions\\u000a associated with a cerebellar gangliocytoma. The seizures began on the first day of life and consisted of paroxysmal contractions\\u000a involving the left orbicularis oculi, often the

K. Minkin; C. Tzekov; E. Naydenov; I. Ivanov; O. Kulev; K. Romansky; V. Busarsky

2008-01-01

228

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

2010-01-01

229

Facial nerve motor-evoked potential monitoring during microvascular decompression for hemifacial spasm  

Microsoft Academic Search

ObjectiveTo determine whether monitoring facial nerve motor-evoked potentials (FNMEPs) elicited by transcranial electrical stimulation during microvascular decompression (MVD) for hemifacial spasm (HFS) is useful for predicting postoperative outcome.MethodsThe authors analysed FNMEP findings in 25 patients with HFS. Corkscrew electrodes positioned at C3 or C4 and Cz were used to deliver supramaximal stimuli (152–450 V). FNMEPs were recorded from the orbicularis

Masafumi Fukuda; Makoto Oishi; Tetsuya Hiraishi; Yukihiko Fujii

2010-01-01

230

Monitoring of Facial Evoked EMG for Hemifacial Spasm: a Critical Analysis of its Prognostic Value  

Microsoft Academic Search

Summary  ?Microvascular decompression (MVD) has come to stay as an effective way of treating hemifacial spasm. But it remains to be\\u000a seen how much each of the electrophysiological monitoring techniques (intra-operative) are contributing to its increased efficacy.\\u000a Their role as indicators for re-exploration or recurrence is to be evaluated with more studies. We have used the lateral spread\\u000a response in those

N. Kiya; U. Bannur; A. Yamauchi; K. Yoshida; Y. Kato; T. Kanno

2001-01-01

231

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. PMID:21277149

Ding, Qinxue; Chai, Hong; Mahmood, Nausheen; Tsao, Jerry; Mochly-Rosen, Daria; Zhou, Wei

2012-01-01

232

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

Microsoft Academic Search

Ostreolysin (Oly), a cytolytic and cardiotoxic protein from the oyster mushroom (Pleurotus ostreatus), is lethal for mice with an LD50 of 1170?g\\/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,

Polona Juntes; Katja Rebolj; Kristina Sep?i?; Peter Ma?ek; Monika Cecilija Žužek; Vojteh Cestnik; Robert Frangež

2009-01-01

233

Hirudin-Based Anticoagulant Strategies for Patients with Suspected Heparin-Induced Thrombocytopenia Undergoing Percutaneous Coronary Interventions and Bypass Grafting  

Microsoft Academic Search

Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse drug reaction that is associated with thrombotic events of the venous and arterial circulatory systems stemming from an intense and well-characterized prothrombotic triad of platelet activation, coagulation cascade stimulation and vascular endothelial cell injury. Although heparin (or other sulfated mucopolysaccharide compound) cessation represents a vital first step in management, patients remain susceptible to

Richard C. Becker

2000-01-01

234

Mechanisms of myocardium-coronary vessel interaction  

PubMed Central

The mechanisms by which the contracting myocardium exerts extravascular forces (intramyocardial pressure, IMP) on coronary blood vessels and by which it affects the coronary flow remain incompletely understood. Several myocardium-vessel interaction (MVI) mechanisms have been proposed, but none can account for all the major flow features. In the present study, we hypothesized that only a specific combination of MVI mechanisms can account for all observed coronary flow features. Three basic interaction mechanisms (time-varying elasticity, myocardial shortening-induced intracellular pressure, and ventricular cavity-induced extracellular pressure) and their combinations were analyzed based on physical principles (conservation of mass and force equilibrium) in a realistic data-based vascular network. Mechanical properties of both vessel wall and myocardium were coupled through stress analysis to simulate the response of vessels to internal blood pressure and external (myocardial) mechanical loading. Predictions of transmural dynamic vascular pressure, diameter, and flow velocity were determined under each MVI mechanism and compared with reported data. The results show that none of the three basic mechanisms alone can account for the measured data. Only the combined effect of the cavity-induced extracellular pressure and the shortening-induced intramyocyte pressure provides good agreement with the majority of measurements. These findings have important implications for elucidating the physical basis of IMP and for understanding coronary phasic flow and coronary artery and microcirculatory disease. PMID:19966048

Algranati, Dotan; Kassab, Ghassan S.

2010-01-01

235

A Case of Hemifacial Spasm Caused by an Artery Passing Through the Facial Nerve  

PubMed Central

Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques. PMID:25810866

Oh, Chang Hyun; Shim, Yu Shik; Park, Hyeonseon

2015-01-01

236

Vaginal spasm, pain, and behavior: an empirical investigation of the diagnosis of vaginismus.  

PubMed

This study investigated the roles of vaginal spasm, pain, and behavior in vaginismus and the ability of psychologists, gynecologists, and physical therapists to agree on a diagnosis of vaginismus. Eighty-seven women, matched on age, relationship status, and parity, were assigned to one of three groups: vaginismus, dyspareunia resulting from vulvar vestibulitis syndrome (VVS), and no pain with intercourse. Diagnostic agreement was poor for vaginismus; vaginal spasm and pain measures did not differentiate between women in the vaginismus and dyspareunia/VVS groups; however, women in the vaginismus group demonstrated significantly higher vaginal/pelvic muscle tone and lower muscle strength. Women in the vaginismus group also displayed a significantly higher frequency of defensive/avoidant distress behaviors during pelvic examinations and recalled past attempts at intercourse with more affective distress. These data suggest that the spasm-based definition of vaginismus is not adequate as a diagnostic marker for vaginismus. Pain and fear of pain, pelvic floor dysfunction, and behavioral avoidance need to be included in a multidimensional reconceptualization of vaginismus. PMID:14739686

Reissing, Elke D; Binik, Yitzchak M; Khalifé, Samir; Cohen, Deborah; Amsel, Rhonda

2004-02-01

237

Altered Spontaneous Brain Activity in Patients with Hemifacial Spasm: A Resting-State Functional MRI Study  

PubMed Central

Resting-state functional magnetic resonance imaging (fMRI) has been used to detect the alterations of spontaneous neuronal activity in various neurological and neuropsychiatric diseases, but rarely in hemifacial spasm (HFS), a nervous system disorder. We used resting-state fMRI with regional homogeneity (ReHo) analysis to investigate changes in spontaneous brain activity of patients with HFS and to determine the relationship of these functional changes with clinical features. Thirty patients with HFS and 33 age-, sex-, and education-matched healthy controls were included in this study. Compared with controls, HFS patients had significantly decreased ReHo values in left middle frontal gyrus (MFG), left medial cingulate cortex (MCC), left lingual gyrus, right superior temporal gyrus (STG) and right precuneus; and increased ReHo values in left precentral gyrus, anterior cingulate cortex (ACC), right brainstem, and right cerebellum. Furthermore, the mean ReHo value in brainstem showed a positive correlation with the spasm severity (r = 0.404, p = 0.027), and the mean ReHo value in MFG was inversely related with spasm severity in HFS group (r = -0.398, p = 0.028). This study reveals that HFS is associated with abnormal spontaneous brain activity in brain regions most involved in motor control and blinking movement. The disturbances of spontaneous brain activity reflected by ReHo measurements may provide insights into the neurological pathophysiology of HFS. PMID:25603126

Tu, Ye; Wei, Yongxu; Sun, Kun; Zhao, Weiguo; Yu, Buwei

2015-01-01

238

A case of hemifacial spasm caused by an artery passing through the facial nerve.  

PubMed

Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques. PMID:25810866

Oh, Chang Hyun; Shim, Yu Shik; Park, Hyeonseon; Kim, Eun-Young

2015-03-01

239

Overview of clinical trials of glycoprotein IIb-IIIa inhibitors in acute coronary syndromes  

Microsoft Academic Search

Acute coronary syndromes (ACS) are the major cause of mortality and morbidity in Western countries. The primary pathophysiologic mechanism of ACS involves the formation of thrombus in coronary arteries in response to spontaneous or intervention-induced endothelial damage. This leads to myocardial ischemia. The final common pathway to the coronary thrombosis underlying ACS involves the aggregation of platelets mediated by the

Robert A. Harrington

1999-01-01

240

Contrast Volume/Raw eGFR Ratio for Predicting Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention for Myocardial Infarction  

PubMed Central

Background Considering that contrast medium is excreted through the whole kidney in a similar manner to drug excretion, the use of raw estimated glomerular filtration rate (eGFR) rather than body surface area (BSA)-normalized eGFR is thought to be more appropriate for evaluating the risk of contrast-induced acute kidney injury (CI-AKI). Methods This study included 2,189 myocardial infarction patients treated with percutaneous coronary intervention. Logistic regression analysis was performed to identify the independent risk factors. We used receiver-operating characteristic (ROC) curves to compare the ratios of contrast volume (CV) to eGFR with and without BSA normalization in predicting CI-AKI. Results The area under the curve (AUC) of the ROC curve for the model including all the significant variables such as diabetes mellitus, left ventricular ejection fraction, preprocedural glucose, and the CV/raw modification of diet in renal disease (MDRD) eGFR ratio was 0.768 [95% confidence interval (CI), 0.720-0.816; p < 0.001]. When the CV/raw MDRD eGFR ratio was used as a single risk value, the AUC of the ROC curve was 0.650 (95% CI, 0.590-0.711; p < 0.001). When the CV/MDRD eGFR ratio with BSA normalization ratio was used, the AUC of the ROC curve further decreased to 0.635 (95% CI, 0.574-0.696; p < 0.001). The difference between the two AUCs was significant (p = 0.002). Conclusions Raw eGFR is a better predictor for CI-AKI than BSA-normalized eGFR.

Park, Hoon Suk; Kim, Chan Joon; Yi, Jeong-Eun; Hwang, Byung-Hee; Kim, Tae-Hoon; Koh, Yoon Seok; Park, Hun-Jun; Her, Sung-Ho; Jang, Sung Won; Park, Chul-Soo; Lee, Jong Min; Kim, Hee Yeol; Jeon, Doo Soo; Kim, Pum-Joon; Yoo, Ki-Dong; Chang, Kiyuk; Jin, Dong Chan; Seung, Ki-Bae

2015-01-01

241

Comparison of the Efficacy of Rosuvastatin versus Atorvastatin in Preventing Contrast Induced Nephropathy in Patient with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention  

PubMed Central

Objectives We prospectively compared the preventive effects of rosuvastatin and atorvastatin on contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). Methods We enrolled 1078 consecutive patients with CKD undergoing elective PCI. Patients in Group 1 (n?=?273) received rosuvastatin (10 mg), and those in group 2 (n?=?805) received atorvastatin (20 mg). The primary end-point was the development of CIN, defined as an absolute increase in serum creatinine ?0.5 mg/dL, or an increase ?25% from baseline within 48–72 h after contrast medium exposure. Results CIN was observed in 58 (5.4%) patients. The incidence of CIN was similar in patients pretreated with either rosuvastatin or atorvastatin (5.9% vs. 5.2%, p?=?0.684). The same results were also observed when using other definitions of CIN. Clinical and procedural characteristics did not show significant differences between the two groups (p>0.05). Additionally, there were no significant inter-group differences with respect to in-hospital mortality rates (0.4% vs. 1.5%, p?=?0.141), or other in-hospital complications. Multivariate logistic regression analysis revealed that rosuvastatin and atorvastatin demonstrated similar efficacies for preventing CIN, after adjusting for potential confounding risk factors (odds ratio?=?1.17, 95% confidence interval, 0.62–2.20, p?=?0.623). A Kaplan–Meier survival analysis showed that patients taking either rosuvastatin or atorvastatin had similar incidences of all-cause mortality (9.4% vs. 7.1%, respectively; p?=?0.290) and major adverse cardiovascular events (29.32% vs. 23.14%, respectively; p?=?0.135) during follow-up. Conclusions Rosuvastatin and atorvastatin have similar efficacies for preventing CIN in patients with CKD undergoing PCI. PMID:25357250

Tan, Ning; Chen, Ji-yan; Zhou, Ying-ling; Li, Li-wen; Duan, Chong-yang; Chen, Ping-Yan; Luo, Jian-fang; Li, Hua-long; Wei-Guo

2014-01-01

242

Idiopathic carotid and coronary vasospasm: A case treated by carotid artery stenting  

PubMed Central

Background: We previously reported a case of cerebral infarction complicated by myocardial infarction. The pathogenesis of both infarctions was thought to be vasospasm; thus, we named this condition ‘idiopathic carotid and coronary vasospasm’. Various medical treatments for the prevention of carotid vasospasm have been unsuccessfully tried. Thus, other effective treatments should be established for patients who frequently suffer cerebral ischemic attacks. Case Description: We treated the present case of ‘idiopathic carotid and coronary vasospasm’ by carotid artery stenting (CAS). The first stenting, of the carotid bifurcation, failed to prevent internal carotid artery (ICA) vasospasm. However, after an additional stent placement to the prepetrous portion, ischemic attacks were dramatically reduced. Conclusion: The effect of CAS for extracranial ICA vasospasm was dramatic and control of the spasm at the prepetrous portion seems to be essential. Further validation of the effectiveness and safety of CAS for ICA vasospasm will be necessary. PMID:25422789

Yoshimoto, Haruko; Asakuno, Keizo; Matsuo, Seigo; Ishida, Atsushi; Shiramizu, Hideki; Niimura, Kaku; Yuzawa, Miki; Yamagishi, Yasumichi; Munakata, Takehiko; Moriyama, Takashi; Hori, Tomokatsu

2014-01-01

243

Influence of a variant angina on the results of percutaneous transluminal coronary angioplasty.  

PubMed Central

Nineteen (86%) of 22 patients with variant angina and important coronary stenoses (greater than 60%) had successful percutaneous transluminal coronary angioplasty. The acute complications in two patients were not caused by coronary spasms but by dissection with disturbance of perfusion. One of these two patients required a coronary bypass graft; the other was treated conservatively. Myocardial infarction developed in both patients. Despite long term administration of nifedipine (30-80 mg daily), restenoses occurred within six months (on average after 10 weeks) in nine patients with symptoms and one without. In four patients the restenoses exceeded the degree of stenosis before angioplasty. Five patients were revascularised by surgical means. Vessels in three out of four patients were later successfully dilated. After a mean period of observation of 24 months (6-51 months) 18 of the 19 patients are symptom free and do not require medication. The results confirm that angioplasty is an effective method of treating patients with variant angina and important coronary stenoses. The problem of the high frequency of restenosis, however, remains unresolved. PMID:2945575

Leisch, F; Schützenberger, W; Kerschner, K; Herbinger, W

1986-01-01

244

Coronary vasomotion dysfunction after everolimus-eluting stent implantation  

PubMed Central

First generation drug-eluting stent can cause a paradoxical “in-segment” coronary vasoconstriction. This phenomenon was seen with sirolimus, paclitaxel, and, more recently, also with zotarolimus-eluting stent. For the first time, we describe a case of coronary-induced vasoconstriction by everolimus-eluting stents (EES). PMID:25598992

Giudice, Pietro; Di Maio, Marco; Bellino, Elisabetta M.; Polito, Maria V.; Baldi, Cesare; Vigorito, Francesco; Di Muro, Michele R.; Tomasello, Salvatore D.; Galassi, Alfredo R.; Piscione, Federico

2014-01-01

245

Diagnostic Ultrasound Induced Inertial Cavitation to Non-Invasively Restore Coronary and Microvascular Flow in Acute Myocardial Infarction  

PubMed Central

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) ˝ 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.

2013-01-01

246

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.

1985-02-01

247

Acute Effects of Celiprolol on Angiographically Normal and Stenotic Coronary Arteries  

Microsoft Academic Search

Unselective and ß_1-selective beta-blockers may induce vasoconstriction of normal and stenotic epicardial coronary arteries. To analyze the influence of the vasodilatory beta-blocker celiprolol on coronary vasomotility, 0.4 mg celiprolol\\/kg were intravenously infused over 4 minutes in 13 patients with coronary artery disease. Coronary angiograms were taken before (control) and at 4, 6, 8, 10, 15, and 20 minutes after the

Stefan Jost; Dirk Hausmann; Peter Lippolt; Matthias Sturm

1997-01-01

248

Suppression of high lipid diet induced by atherosclerosis sarpogrelate  

PubMed Central

Sarpogrelate (SP), a serotonin (5-HT2A) receptor antagonist, is used as an anti-platelet agent for the treatment of some vascular diseases. SP has been reported to inhibit 5-HT induced coronary artery spasm, increase in intracellular calcium and smooth muscle cells proliferation. This study was undertaken to test that SP suppresses the development of atherosclerosis due to high cholesterol diet (HCD) by decreasing blood viscosity and oxidative stress. For this purpose, 29 rabbits were divided into four groups: control group (normal diet); normal diet group with SP at the dose of 5 mg/kg/day; HCD group fed 1% cholesterol; and HCD group with SP at the dose of 5 mg/kg/day. After 90 days of the experiment, blood samples were collected and the animals were killed; the thoracic aorta was stained by the Oil Red O staining method. The results indicate that plasma levels of cholesterol, triglycerides and malondialdehyde were increased in rabbits fed HCD. Plasma viscosity and whole blood viscosity were also higher in the HCD group than that in normal diet group. Treatment with SP prevented these alterations induced by HCD whereas this agent had no significant effect in rabbits fed normal diet. Morphological examination of the aorta revealed that SP treatment prevented the formation of foam cells and atherosclerotic plaque. It is suggested that the beneficial effects of SP in atherosclerosis may be due to actions on blood viscosity, lipid levels and oxidative stress. PMID:22348587

Xu, Yan-Jun; Zhang, Ming; Ji, Lei; Elimban, Vijayan; Chen, Li; Dhalla, Naranjan S

2012-01-01

249

Selective Coronary Arteriography  

PubMed Central

The technique of selective coronary arteriography, as described originally by Sones, was employed in 255 patients. Successful catheterization of both coronary arteries was carried out in 88% of these patients, and in the last 100 examinations both coronary arteries were entered in 95 patients. Selective coronary arteriography is a useful diagnostic tool but is a potentially hazardous form of examination as we encountered four episodes of ventricular fibrillation in the present series. ImagesFig. 1Fig. 2Figs. 3A-DFig. 3EFig. 3FFig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9 PMID:5902704

Parker, John O.; Challis, Thomas W.; West, Roxroy O.

1966-01-01

250

Double left anterior descending coronary artery originating from left main coronary stem and right coronary artery.  

PubMed

Double left anterior descending coronary artery originating from left main coronary stem and right coronary artery is a rare congenital coronary anomaly. In this case report, we are describing a patient with double left anterior descending coronary artery, one with normal origin, and the other originating from the right coronary artery. To the best of our knowledge, there are only a few reports resembling such case. PMID:24251016

Akbarzadeh, Fariborz; Shadravan, Sepide; Ghorbanian, Maryam; Piri, Reza; Naghavi-Behzad, Mohammad

2013-01-01

251

Double Left Anterior Descending Coronary Artery Originating from Left Main Coronary Stem and Right Coronary Artery  

PubMed Central

Double left anterior descending coronary artery originating from left main coronary stem and right coronary artery is a rare congenital coronary anomaly. In this case report, we are describing a patient with double left anterior descending coronary artery, one with normal origin, and the other originating from the right coronary artery. To the best of our knowledge, there are only a few reports resembling such case. PMID:24251016

Akbarzadeh, Fariborz; Shadravan, Sepide; Ghorbanian, Maryam; Piri, Reza; Naghavi-Behzad, Mohammad

2013-01-01

252

Molecular characterization of a cohort of 73 patients with infantile spasms syndrome.  

PubMed

Infantile Spasms syndrome (ISs) is a characterized by epileptic spasms occurring in clusters with an onset in the first year of life. West syndrome represents a subset of ISs that associates spasms in clusters, a hypsarrhythmia EEG pattern and a developmental arrest or regression. Aetiology of ISs is widely heterogeneous including many genetic causes. Many patients, however, remain without etiological diagnosis, which is critical for prognostic purpose and genetic counselling. In the present study, we performed genetic screening of 73 patients with different types of ISs by array-CGH and molecular analysis of 5 genes: CDKL5, STXBP1, KCNQ2, and GRIN2A, whose mutations cause different types of epileptic encephalopathies, including ISs, as well as MAGI2, which was suggested to be related to a subset of ISs. In total, we found a disease-causing mutation or CNV (Copy Number Variation) in 15% of the patients. These included 6 point mutations found in CDKL5 (n = 3) and STXBP1 (n = 3), 3 microdeletions (10 Mb in 2q24.3, 3.2 Mb in 5q14.3 including the region upstream to MEF2C, and 256 kb in 9q34 disrupting EHMT1), and 2 microduplications (671 kb in 2q24.3 encompassing SCN2A, and 11.93 Mb in Xq28). In addition, we discuss 3 CNVs as potential risk factors, including one 16p12.1 deletion, one intronic deletion of the NEDD4 gene, and one intronic deletion of CALN1 gene. The present findings highlight the efficacy of combined cytogenetic and targeted mutation screening to improve the diagnostic yield in patient with ISs. PMID:25497044

Boutry-Kryza, Nadia; Labalme, Audrey; Ville, Dorothee; de Bellescize, Julitta; Touraine, Renaud; Prieur, Fabienne; Dimassi, Sarra; Poulat, Anne-Lise; Till, Marianne; Rossi, Massimiliano; Bourel-Ponchel, Emilie; Deligničres, Aline; Le Moing, Anne-Gaelle; Rivier, Clotilde; des Portes, Vincent; Edery, Patrick; Calender, Alain; Sanlaville, Damien; Lesca, Gaetan

2015-02-01

253

Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores?  

Microsoft Academic Search

Objective: Previous studies have shown that cortical-evoked potentials on magnetic stimulation of muscles are influenced by muscle contraction, vibration, and muscle spasm. This study was carried out to determine whether these potentials correlate with palpatory muscle spasm, patient symptoms, and disability in patients with low back pain. Methods: A prospective observational study was performed on 13 subjects with a history

Yu Zhu; Scott Haldeman; Chang-Yu J. Hsieh; Pingjia Wu; Arnold Starr

2000-01-01

254

Hemifacial Spasm Associated with Intraparenchymal Brain Stem Tumor Athanassios Leonardos, MD, Paul E. Greene, MD, Louis H. Weimer, MD, Alexander G. Khandji, MD,  

E-print Network

Hemifacial Spasm Associated with Intraparenchymal Brain Stem Tumor Athanassios Leonardos, MD, PaulD* The Neurological Institute, Columbia University, New York, New York, USA Hemifacial spasm (HFS) is characterized by paroxys- mal bursts of involuntary clonic and tonic activity in muscles innervated by the facial nerve.1

255

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. PMID:22259603

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

2011-01-01

256

Microneurovascular decompression in patients with hemifacial spasm caused by vascular compression of facial nerve at cisternal portion  

Microsoft Academic Search

Background  Hemifacial spasm is commonly caused by arterial compression of the facial nerve. Although vascular compression usually occurs\\u000a at the facial nerve exit zone, in some cases, the facial nerve is compressed more distally. We analyzed the clinical outcome\\u000a of microneurovascular decompression in patients with hemifacial spasm caused by either distal or proximal compression.\\u000a \\u000a \\u000a \\u000a \\u000a Method  From September 1978 to March 2009, 2,137

Won Seok Chang; Hae Yu Kim; Sang Sup Chung; Jin Woo Chang

2010-01-01

257

Coronary artery ectasia--a variant of occlusive coronary arteriosclerosis  

Microsoft Academic Search

In a study of 1000 consecutive coronary arteriograms, 12 patients (all men) had coronary artery ectasia. Ectasia was found most frequently in the circumflex or right coronary artery. Only 1 patient had ectasia in the left anterior descending coronary artery. In 11 patients, ectasia of one artery was associated with severe stenosis or occlusion of other vessels, typical of arteriosclerosis.

R H Swanton; M L Thomas; D J Coltart; B S Jenkins; M M Webb-Peploe; B T Williams

1978-01-01

258

Coronary venous outflow persists after cessation of coronary arterial inflow.  

PubMed

During single long diastoles we simultaneously measured coronary arterial blood flow and coronary venous outflow. When vasomotor tone was intact, approximately 20% of the total volume of diastolic coronary venous outflow appeared after cessation of inflow. During maximal coronary dilation, approximately 40% of the total volume of diastolic coronary venous outflow appeared after cessation of inflow. Theoretically, coronary capacitance could enable persistence of diastolic coronary venous outflow during zero coronary artery inflow. Intramyocardial coronary capacitance calculated from these data was 0.10 ml X mmHg-1 X 100 g-1 with vasomotor tone intact and 0.21 during maximal coronary dilation. These results indicate that the diastolic coronary arterial stop-flow pressure cannot be equated with cessation of flow throughout the coronary vasculature due to the significant contribution of intramyocardial capacitance. We also found that the arterial pressure at which coronary outflow stopped (10-14 mmHg) was substantially less than that at which coronary artery inflow ceased (19-31 mmHg), yet slightly above right atrial pressure (5-9 mmHg). These studies indicate that coronary venous outflow stops at a lower pressure than arterial inflow. Furthermore, the cessation of venous blood flow in the coronary system during long diastoles occurs at pressures only a few mmHg above right atrial pressure. PMID:6507646

Chilian, W M; Marcus, M L

1984-12-01

259

Normalization of coronary flow reserve by percutaneous transluminal coronary angioplasty  

Microsoft Academic Search

Fifteen patients undergoing routine follow-up angiography 5 months after successful percutaneous transluminal coronary angioplasty (PTCA) without angina and with normal exercise thallium scintigraphy were selected for analysis. The coronary flow reserves of these patients were compared with those of 24 patients with angiographically normal coronary arteries to establish whether PTCA can restore to normal the coronary flow reserve of patients

F. Zijlstra; J. H. C. Reiber; Y. Juilliere; P. W. J. C. Serruys

1988-01-01

260

Pathophysiology of Coronary Collaterals#  

PubMed Central

While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand. However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion. This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation. PMID:23701025

Stoller, Michael; Seiler, Christian

2014-01-01

261

Intravascular Optical Imaging Technology for Investigating the Coronary Artery  

PubMed Central

There is an ever-increasing demand for new imaging methods that can provide additional information about the coronary wall to better characterize and stratify high-risk plaques, and to guide interventional and pharmacologic management of patients with coronary artery disease. While there are a number of imaging modalities that facilitate the assessment of coronary artery pathology, this review paper focuses on intravascular optical imaging modalities that provide information on the microstructural, compositional, biochemical, biomechanical, and molecular features of coronary lesions and stents. The optical imaging modalities discussed include angioscopy, optical coherence tomography, polarization sensitive-optical coherence tomography, laser speckle imaging, near-infrared spectroscopy, time-resolved laser induced fluorescence spectroscopy, Raman spectroscopy, and near-infrared fluorescence molecular imaging. Given the wealth of information that these techniques can provide, optical imaging modalities are poised to play an increasingly significant role in the evaluation of the coronary artery in the future. PMID:21920342

Suter, Melissa J.; Nadkarni, Seemantini K.; Weisz, Giora; Tanaka, Atsushi; Jaffer, Farouc A.; Bouma, Brett E.; Tearney, Guillermo J.

2012-01-01

262

Haemodynamic observations during percutaneous transluminal coronary angioplasty in the presence of synchronised diastolic coronary sinus retroperfusion.  

PubMed

Animal studies have demonstrated that synchronised coronary sinus retroperfusion with arterial blood can provide effective perfusion of ischaemic myocardium. Preliminary clinical studies have shown that the technique can also be used with safety in human beings, and in the present study its effectiveness was assessed in three patients undergoing repeated coronary artery occlusions during percutaneous transluminal coronary angioplasty. Arterial blood was removed via an 8F catheter positioned in the femoral artery and delivered by a retroperfusion pumping system to a 7F retroperfusion balloon catheter positioned in the anterior cardiac vein. Ischaemia-related indices were monitored both before and during coronary sinus retroperfusion. These indices included high fidelity left ventricular pressure recordings and pressure derived indices (including velocities of isovolumic contraction and relaxation), as well as electrocardiographic changes and symptoms. Analysis of these variables showed that the ischaemic changes induced during coronary artery occlusion were not prevented by this type of coronary sinus retroperfusion. There was no major complication in any of the patients. It may be that adaptation of the technique or the use of alternative end points will establish a benefit, but further modifications of the delivery system are necessary for effective clinical use. PMID:2963657

Beatt, K J; Serruys, P W; de Feyter, P; van den Brand, M; Verdouw, P D; Hugenholtz, P G

1988-02-01

263

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

1998-01-01

264

(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. PMID:23555365

Yoko, Kawawa; Ehiichi, Kohda; Toshiharu, Ishii

2009-01-01

265

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

2004-01-01

266

The influence of etiology upon ictal semiology, treatment decisions and long-term outcomes in infantile spasms and West syndrome  

Microsoft Academic Search

Studying infantile spasms is challenging because there are so many aspects of variation that introduce potential bias. These might relate to the many underlying etiologies, and variations in clinical semiology and electroencephalographic features that relate more to age or timing of investigation than to the underlying epilepsy or seizures type. New gene defects associated with the CDKL5\\/STK9 and ARX genes

Andrew L. Lux; John P. Osborne

2006-01-01

267

Copy number variants and infantile spasms: evidence for abnormalities in ventral forebrain development and pathways of synaptic function  

Microsoft Academic Search

Infantile spasms (ISS) are an epilepsy disorder frequently associated with severe developmental outcome and have diverse genetic etiologies. We ascertained 11 subjects with ISS and novel copy number variants (CNVs) and combined these with a new cohort with deletion 1p36 and ISS, and additional published patients with ISS and other chromosomal abnormalities. Using bioinformatics tools, we analyzed the gene content

Alex R Paciorkowski; Liu Lin Thio; Jill A Rosenfeld; Marzena Gajecka; Christina A Gurnett; Shashikant Kulkarni; Wendy K Chung; Eric D Marsh; Mattia Gentile; James D Reggin; James W Wheless; Sandhya Balasubramanian; Ravinesh Kumar; Susan L Christian; Carla Marini; Renzo Guerrini; Natalia Maltsev; Lisa G Shaffer; William B Dobyns

2011-01-01

268

Coronary Artery Disease  

MedlinePLUS

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 ...

269

Coronary artery fistulas  

PubMed Central

The aetiology of congenital coronary artery fistulas remains a challenging issue. Coronary arteries with an anatomically normal origin may, for obscure reasons, terminate abnormally and communicate with different single or multiple cardiac chambers or great vessels. When this occurs, the angiographic morphological appearance may vary greatly from discrete channels to plexiform network of vessels. Coronary arteriovenous fistulas (CAVFs) have neither specific signs nor pathognomonic symptoms; the spectrum of clinical features varies considerably. The clinical presentation of symptomatic cases can include angina pectoris, myocardial infarction, fatigue, dyspnoea, CHF, SBE, ventricular and supraventricular tachyarrhythmias or even sudden cardiac death. CAVFs may, however, be a coincidental finding during diagnostic coronary angiography (CAG). CAG is considered the gold standard for diagnosing and delineating the morphological anatomy and pathway of CAVFs. There are various tailored therapeutic modalities for the wide spectrum of clinical manifestations of CAVFs, including conservative pharmacological strategy, percutaneous transluminal embolisation and surgical ligation. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696067

Said, S.A.M.; Thiadens, A.A.H.J.; Fieren, M.J.C.H.; Meijboom, E.J.; van der Werf, T.; Bennink, G.B.W.E.

2002-01-01

270

Coronary artery wall imaging.  

PubMed

Like X-Ray contrast angiography, MR coronary angiograms show the vessel lumens rather than the vessels themselves. Consequently, outward remodeling of the vessel wall, which occurs in subclinical coronary disease before luminal narrowing, cannot be seen. The current gold standard for assessing the coronary vessel wall is intravascular ultrasound, and more recently, optical coherence tomography, both of which are invasive and use ionizing radiation. A noninvasive, low-risk technique for assessing the vessel wall would be beneficial to cardiologists interested in the early detection of preclinical disease and for the safe monitoring of the progression or regression of disease in longitudinal studies. In this review article, the current state of the art in MR coronary vessel wall imaging is discussed, together with validation studies and recent developments. J. Magn. Reson. Imaging 2015;41:1190-1202. © 2014 Wiley Periodicals, Inc. PMID:25303707

Keegan, Jennifer

2015-05-01

271

Coronary Artery Bypass Surgery  

MedlinePLUS

... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

272

Obsessive-compulsive-spectrum symptoms in patients with focal dystonia, hemifacial spasm, and healthy subjects.  

PubMed

This study is aimed at investigating obsessive-compulsive disorder (OCD) in three groups of patients matched for age and gender; namely, focal dystonia (FD), hemifacial spasm (HFS), and healthy-control subjects (HC). All subjects were investigated with the Structured Clinical Interview for DSM-I, the Hospital Anxiety and Depression Scale, the Symptom Checklist-90, the Yale-Brown Obsessive-Compulsive Scale, and the Structured Clinical Interview for Obsessive-Compulsive Spectrum Self-Report, Lifetime Version (SCI-OBS-SR-LT). The prevalence of OCD was significantly higher in both FD and HFS than in HC participants. On the SCI-OBS, HFS patients showed higher scores than FD or HC for "contamination" and "aggressiveness." Despite the different pathophysiology, OCD is highly represented in both FD and HFS, with different thematic content characterizing the two conditions. PMID:22450617

Mula, Marco; Strigaro, Gionata; Marotta, Antonella E; Ruggerone, Simona; Tribolo, Antonella; Monaco, Roberto; Cantello, Francesco

2012-01-01

273

The mechanism of hemifacial spasm: a new understanding of the offending artery.  

PubMed

Although neurovascular confliction was believed to be the cause of hemifacial spasm (HFS), the mechanism of the disorder remains unclear to date. Current theories, merely focusing on the facial nerve, have failed to explain the clinical phenomenon of immediate relief following a successful microvascular decompression surgery (MVD). With the experience of thousands of microvascular decompression surgeries and preliminary investigations, we have learned that the offending artery may play a more important role than the effect of merely mechanical compression in the pathogenesis of the disease. We believe that the attrition of neurovascular interface is the essence of the etiology, and the substance of the disease is emersion of ectopic action potentials from the demyelinated facial nerve fibers, which were triggered by the sympathetic endings from the offending artery wall. In this paper, we put forward evidence to support this hypothesis, both logically and theoretically. PMID:25034027

Dou, Ning-Ning; Zhong, Jun; Zhou, Qiu-Meng; Zhu, Jin; Wang, Yong-Nan; Xia, Lei; Yang, Xiao-Sheng; Ying, Ting-Ting; Zheng, Xue-Sheng; Li, Shi-Ting

2015-02-01

274

Coronary Artery Imaging in Children  

PubMed Central

Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy. PMID:25741188

2015-01-01

275

Tail spasms in rat spinal cord injury: changes in interneuronal connectivity.  

PubMed

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

2012-07-01

276

Spontaneous multivessel coronary artery dissection with anomalous coronary artery  

PubMed Central

Spontaneous coronary artery dissection (SCAD) is one of the rare causes of acute coronary syndrome in young healthy individuals especially women without having any conventional risk factors for coronary artery disease. We describe a case of 34-year-old healthy man with diffuse multiple SCADs who presented with acute coronary syndrome and was managed conservatively with an uneventful course on long-term follow-up. PMID:23595252

Mahadevappa, Nagesh; Singh, Bhupinder; Bhairappa, Shivakumar; Nanjappa, Manjunath

2013-01-01

277

Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Initially Visualized by Echocardiography and Multidetector Computed Tomography Coronary Angiography  

PubMed Central

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly associated with very high mortality during infancy. We report a 35-year-old female patient with ALCAPA initially visualized by echocardiography. She visited outpatient department presenting with intermittent chest discomfort for 3 weeks. Transthoracic echocardiography showed left coronary artery arising from main pulmonary artery and abundant septal color flow Doppler signals. Transesophageal echocardiography clearly revealed markedly dilated and tortuous right coronary artery showing windsock appearance. Multidetector computed tomography and coronary angiography enabled visualization of anomalous left coronary artery originating from left side of main pulmonary trunk. After treadmill exercise test which showed ST-segment depression presenting inducible myocardial ischemia, patient underwent direct re-implantation of the anomalous coronary artery into the aorta without any complication. PMID:23346290

Kim, Byung-Ho; Park, Yon Woong; Hong, Seung-Pyo; Son, Ja-Yung; Lee, Young-Soo; Lee, Jin-Bae; Choi, Ji-Yong; Kim, Kee-Sik; Chang, Sung-Guk

2012-01-01

278

Effect of Rate of Administration of Recombinant Tissue Plasminogen Activator on Efficacy of Coronary Thrombolysis  

Microsoft Academic Search

The authors employed a canine model of coronary thrombosis, induced by injection of radioactive blood clot, via a catheter placed in the left anterior descending (LAD) coronary artery, to compare effects of different rates of administration of recombinant tissue plasminogen activator (rtPA) on efficacy of coronary thrombolysis. In one group of dogs 0.75 mg\\/kg of rtPA was administered via the

Richard M. Prewitt; Shian Gu; Usha Schick; John Ducas

1994-01-01

279

What Causes Coronary Microvascular Disease?  

MedlinePLUS

... Living With Clinical Trials Links Related Topics Angina Atherosclerosis Coronary Heart Disease Coronary Heart Disease Risk Factors ... Microvascular Disease? The same risk factors that cause atherosclerosis (ATH-er-o-skler-O-sis) may cause ...

280

Integrative physiology of coronary microcirculation.  

PubMed

Coronary microvessels play a crucial role for mechanoenergetic interaction between blood flow and myocardial function, which is not uniform transmurally. Thus, highly organized vascular regulations are required for matching local blood flow with myocardial energy requirement. Recently, new technologies to investigate in vivo coronary microcirculation with new knowledge of the signaling molecules for vascular regulation have revolutionized our abilities to understand the integrative regulation of coronary microcirculation. In this review, the mechanical aspects of the interaction between coronary blood flow and myocardium, coronary arte-rial tree and its roles in myocardial blood flow regulation, hierarchical and dynamic control of coronary flow, capillary network and function, function of venous drainage system, and molecular and cellular aspects of integrative coronary blood flow regulation are discussed, focusing on their integrational roles in maintaining coronary microvascular function and cell signaling. PMID:10529484

Kajiya, F; Goto, M

1999-06-01

281

Living with Coronary Heart Disease  

MedlinePLUS

... from the NHLBI on Twitter. Living With Coronary Heart Disease Coronary heart disease (CHD) can cause serious ... any new symptoms or if your symptoms worsen. Heart Attack Warning Signs CHD raises your risk for ...

282

Functional Testing Underlying Coronary Revascularisation  

ClinicalTrials.gov

Multivessel Coronary Artery Disease; Vessel Disease; Stable Angina; Unstable Angina or Stabilized Non-ST Elevated Myocardial Infarction; Patients With ST-elevated Myocardial Infarction; Revascularization of Culprit Coronary Artery

2014-08-08

283

Effect of ivabradine-induced heart rate reduction on flow-mediated dilation measured with high-sensitivity ultrasound in patients with stable coronary heart disease  

PubMed Central

Background Experimental data suggests that exclusive heart rate reduction with ivabradine is associated with the amelioration of the endothelial function. Since it is presently unknown whether this also applies to humans, the aim of this pilot study was to investigate whether heart rate reduction with ivabradine modulates the endothelial function in humans with an established coronary heart disease. Methods Using high-sensitivity ultrasound, we analysed the flow-mediated (FMD) and nitro-mediated dilation (NMD) of the brachial artery in 25 patients (62.9?±?8.4 years) with a stable coronary heart disease and a resting heart rate of ?70 beats per minute (bpm). To assess acute effects, measurements were performed before and 4 hours after the first intake of ivabradine 7.5 mg. Sustained effects of an ivabradine therapy (5 mg to 7.5 mg twice daily) were investigated after 4 weeks. Results We found a significant decrease in heart rate, both 4 hours after the intake of 7.5 mg of ivabradine (median -8 [interquartile range (IQR) -14 to -4] bpm) and after 4 weeks of twice daily intake (median -10 [IQR-17 to -5] bpm) (p?coronary heart disease. Moreover, we found no correlation between the heart rate and the endothelial function. PMID:24479706

2014-01-01

284

Factors influencing the functional significance in intermediate coronary stenosis  

PubMed Central

Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve (FFR) in intermediate coronary artery stenosis. Methods The study enrolled 143 patients with 203 intermediate coronary lesions. Pressure-derived FFR of these lesions was gained at maximal hyperemia induced by intravenous adenosine infusion. An FFR < 0.80 was considered as abnormal functional significance. Anatomic parameters at the lesion sites were obtained by off-line quantitative coronary angiography analysis (QCA). The predictive value of the demographic characteristics and anatomic parameters for FFR in these intermediate lesions was assessed using multiple linear and binary logistic regression analysis. Results Overall, FFR < 0.8 was found in 70 (34%) of the total 203 intermediate coronary lesions. FFR values were positively correlated with QCA-measured minimum lumen diameters (MLD, r = 0.372, P = 0.000) and the reference vessel diameters (RVD, r = 0.217, P = 0.002) were negatively correlated with percent area stenosis (AS, r = ?0.251, P = 0.000) and percent diameter stenosis (DS, r = ?0.210, P = 0.000). Age, MLD and the lesion location in different coronary arteries were the independent determinants of FFR < 0.8. Conclusions MLD can predict the functional significance of intermediate coronary stenosis, while age and the lesion location in different coronary arteries should be taken into account as important influencing factors of FFR values.

Sun, Li-Jie; Wang, Gui-Song; Cui, Ming; Guo, Li-Jun; Zhang, Yong-Zhen; Zhang, Fu-Chun; Niu, Jie; Han, Jiang-Li; Xu, Wei-Xian; Zhu, Dan; Gao, Wei

2015-01-01

285

Coronary vasodilator reserve persists despite tachycardia and myocardial ischemia.  

PubMed

During myocardial ischemia, we tested whether coronary blood flow would increase in response to tachycardia, thereby employing known coronary flow reserve. We instrumented the left anterior descending (LAD) coronary circulation in anesthetized pigs and performed three sets of experiments while coronary pressure was controlled and several heart rate increases were produced. Pacing-induced tachycardia at normal LAD pressure was characterized by increased LAD flow and myocardial oxygen consumption, without production of lactate. Tachycardia at a mean LAD pressure of 38 mmHg was associated with a lower, fixed coronary flow and oxygen consumption. At average heart rates of 90 and 150 beats/min, LAD flow was 19.6 and 19.4 ml/min and corresponding myocardial blood flows were 0.59 and 0.54 ml X g-1 X min-1. Lactate was produced at all rates and local myocardial function declined progressively. Coronary flow at low LAD pressure doubled during tachycardia when intracoronary adenosine was added. The increase to the subepicardium was greater than 100%, whereas subendocardial flow changed little. There is persistent coronary flow reserve during moderately severe myocardial ischemia, even when metabolic demand is increased by tachycardia. This reserve, however, is predominantly subepicardial. PMID:3618815

Bristow, J D; McFalls, E O; Anselone, C G; Pantely, G A

1987-08-01

286

Coronary vasodilator reserve persists despite tachycardia and myocardial ischemia  

SciTech Connect

During myocardial ischemia, the authors tested whether coronary blood flow measured with radioactive microspheres labeled with {sup 141}Ce, {sup 51}Cr, {sup 103}Ru, and {sup 95}Nb would increase in response to tachycardia thereby employing known coronary flow reserve. The authors instrumented the left anterior descending (LAD) coronary circulation in anesthetized pigs and performed three sets of experiments while coronary pressure was controlled and several heart rate increases were produced. (1) Pacing-induced tachycardia at normal LAD pressure was characterized by increased LAD flow and myocardial oxygen consumption, without production of lactate. (2) Tachycardia at a mean LAD pressure of 38 mmHg was associated with a lower, fixed coronary flow and oxygen consumption. Lactate was produced at all rates and local myocardial function declined progressively. (3) Coronary flow at low LAD pressure doubled during tachycardia when intracoronary adenosine was added. The increase to the subepicardium was >100%, whereas subendocardial flow changed little. There is persistent coronary flow reserve during moderately severe myocardial ischemia, even when metabolic demand is increased by tachycardia. This reserve, however, is predominantly subepicardial.

Bristow, J.D.; McFalls, E.O.; Anselone, C.G.; Pantely, G.A. (Oregon Health Sciences Univ., Portland (USA))

1987-08-01

287

Spontaneous coronary artery dissection.  

PubMed

Spontaneous coronary artery dissection (SCAD) is a rare but challenging clinical entity of unknown etiology. From a pathophysiological standpoint, SCAD may occur in patients with a coronary intimal tear (presenting with the classic angiographic "flap" and multiple lumens), but also in patients without an intimal rupture (presenting as an intramural hematoma). Until now, available information on SCAD was largely based on multiple, small case-series studies but, recently, data from relatively large registries have cast a new light on this disease. Classically, SCAD was thought to present in young females without traditional atherosclerotic risk factors but recent reports suggest a broader clinical spectrum encompassing older patients with associated coronary artery disease. In this review, we concentrate on 3 main aspects of this unique disease: (1) the value of intracoronary diagnostic techniques (intravascular ultrasound and optical coherence tomography) to complement coronary angiography and to provide novel diagnostic insights on this elusive clinical condition; (2) the growing clinical evidence suggesting an association and potential causation between fibromuscular dysplasia and SCAD; and (3) the challenges of coronary revascularization in this adverse anatomic setting, together with recent data suggesting that a initial, conservative medical management may be preferable for the majority of patients with SCAD. PMID:25131524

Alfonso, Fernando; Bastante, Teresa; Rivero, Fernando; Cuesta, Javier; Benedicto, Amparo; Saw, Jacqueline; Gulati, Rajiv

2014-01-01

288

Spontaneous coronary artery dissection of all major coronary arteries  

PubMed Central

Spontaneous coronary artery dissection is a rare cause of myocardial infarction and sudden cardiac death. A 32-year-old man presented with effort angina. He had a positive treadmill exercise electrocardiogram test, and coronary angiography showed that he had dissection of all major coronary vessels. The left anterior descending coronary artery was completely blocked, probably secondary to dissection and subsequent occlusion. He was advised to undergo coronary artery bypass surgery, to which he did not agree; instead, he was treated by medication and followed up. PMID:17380226

Harikrishnan, S; Ajithkumar, VK; Tharakan, JM

2007-01-01

289

Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease  

Microsoft Academic Search

BACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS We randomly assigned 1800 patients with three-vessel or left

Patrick W. Serruys; Marie-Claude Morice; A. Pieter Kappetein; Antonio Colombo; David R. Holmes; Michael J. Mack; E. Stahle; Ted E. Feldman; Marcel van den Brand; Eric J. Bass; Nic Van Dyck; K. Leadly; Keith D. Dawkins; Friedrich W. Mohr

2009-01-01

290

Spontaneous coronary artery dissection.  

PubMed

Spontaneous coronary artery dissection (SCAD) is a relatively rare and unexplored type of coronary disease. Although atherosclerosis, hormonal changes during pregnancy and connective tissue disorders might represent a sufficiently convincing explanation for some patients with SCAD, the many remaining cases display only a weak relationship with these causes. While on one side the clinical heterogeneity of SCAD masks a full understanding of their underlying pathophysiologic process, on the other side paucity of data and misleading presentations hamper the quick diagnosis and optimal management of this condition. A definite diagnosis of SCAD can be significantly facilitated by endovascular imaging techniques. In fact, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) overcome the limitations of coronary angiography providing detailed endovascular morphologic information. In contrast, optimal treatment strategies for SCAD still represent a burning controversial question. Herein, we review the published data examining possible causes and investigating the best therapy for SCAD in different clinical scenarios. PMID:24861255

Giacoppo, Daniele; Capodanno, Davide; Dangas, George; Tamburino, Corrado

2014-07-15

291

Extracardiac coronary arterial anastomoses.  

PubMed

The collateral arterial circulation of the heart has been extensively studied. However, less attention has been paid to extracardiac anastomoses, which may also be of significant clinical importance. In this review, we will describe the most common types of these anastomoses, which include bronchial to coronary arteries and internal thoracic to coronary arteries. In a much lesser degree, anastomoses between coronary arteries and pericardiacophrenic branches of the internal thoracic arteries, anterior mediastinal arteries, intercostal arteries, and esophageal arterial branches have also been described. Knowledge of the likely morphology and function of the anastomoses, therefore, could prove helpful in the clinical evaluation of patients with myocardial ischemia, particularly when selecting candidates for myocardial revascularization. PMID:21322035

Loukas, Marios; Hanna, Michael; Chen, Justin; Tubbs, R Shane; Anderson, Robert H

2011-03-01

292

[Coronary flow in experimental cardiac hypertrophy caused by arterial hypertension].  

PubMed

We studied the effects of left ventricular hypertrophy (LVH) induced by one clip-two kidney Goldblatt hypertension on coronary circulation of conscious rats. Twenty four weeks after clipping, coronary blood flow per unit mass after pharmacological dilation by carbochrome (6 mg/kg) (coronary flow reserve-CFR) was measured using radioactive microspheres. Coronary flow reserve remained normal either during development or LVH in untreated rats or after reversal of LVH in rats treated with captopril or nephrectomy. An appropriate relationship between pressure and mass, which varied in parallel, layed a significant role in maintaining a normal CFR. This, if confirmed in man, our results would suggest that antihypertensive drugs that alter this relationship by decreasing pressure but not LV mass may adversely affect CFR. PMID:6214231

Wicker, P; Tarazi, R; Dallocchio, M; Bricaud, H

1982-06-01

293

Coronary Artery Bypass Graft  

NSDL National Science Digital Library

This patient education program explains the benefits and risks of coronary artery bypass graft surgery for the treatment of coronary arteriosclerosis. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary

Patient Education Institute

294

Evaluation of concentrations of botulinum toxin A for the treatment of hemifacial spasm: a randomized double-blind crossover trial.  

PubMed

The aim of our study was to evaluate the efficacy and safety of two concentrations of botulinum toxin A (BTX-A) for the treatment of hemifacial spasm. We randomly divided 20 patients with hemifacial spasm into high- and low-concentration groups; they were administered 50 and 25 U/mL BTX-A injection, respectively. Further, we compared the curative effects and the occurrence of adverse reactions in the two groups. Our results showed that both the concentrations of BTX-A were effective and no significant difference was observed in the onset time and therapeutic efficacy between the two groups; however, the duration of efficacy was longer in the high-concentration group than in the low-concentration group. Patients in both groups had no allergic reactions and systemic toxic reactions, but those in the high-concentration group had more serious adverse reactions and they lasted for longer durations. The adverse reactions in the two groups were not specifically treated, and they resolved in a relatively short time. In conclusion, local injection of BTX-A was effective in treating hemifacial spasm and each concentration of BTX-A had advantages and disadvantages, which indicated that the concentration of BTX-A can be selected according to the clinical characteristics and willingness of the patients. PMID:25730053

Li, Y J; Huang, Y; Ding, Q; Gu, Z H; Pan, X L

2015-01-01

295

The influence of etiology upon ictal semiology, treatment decisions and long-term outcomes in infantile spasms and West syndrome.  

PubMed

Studying infantile spasms is challenging because there are so many aspects of variation that introduce potential bias. These might relate to the many underlying etiologies, and variations in clinical semiology and electroencephalographic features that relate more to age or timing of investigation than to the underlying epilepsy or seizures type. New gene defects associated with the CDKL5/STK9 and ARX genes are associated with infantile spasms, but these illustrate that, when studying neurodevelopmental outcomes, it is necessary to deal also with heterogeneity at the level of genotype-phenotype correlation. We discuss these design issues with consideration of data from the United Kingdom infantile spasms study (UKISS)--in which neurodevelopmental outcomes show evidence of an interaction between underlying etiologic classification and randomised treatment--and with consideration to proposals on study design from the recent consensus statement of the West Delphi group. In the continual debate about whether we should "lump" or "split" when studying epilepsy syndromes, we propose the adoption of study designs using valid and consistent methods that permit both lumping and splitting. PMID:16828260

Lux, Andrew L; Osborne, John P

2006-08-01

296

Disruption of the serine/threonine kinase 9 gene causes severe X-linked infantile spasms and mental retardation.  

PubMed

X-linked West syndrome, also called "X-linked infantile spasms" (ISSX), is characterized by early-onset generalized seizures, hypsarrhythmia, and mental retardation. Recently, we have shown that the majority of the X-linked families with infantile spasms carry mutations in the aristaless-related homeobox gene (ARX), which maps to the Xp21.3-p22.1 interval, and that the clinical picture in these patients can vary from mild mental retardation to severe ISSX with additional neurological abnormalities. Here, we report a study of two severely affected female patients with apparently de novo balanced X;autosome translocations, both disrupting the serine-threonine kinase 9 (STK9) gene, which maps distal to ARX in the Xp22.3 region. We show that STK9 is subject to X-inactivation in normal female somatic cells and is functionally absent in the two patients, because of preferential inactivation of the normal X. Disruption of the same gene in two unrelated patients who have identical phenotypes (consisting of early-onset severe infantile spasms, profound global developmental arrest, hypsarrhythmia, and severe mental retardation) strongly suggests that lack of functional STK9 protein causes severe ISSX and that STK9 is a second X-chromosomal locus for this disorder. PMID:12736870

Kalscheuer, Vera M; Tao, Jiong; Donnelly, Andrew; Hollway, Georgina; Schwinger, Eberhard; Kübart, Sabine; Menzel, Corinna; Hoeltzenbein, Maria; Tommerup, Niels; Eyre, Helen; Harbord, Michael; Haan, Eric; Sutherland, Grant R; Ropers, Hans-Hilger; Gécz, Jozef

2003-06-01

297

Hypsarrhythmia paroxysm index: A tool for early prediction of infantile spasms.  

PubMed

Recurrence of infantile spasms (ISs) is common subsequent to treatment with adrenocorticotropic hormone (ACTH) for West syndrome, and prolonged hypsarrhythmia results in psychomotor deterioration. The evolution to hypsarrhythmia involves conversion of prehypsarrhythmic EEG findings to sporadic hypsarrhythmia paroxysms (HPs), and when paroxysms reach a certain frequency, ISs begin to occur. This retrospective chart study aimed to determine the HP threshold frequency after which ISs begin. Recorded either prior (Group A) or subsequent (Group B) to IS relapse, 248 EEGs were examined in 42 patients. The number of HPs in non-rapid eye movement (NREM) sleep divided by NREM duration constituted the countable hypsarrhythmia paroxysms index (cHPI). After reaching a rate of approximately 10/min, the cHPI lost its feasibility due to the merging of HPs. The durational HPI (dHPI) was also calculated (total duration of HPs during NREM/NREM sleep time×100). ACTH treatment was administered if cHPI was ?2/min, with the aim of preventing relapse. The mean cHPI value without a concomitant spasm relapse (in Group A) was 1.20/min. Following relapse, this value rose to 4.10/min. EEGs performed subsequent to relapse (in Group B) were classified into three subgroups (B1, B2, and B3) according to the duration of the time interval between IS relapse and the succeeding EEG recording. One-way analysis of variance (ANOVA) indicated that cHPI values differed significantly between the Group B subgroups. In subgroups B2 and B3, a higher number of EEGs were evaluated via dHPI. Linear regression analysis established that the interval between recurrence and the succeeding EEG recording significantly predicted cHPI values and accounted for 54.2% of the explained variability in cHPI values. Therefore, use of the cHPI for early recognition and intervention may aid in preventing the onset and recurrence of ISs and further deterioration of psychomotor development. PMID:25769373

Altunel, Attila; Sever, Ali; Altunel, Emine Özlem

2015-03-01

298

Sudden Cardiac Arrest at the Finish Line: In Coronary Ectopia, the Cause of Ischemia Is from Intramural Course, Not Ostial Location  

PubMed Central

A 26-year-old woman, a well-trained runner, had a sudden cardiac arrest just before crossing the finish line of a marathon. She was rapidly resuscitated and was later found to have an ectopic origin of the left coronary artery. This anomaly was surgically repaired by translocating the ostium from the right to the left sinus of Valsalva. Her difficult postoperative course prompted further coronary evaluation, which revealed severe stenosis of the neoostium. The patient underwent a second operation: this time, the stenosis was bypassed via a left internal mammary artery-to-left anterior descending coronary artery (LAD) graft. Hypoplasia of the LAD and spasm during manipulation caused the graft to fail, necessitating double-stent angioplasty of the left main ostium and the LAD 2 months later. At the patient's 6-month follow-up examination, she had no further evidence of functional ischemia, and she resumed jogging. Because the mode and mechanism of the patient's condition and events were documented in unusual detail, this case furthers our understanding of sudden cardiac arrest in athletes who have rare coronary anomalies. We conclude that ectopia of a coronary artery does not itself cause potentially fatal ischemia. Rather, these events are due to the ectopic artery's intramural proximal course within the aortic media, which might result in critical stenosis by means of hypoplasia or lateral compression of the artery. PMID:24808787

Joggerst, Steven; Monge, Jorge; Uribe, Carlo; Sherron, Scott; Angelini, Paolo

2014-01-01

299

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

2003-01-01

300

Percutaneous coronary intervention in two patients with a solitary coronary artery from the right coronary sinus of Valsalva  

PubMed Central

Two patients with a common coronary artery arising from the right sinus of Valsalva, who underwent coronary angiography and percutaneous coronary intervention following an acute coronary syndrome, are presented. The anatomic description based on previously published classification schemes is described. The clinical implications of this rare coronary anomaly and interventional considerations are addressed. PMID:22048514

AlFaleh, Hussam F.

2011-01-01

301

The distribution of ischaemia in perfused Wistar rat hearts following coronary artery occlusion.  

PubMed Central

Ischaemia induced in Wistar rat hearts by ligation of the main coronary arteries, was studied by NADH-fluorescence photography. The coronary anatomy was examined by barium angiography and intravascular resin infusion and it was confirmed that the main arteries were the left and right coronaries and the septal artery. The septal artery branched from the right coronary orifice in 90% of hearts examined. The long-axial cross-sectional view of the heart showed the ischaemic area to be limited to the left ventricular free wall following ligation of the left coronary, to the right ventricular free wall following ligation of the right coronary artery and to the ventricular septum after ligation of the septal artery. When the left coronary artery was ligated at its origin, the ratio of ischaemic area to cross-sectional area increased from the base to the apex of the heart. The borders of the epicardial ischaemic area induced by left and right coronary ligation made contact without any overlapping or broad separation. This indicates that the area perfused by the left and right coronary arteries was contiguous but physically separated. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 7 PMID:4063163

Taira, Y.; Kanaide, H.; Nakamura, M.

1985-01-01

302

Coronary Pressure Measurement Based Decision Making for Percutaneous Coronary Intervention  

PubMed Central

The fractional flow reserve (FFR) is a simple, reliable, and reproducible physiologic index of lesion severity. In patients with intermediate stenosis, FFR?0.75 can be used to safely defer percutaneous coronary intervention (PCI), and patients with FFR?0.75 have a very low cardiac event rate. Coronary pressure measurement can determine which lesion should be treated with PCI in patients with tandem lesions, and PCI on the basis of FFR has been demonstrated to result in an acceptably low repeat PCI rate. FFR can identify patients with equivocal left main coronary artery disease who benefit from coronary bypass surgery. Coronary pressure measurement distinguishes patients with an abrupt pressure drop pattern from those with a gradual pressure drop pattern, and the former group of patients benefit from PCI. Coronary pressure measurement is clinically useful in evaluating sufficient recruitable coronary collateral blood flow for prevention of ischemia, which affects future cardiac events. FFR is useful for the prediction of restenosis after PCI. As an end-point of PCI, FFR ?0.95 and ?0.90 would be appropriate for coronary stenting and coronary angioplasty, respectively. In summary, if you encounter a coronary stenosis in doubt you should measure pressure rather than dilate it. PMID:21037849

Iwasaki, Kohichiro; Kusachi, Shozo

2009-01-01

303

Impact of smoking on coronary microcirculatory resistance in patients with coronary artery disease.  

PubMed

The aim of this study was to investigate the relationship between coronary microvascular function and smoking using the 3 parameters fractional flow reserve (FFR), coronary flow reserve (CFRthermo), and index of microcirculatory resistance (IMR) in patients with coronary artery disease (CAD). A total of 97 CAD patients with 148 intermediate stenotic lesions were divided into two groups: current and former smokers (Smokers: n = 54), and those who had never smoked (Non-smokers: n = 43). Coronary physiology measurements were made following coronary angiography at rest and during hyperemia induced with intravenous adenosine triphosphate. If a patient had several intermediate lesions, the lesion producing the largest IMR value and minimum FFRmyo and CFRthermo value was selected. Averaged over all patients, the FFRmyo, CFRthermo, and IMR values were 0.86 ± 0.10, 2.66 ± 1.50, and 20.8 ± 10.7, respectively. There was no significant correlation between FFRmyoand IMR. There were no significant differences between smokers and non-smokers in FFRmyo value (median: 0.85 [IQR: 0.74-0.90] versus 0.87 [IQR: 0.83-0.90], P = 0.15) and CFRthermo value (median: 1.90 [IQR: 1.56-3.16] versus 2.10 [IQR: 1.50-2.67] U, P = 0.95). The IMR value was significantly greater in smokers (median: 24.2 [IQR: 16.8-32.5] U versus 18.5 [IQR: 15.4-27.0] U, P = 0.04). In multivariate analysis, smoking was an independent predictor of increased IMR. Smoking appears to have a detrimental effect on coronary microvascular function as measured by IMR. PMID:25503655

Miyazaki, Toru; Ashikaga, Takashi; Ohigashi, Hirokazu; Komura, Masatoshi; Kobayashi, Kazuo; Isobe, Mitsuaki

2015-01-21

304

Relation between the persistence of an abnormal muscle response and the long-term clinical course after microvascular decompression for hemifacial spasm.  

PubMed

Mentalis muscle responses to electrical stimulation of the zygomatic branch of the facial nerve are considered abnormal muscle responses (AMRs) and can be used to monitor the success of decompression in microvascular decompression (MVD) surgery. The aim of this study was to compare the long-term outcome of MVD surgery in which the AMR disappeared to the outcome of surgery in which the AMR persisted. From 2005 to 2009, 131 patients with hemifacial spasm received MVD surgery with intraoperative monitoring of AMR. At 1 week postsurgery, spasms had resolved in 82% of cases in the AMR-disappearance group and 46% of cases in the persistent-AMR group, mild spasms were present in 10% of cases in the AMR-disappearance group and 31% of cases in the persistent-AMR group, and moderate were present spasms in 8% of cases in the AMR-disappearance group and 23% of cases in the persistent-AMR group (P < 0.05). At 1 year postsurgery, spasms had resolved in 92% of cases in the AMR-disappearance group and 84% of cases in the persistent-AMR group, mild spasms were present in 6% of cases in the AMR-disappearance group and 8% of cases in the persistent-AMR group, and moderate spasms were present in 3% of cases in the AMR-disappearance group and 8% of the cases in the persistent-AMR group (P = 0.56). These results indicate that the long-term outcome of MVD surgery in which the AMR persisted was no different to that of MVD surgery in which the AMR disappeared. PMID:24305017

Tobishima, Hana; Hatayama, Toru; Ohkuma, Hiroki

2014-06-17

305

A Case of Infantile Alexander Disease Accompanied by Infantile Spasms Diagnosed by DNA Analysis  

PubMed Central

Alexander disease (AD) is a rare leukodystrophy of the central nervous system of unknown etiology. AD is characterized by progressive failure of central myelination and the accumulation of Rosenthal fibers in astrocytes, and is inevitably lethal in nature. Symptomatically, AD is associated with leukoencephalopathy with macrocephaly, seizures, and psychomotor retardation in infants, and usually leads to death within the first decade. Its characteristic magnetic resonance imaging (MRI) findings have been described as demyelination predominantly in the frontal lobe. Moreover, dominant mutations in the GFAP gene, coding for glial fibrillary acidic protein (GFAP), a principal astrocytic intermediate filament protein, have been shown to lead to AD. The disease can now be detected by genetic diagnosis. We report the Korean case of an 8-month-old male patient with AD. He was clinically characterized due to the presence of psychomotor retardation, megalencephaly, spasticity, and recurrent seizures including infantile spasms which is a remarkable presentation. Demyelination in the frontal lobe and in a portion of the temporal lobe was demonstrated by brain MRI. Moreover, DNA analysis of peripheral blood showed the presence of a R239L mutation in the GFAP gene, involving the replacement of guanine with thymine. PMID:17043438

Lee, Jung Mu; Kim, Ae Suk; Lee, Sun Ju; Cho, Sung Min; Lee, Dong Seok; Choi, Sung Min; Ki, Chang Seok; Kim, Jong Won

2006-01-01

306

Botulinum Toxin as an Alternative to Treat the Spasm of the Near Reflex.  

PubMed

Abstract We describe the case of an eight-year-old girl with complaints of headaches and blurred vision (uncorrected visual acuity: 0.1 decimal) that showed on examination miotic pupils, pseudomyopia, no ocular motility restrictions, and no associated neurological disease. After initial treatment with cyclopentolate for two months, pseudomyopia persisted with an intermittent and variable esotropia. Spectacles of +1 both eyes and atropine 1% one drop daily were then prescribed. The situation improved and remained stable for several weeks, with pseudomyopia and esotropia reappearing later. Finally, botulinum toxin (2.5 iu Botox®) was injected in the medial rectus muscle on two occasions and a visual therapy program based on the stimulation of fusional divergence, diplopia, and stereopsis consciousness was recommended. This prescription was combined with the use of atropine during the first few weeks. Orthotropia and corrected distance visual acuity of 1.0 were found three months after treatment. The evolution and clinical results of this case report suggest that botulinum toxin in combination with other therapeutic alternatives may be useful in the treatment of spasm of the near reflex. PMID:24809739

Laria, Carlos; Merino-Suárez, María L; Pińero, David P; Gómez-Hurtado, Arantxa; Pérez-Cambrodí, Rafael J

2014-05-01

307

Microvascular decompression for hemifacial spasm secondary to vertebrobasilar dolichoectasia: surgical strategies, technical nuances and clinical outcomes.  

PubMed

Hemifacial spasm (HFS) due to direct compression of the facial nerve by a dolichoectatic vertebrobasilar artery is rare. Vessels are often non-compliant and tethered by critical brainstem perforators. We set out to determine surgical strategies and outcomes for this challenging disease. All patients undergoing surgery for HFS secondary to vertebrobasilar dolichoectasia were reviewed. Hospital records, clinic notes and radiographic imaging were collected for outcome measures. Seventeen patients (eight males, nine females) were identified. Sixteen patients (94%) were treated with Teflon pledgets (DuPont, Wilmington, DE, USA) and one (6%) patient had a vascular sling placed around a severely diseased vertebral artery. All patients had significant reduction in symptoms and 82% of patients had complete resolution of symptoms (average follow-up: 41.4 months). One patient suffered persistent facial nerve paresis and swallowing difficulty. Two other patients suffered a 1 point decrease in the House-Brackmann facial nerve grading scale. Four patients (23%) required re-operation (infection, cerebrospinal fluid leak, and two patients with delayed recurrence of HFS). Of the latter, one patient required repositioning of a Teflon pledget and another patient underwent a sling decompression. There were no perioperative strokes or death. Excellent relief of symptoms with acceptable preoperative morbidity can be achieved using Teflon pledgets alone in most cases. In recalcitrant cases, sling transposition can be used to further augment the decompression. Careful attention must be paid to prevent vascular kinking and preserve brainstem perforators. PMID:25510536

Zaidi, Hasan A; Awad, Al-Wala; Chowdhry, Shakeel A; Fusco, David; Nakaji, Peter; Spetzler, Robert F

2015-01-01

308

Dipyridamole-induced myocardial ischemia.  

PubMed

Angina and ischemic electrocardiographic changes occurred after administration of oral dipyridamole in four patients awaiting urgent myocardial revascularization procedures. To our knowledge, this has not previously been reported as a side effect of preoperative dipyridamole therapy, although dipyridamole-induced myocardial ischemia has been demonstrated to occur in animals and humans with coronary artery disease. Epicardial coronary collateral vessels were demonstrated in all four patients; a coronary "steal" phenomenon may be the mechanism of the dipyridamole-induced ischemia observed. PMID:2950248

Keltz, T N; Innerfield, M; Gitler, B; Cooper, J A

1987-03-20

309

Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques  

PubMed Central

Coronary computed tomography angiography (CCTA) has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques. PMID:25162010

2014-01-01

310

Assessment of Coronary Artery Stents by Coronary CT Angiography  

Microsoft Academic Search

Stents reduce the acute risk of a coronary intervention and reduce the risk of restenosis afterwards. Today, stent placement\\u000a is the most frequently performed coronary revascularization treatment. CT represents a possible noninvasive method for the\\u000a detection of in-stent restenosis, but in the presence of stents imaging, it is impeded by artifacts. Therefore, coronary CT\\u000a angiography for the evaluation of stents

David Maintz; Harald Seifarth

311

Circulating factors induce coronary endothelial cell activation following exposure to inhaled diesel exhaust and nitrogen dioxide in humans: evidence from a novel translational in vitro model.  

PubMed

The vascular toxicity of inhaled agents may be caused by soluble factors that are released into the systemic circulation. To confirm this in a straightforward manner, we obtained plasma from healthy human volunteers before and after exposure to diesel exhaust (DE) and nitrogen dioxide (NO(2)). Plasma samples were obtained from human volunteers exposed to 100 ?g/m(3) DE or filtered air for 2 h. A second cohort was exposed to 500 ppb NO(2) or filtered air in an identical protocol. Primary human coronary artery endothelial cells (hCAECs) were grown to confluence and treated for 24 h with a 10 or 30% (in media) mixture of plasma obtained before, immediately post or 24 h postexposure to pollutant exposures. Messenger RNA (mRNA) was isolated from hCAECs following the incubation and probed for intracellular cell adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) expression. ICAM-1 mRNA expression was increased by plasma obtained at both timepoints following the NO(2) exposures. VCAM-1 was significantly elevated in cells treated with plasma obtained 24 h following diesel exposure and at both timepoints following NO(2) exposure. Interleukin-8 protein was elevated in the hCAEC supernatant when cells were incubated with plasma from NO(2) exposures. These data indicate that proinflammatory circulating factors are elevated acutely following exposure to both DE and a primary component thereof, NO(2). These functional translational assays offer novel approaches to assessing the cardiovascular risk associated with air pollution exposure. PMID:22331494

Channell, Meghan M; Paffett, Michael L; Devlin, Robert B; Madden, Michael C; Campen, Matthew J

2012-05-01

312

Circulating Factors Induce Coronary Endothelial Cell Activation Following Exposure to Inhaled Diesel Exhaust and Nitrogen Dioxide in Humans: Evidence From a Novel Translational In Vitro Model  

PubMed Central

The vascular toxicity of inhaled agents may be caused by soluble factors that are released into the systemic circulation. To confirm this in a straightforward manner, we obtained plasma from healthy human volunteers before and after exposure to diesel exhaust (DE) and nitrogen dioxide (NO2). Plasma samples were obtained from human volunteers exposed to 100 ?g/m3 DE or filtered air for 2 h. A second cohort was exposed to 500 ppb NO2 or filtered air in an identical protocol. Primary human coronary artery endothelial cells (hCAECs) were grown to confluence and treated for 24 h with a 10 or 30% (in media) mixture of plasma obtained before, immediately post or 24 h postexposure to pollutant exposures. Messenger RNA (mRNA) was isolated from hCAECs following the incubation and probed for intracellular cell adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) expression. ICAM-1 mRNA expression was increased by plasma obtained at both timepoints following the NO2 exposures. VCAM-1 was significantly elevated in cells treated with plasma obtained 24 h following diesel exposure and at both timepoints following NO2 exposure. Interleukin-8 protein was elevated in the hCAEC supernatant when cells were incubated with plasma from NO2 exposures. These data indicate that proinflammatory circulating factors are elevated acutely following exposure to both DE and a primary component thereof, NO2. These functional translational assays offer novel approaches to assessing the cardiovascular risk associated with air pollution exposure. PMID:22331494

Channell, Meghan M.; Paffett, Michael L.; Devlin, Robert B.; Madden, Michael C.; Campen, Matthew J.

2012-01-01

313

Right coronary ostial plasty without patch material.  

PubMed

Isolated right coronary ostial stenosis may require coronary revascularisation during an open-heart operation, especially during aortic valve replacement. We describe here a new method of right coronary ostial plasty without patch material. PMID:17721852

Cebi, N; Walterbusch, G

2007-09-01

314

Coronary reserve is depressed in postmyocardial infarction reactive cardiac hypertrophy.  

PubMed

After a myocardial infarction (MI), the remaining myocardium undergoes a compensatory reactive hypertrophy. Although coronary perfusion to the surviving myocardium can be an important determinant of cardiac function in this setting, there are no available data regarding myocardial blood flow in reactive hypertrophy. Accordingly, we measured coronary blood flow and reserve using radioactive microspheres in rats 4 weeks after induction of an MI by ligation of the left coronary artery. Maximal coronary dilation was induced by Carbochrome, a potent coronary vasodilator, infused at a rate of 0.45 mg/kg/min up to a total dose of 12 mg/kg. Sham-operated rats served as controls. All animals in the infarct group had a large MI affecting 30-51% (average, 41%) of the left ventricle. Left ventricular end-diastolic pressure was significantly elevated (30 +/- 6.5 vs. 8.0 +/- 2.5 mm Hg in sham-operated rats, p less than 0.01) and baseline hemodynamic indexes of cardiac performance were significantly (p less than 0.01) reduced in this group. Myocyte cross-sectional area measurements were used as an index to quantify the degree of reactive hypertrophy and indicated that the infarcted animals had, on average, a 30% hypertrophic response of the surviving left ventricular myocardium. In the infarcted animals, both coronary flow and vasodilator reserve in the surviving myocardium were depressed. Maximal coronary blood flow in the remaining myocardium was significantly lower than that measured in the sham-operated animals (839 and 1,479 ml/min/100 g, respectively; p less than 0.001). Similarly, minimal coronary resistance was significantly higher in the MI group as compared with the sham group (0.12 vs. 0.07 mm Hg/ml/min/100 g, respectively; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2137045

Karam, R; Healy, B P; Wicker, P

1990-01-01

315

Nitric Oxide-Mediated Coronary Flow Regulation in Patients with Coronary Artery Disease: Recent Advances  

PubMed Central

Nitric oxide (NO) formed via endothelial NO synthase (eNOS) plays crucial roles in the regulation of coronary blood flow through vasodilatation and decreased vascular resistance, and in inhibition of platelet aggregation and adhesion, leading to the prevention of coronary circulatory failure, thrombosis, and atherosclerosis. Endothelial function is impaired by several pathogenic factors including smoking, chronic alcohol intake, hypercholesterolemia, obesity, hyperglycemia, and hypertension. The mechanisms underlying endothelial dysfunction include reduced NO synthase (NOS) expression and activity, decreased NO bioavailability, and increased production of oxygen radicals and endogenous NOS inhibitors. Atrial fibrillation appears to be a risk factor for endothelial dysfunction. Endothelial dysfunction is an important predictor of coronary artery disease (CAD) in humans. Penile erectile dysfunction, associated with impaired bioavailability of NO produced by eNOS and neuronal NOS, is also considered to be highly predictive of ischemic heart disease. There is evidence suggesting an important role of nitrergic innervation in coronary blood flow regulation. Prophylactic and therapeutic measures to eliminate pathogenic factors inducing endothelial and nitrergic nerve dysfunction would be quite important in preventing the genesis and development of CAD. PMID:22942627

Toda, Noboru; Tanabe, Shinichi; Nakanishi, Sadanobu

2011-01-01

316

Pathophysiology and natural history 41 Distinct mouse coronary anatomy and myocardial infarction  

E-print Network

Pathophysiology and natural history 41 Distinct mouse coronary anatomy and myocardial infarction mice and the functional impact of that anatomy on myocardial infarctions induced by ligation atrium resulted in reproducible large myocardial infarctions involving the anterolateral, posterior

Kamp, Tim

317

XIENCE PRIME Everolimus Eluting Coronary Stent System (EECSS) China Single-Arm Study  

ClinicalTrials.gov

Angioplasty; Cardiovascular Disease; Chronic Coronary Occlusion; Coronary Artery Bypass Graft (CABG); Coronary Artery Disease; Coronary Heart Disease; Coronary Restenosis; Myocardial Infarction; Myocardial Ischemia; Stent Thrombosis; Vascular Disease

2015-01-12

318

Depression and Coronary Heart Disease  

PubMed Central

There are exciting findings in the field of depression and coronary heart disease. Whether diagnosed or simply self-reported, depression continues to mark very high risk for a recurrent acute coronary syndrome or for death in patients with coronary heart disease. Many intriguing mechanisms have been posited to be implicated in the association between depression and heart disease, and randomized controlled trials of depression treatment are beginning to delineate the types of depression management strategies that may benefit the many coronary heart disease patients with depression. PMID:23227360

Davidson, Karina W.

2012-01-01

319

Sudden coronary death.  

PubMed

Many reports have described the amounts of atherosclerotic plaque in victims of sudden coronary death, defining the number of coronary arteries narrowed at some point greater than 75% in cross-sectional area (XSA). In order to quantitate more precisely the amount and distribution of plaque, 70 victims of sudden coronary death aged 22-81 years (mean 50) were studied. The four major epicardial coronary arteries (left main, left anterior descending, left circumflex, and right) from each of 70 victims were cut into 5-mm segments (average 50 per patient) and a histologic section prepared from each segment. The amount of luminal narrowing by plaque was categorized into five groups (0-25%, 26-50%, 51-75%, 76-95%, 96-100%). Of 3,484 five-mm segments, 950 (27%) were narrowed 76-100% in XSA. Comparison of 31 previously symptomatic victims (angina pectoris and/or myocardial infarction) to 39 victims who had been asymptomatic disclosed a higher mean percent of severely narrowed segments (30% vs. 25%, p = less than 0.005) and a lower mean percent of minimally narrowed segments in the symptomatic group. Comparison of the 31 patients with a healed myocardial infarction at necropsy with 39 patients with no left ventricular scar disclosed a higher mean percent of segments severely narrowed (33% vs. 24%, p = less than 0.001) and a lower mean percent of segments narrowed minimally in those with a left ventricular scar (13% vs. 26%, p = less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2612077

Warnes, C A

1989-12-01

320

Coronary Artery Development  

Microsoft Academic Search

Lineage mapping studies have shown an extracardiac origin for the coronary vasculature. Mesothelial cells arising from septum\\u000a transversum mesenchyme contact the developing myocardium via a transient structure called the proepicardial organ (PEO). Proepicardial\\u000a cells first extend over the surface of the heart to form the epicardial layer. Then, a subset of epicardial cells transform\\u000a from epithelial to mesenchymal cells, migrate

Mark W. Majesky

321

Abnormalities of capillary microarchitecture in a rat model of coronary ischemic congestive heart failure.  

PubMed

The aim of the present study is to explore the role of capillary disorder in coronary ischemic congestive heart failure (CHF). CHF was induced in rats by aortic banding plus ischemia-reperfusion followed by aortic debanding. Coronary arteries were perfused with plastic polymer containing fluorescent dye. Multiple fluorescent images of casted heart sections and scanning electric microscope of coronary vessels were obtained to characterize changes in the heart. Cardiac function was assessed by echocardiography and in vivo hemodynamics. Stenosis was found in all levels of the coronary arteries in CHF. Coronary vasculature volume and capillary density in remote myocardium were significantly increased in CHF compared with control. This occurred largely in microvessels with a diameter of ?3 ?m. Capillaries in CHF had a tortuous structure, while normal capillaries were linear. Capillaries in CHF had inconsistent diameters, with assortments of narrowed and bulged segments. Their surfaces appeared rough, potentially indicating endothelial dysfunction in CHF. Segments of main capillaries between bifurcations were significantly shorter in length in CHF than in control. Transiently increasing preload by injecting 50 ?l of 30% NaCl demonstrated that the CHF heart had lower functional reserve; this may be associated with congestion in coronary microcirculation. Ischemic coronary vascular disorder is not limited to the main coronary arteries, as it occurs in arterioles and capillaries. Capillary disorder in CHF included stenosis, deformed structure, proliferation, and roughened surfaces. This disorder in the coronary artery architecture may contribute to the reduction in myocyte contractility in the setting of heart failure. PMID:25659485

Chen, Jiqiu; Yaniz-Galende, Elisa; Kagan, Heather J; Liang, Lifan; Hekmaty, Saboor; Giannarelli, Chiara; Hajjar, Roger

2015-04-15

322

[Pre-surgical simulation of microvascular decompression for hemifacial spasm using 3D-models].  

PubMed

We have been performing pre-surgical simulations using custom-built patient-specific 3D-models. Here we report the advantageous use of 3D-models for simulating microvascular decompression(MVD)for hemifacial spasms. Seven cases of MVD surgery were performed. Two types of 3D-printers were used to fabricate the 3D-models:one using plaster as the modeling material(Z Printer®450, 3D systems, Rock Hill, SC, USA)and the other using acrylonitrile butadiene styrene(ABS)(UP! Plus 3D printer®, Beijing Tiertime Technology, Beijing). We tested three types of models. Type 1 was a plaster model of the brainstem, cerebellum, facial nerve, and the artery compressing the root exit zone of the facial nerve. Part of the cerebellum was digitally trimmed off to observe "the compressing point" from the same angle as that used during actual surgery. Type 2 was a modified Type 1 in which part of the skull was opened digitally to mimic a craniectomy. Type 3 was a combined model in which the cerebellum and the artery of the Type 2 model were replaced by a soft retractable cerebellum and an elastic artery. The cerebellum was made from polyurethane and cast from a plaster prototype. To fabricate elastic arteries, liquid silicone was painted onto the surface of an ABS artery and the inner ABS model was dissolved away using solvent. In all cases, the 3D-models were very useful. Although each type has advantages, the Type-3 model was judged extremely useful for training junior surgeons in microsurgical approaches. PMID:25557098

Mashiko, Toshihiro; Yang, Qiang; Kaneko, Naoki; Konno, Takehiko; Yamaguchi, Takashi; Watanabe, Eiju

2015-01-01

323

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. PMID:23408927

Yong, Ming-Hui; Allen, John C.; Prakash, Kumar M.; Tan, Eng-King

2013-01-01

324

Perioperative prostate specific antigen levels among coronary artery bypass grafting patients: Does extracorporeal circulation and body temperature induce prostate specific antigen levels alterations?  

PubMed Central

Purpose: The purpose of this study is to compare the perioperative total prostate specific antigen (tPSA) levels among coronary artery bypass grafting (CABG) patients with and without extracorporeal circulation (ECC), to investigate the changes overtime of tPSA in each group separately and to determine the effect of body core temperature on tPSA levels. Materials and Methods: A prospective study was conducted. Our sample was allocated to: (a) Seven patients who underwent off pump CABG (Group I) and (b) 16 CABG patients with ECC (Group II). The levels of tPSA were measured preoperatively (baseline), intra-operatively and at the 4th postoperative day. We compared the two groups on their tPSA levels and we investigated the changes of tPSA overtime in each group separately. Results: Intra-operative serum samples were obtained in significantly lower body temperature in patients of Group II than in those of Group I (31°C vs. 36.9°C, P < 0.001). In each group separately, postoperative tPSA levels were increased significantly compared to the baseline values (2.55 ng/ml vs. 0.39 ng/ml for Group I, P = 0.005 and 4.36 ng/ml vs. 0.77 for Group II, P < 0.001). CABG patients with ECC had significantly lower intra-operative tPSA levels than the baseline values (0.67 ng/ml vs. 0.77 ng/ml, P = 0.008). We did not observe significant differences of tPSA levels between the two groups. Conclusions: CABG surgery affects similarly the perioperative tPSA independently the involvement of ECC. Although all patients had significantly higher early postoperative tPSA levels, only those who underwent CABG with ECC had exceeded normal values and significantly decreased intra-operative tPSA. Hypothermia seems to be the causal factor of tPSA reduction. PMID:25657546

Patris, Emmanuel; Giakoumidakis, Konstantinos; Patris, Vasileios; Kuduvalli, Manoj; Argiriou, Mihalis; Charitos, Christos; Kalaitzis, Christos; Touloupidis, Stavros

2015-01-01

325

Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography  

Microsoft Academic Search

Objectives. This investigation sought to determine the relative prognostic value of coronary calcific deposits and coronary angiographic findings for predicting coronary heart disease-related events in patients referred for angiography.Background. The relation among coronary calcification, coronary stenoses and coronary heart disease-related events is of interest on a clinical as well as a pathophysiologic basis.Methods. Four hundred ninety-one symptomatic patients underwent coronary

Robert Detrano; Tzung Hsiai; Shaojung Wang; Gail Puentes; James Fallavollita; Paul Shields; William Stanford; Chris Wolfkiel; Demetrious Georgiou; Matthew Budoff; Judd Reed

1996-01-01

326

Does Coronary Stenting Following Balloon Angioplasty Improve Myocardial Fractional Flow Reserve?  

SciTech Connect

Purpose: Suboptimal distal coronary flow reserve after successful balloon angioplasty has been attributed to angiographically unrecognized inadequate lumen expansion, and adjunct coronary stenting has been shown to improve coronary flow reserve. The aim of this study was to investigate whether myocardial fractional flow reserve (FFRmyo) would increase further after coronary stenting compared with balloon angioplasty alone in the same patient group. Methods: FFRmyo and quantitative coronary angiography were obtained before and after pre-stent balloon dilation, and again after stent placement in 11 patients (7 left anterior descending artery, 3 right coronary artery and 1 left circumflex artery). FFRmyo was calculated as the ratio of Pd/Pa during intracoronary adenosine 5'-triphosphate (50 {mu}g and 20 {mu}g in the left and right coronary arteries, respectively)-induced maximum hyperemia, where Pd represents mean distal coronary pressure measured by a 2.1 Fr infusion catheter and Pa represents mean aortic pressure measured by the guiding catheter. Results: Percent diameter stenosis significantly decreased after balloon angioplasty (74% {+-} 15% vs 37% {+-} 17%, p < 0.001), and decreased further after stent placement (18% {+-} 10%, p < 0.001 vs baseline and balloon angioplasty). FFRmyo after coronary stenting (0.85 {+-} 0.09) was significantly higher than that at baseline (0.51 {+-} 0.16, p < 0.001) and after balloon angioplasty (0.77 {+-} 0.11, p < 0.05). There was a significant correlation between angiographic variables and FFRmyo. The increase in lumen dimensions after coronary stenting was followed by a further significant improvement of FFRmyo. Conclusion: These results suggest that coronary stenting may provide a more favorable functional status and lumen geometry of residual coronary stenosis compared with balloon angioplasty alone.

Takeuchi, Masaaki; Himeno, Etsuro [Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu (Japan)

1998-11-15

327

Surgical Treatment of Coronary Artery Aneurysm with Coronary Artery Fistula  

Microsoft Academic Search

Coronary artery aneurysm (CAA) is an uncommon disease with an incidence of 1%-5% in evaluated patients. Atherosclerosis is its most common etiology in adults, occurring in 50% of cases. Also, CAA is associated with predisposing factors such as Kawasaki disease, stent- angioplasty, and notably, coronary artery fistula. Most CAAs are asymptomatic but occasionally lead to life-threatening conditions, such as rupture,

Hironori Inoue; Masahiro Ueno; Hiroyuki Yamamoto; Kazuhisa Matsumoto; Koji Tao; Ryuzo Sakata

328

Outcome of extensive coronary artery dissection during coronary angioplasty  

Microsoft Academic Search

A total of 32 (3.6%) patients of 880 undergoing coronary angioplasty during a nine year period at one hospital had extensive dissection (defined as a dissection extending beyond the limits of the dilated angioplasty balloon) in the coronary artery in which the angioplasty procedure was performed. Two (6.25%) of the 32 patients (both of whom were undergoing angioplasty because of

T R Cripps; J M Morgan; A F Rickards

1991-01-01

329

Percutaneous coronary angioscopy during coronary angioplasty: clinical findings and implications  

NASA Astrophysics Data System (ADS)

Percutaneous coronary angioscopy was successfully performed with a steerable, balloon-tipped microangioscope in 36 of 43 patients undergoing percutaneous transluminal coronary angioplasty. The design of the device, technique of performing angioscopy, reasons for failure to image successfully, angioscopy findings, and clinical implications will be discussed.

Ramee, Stephen R.; White, Christopher J.; Mesa, Juan E.; Jain, Ashit; Collins, Tyrone J.

1991-07-01

330

Microvascular decompression under neuroendoscopic view in hemifacial spasm: rostral-type compression and perforator-type compression.  

PubMed

We report microvascular decompression (MVD) under neuroendoscopic view in hemifacial spasm (HFS) patients with rostral- and perforator-type compression of the root exit zone (REZ) of the facial nerve. Using either a wireless iPad Mini as a monitor on the microscope or a high-resolution monitor, microscopic and endoscopic views enabled MVD for complete cure of HFS with rostral-type compression (the offender compressing the REZ on the opposite rostral side to the operative approach) or perforator-type compression (the offender tethered to the REZ by the perforator). MVD under neuroendoscopic view may offer more accurate MVD and complete resolution of HFS. PMID:25502988

Ishikawa, Mami; Tanaka, Yuichi; Watanabe, Eiju

2015-02-01

331

Simulation of stent deployment in a realistic human coronary artery  

Microsoft Academic Search

BACKGROUND: The process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The knowledge of these parameters after stent deployment in a patient derived 3D reconstruction of a diseased coronary artery might

Frank JH Gijsen; Francesco Migliavacca; Silvia Schievano; Laura Socci; Lorenza Petrini; Attila Thury; Jolanda J Wentzel; Anton FW van der Steen; Patrick WS Serruys; Gabriele Dubini

2008-01-01

332

Coronary artery compression three months after transcatheter pulmonary valve implantation.  

PubMed

We report a case of a 29-year-old man who developed exercised-induced myocardial infarction 3 months post Melody valve implantation. We introduce the concept of ruling out dynamic coronary artery compression by simulating transcatheter pulmonary valve implant while increasing cardiac output and thus aortic dimensions in the catheterization laboratory. © 2014 Wiley Periodicals, Inc. PMID:25115934

Dehghani, Payam; Kraushaar, Greg; Taylor, Dylan A

2015-03-01

333

Coronary Arteriovenous Fistulae: A Review  

PubMed Central

Coronary arteriovenous fistulae are a coronary anomaly, presenting in 0.002% of the general population. Their etiology can be congenital or acquired. We present a review of recent literature related to their epidemiology, etiology, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management. PMID:24940026

Challoumas, Dimitris; Pericleous, Agamemnon; Dimitrakaki, Inetzi A.; Danelatos, Christos; Dimitrakakis, Georgios

2014-01-01

334

Problems of Coronary Flow Reserve  

Microsoft Academic Search

Coronary flow reserve is used to aid understanding why myocardial oxygen consumption may fail to meet demand. Its general aspects are well known, but the problems of using it are not. This manuscript describes three important factors that need to be considered when assessing coronary flow reserve. (1) Maximal flow is usually achieved by giving either increasing doses or else

Julien I. E. Hoffman

2000-01-01

335

The Coronary Patient in Industry  

NASA Technical Reports Server (NTRS)

The coronary patient, as he pertains to industry particularly NASA, is discussed. Concepts of precoronary care, acute attacks which may develop while on the job, and the return of the cardiac patient to work are covered. Major emphasis was on the prevention of sudden death due to coronary disease.

Schuster, B.

1971-01-01

336

Coronary endothelial damage during off-pump CABG related to coronary-clamping and gas insufflation  

Microsoft Academic Search

Objective: Although off-pump coronary artery bypass grafting (CABG) has been recognized less invasive than conventional CABG on cardiopulmonary bypass, off-pump CABG may be partly invasive especially to the coronary endothelium. The present study was designed to evaluate the adverse effects of coronary snaring with looped sutures and gas insufflation on the coronary endothelium. The protective efficacies on the coronary endothelium

Yukio Okazaki; Kyomi Takarabe; Jun-ichi Murayama; Etsuro Suenaga; Kojiro Furukawa; Kazuhisa Rikitake; Masafumi Natsuaki; Tsuyoshi Itoh

2001-01-01

337

High frequency rotational ablation: an alternative in treating coronary artery stenoses and occlusions.  

PubMed Central

OBJECTIVE--To prove the safety and effectiveness of high frequency rotational ablation of coronary artery stenoses and occlusion in humans. SUBJECTS--106 patients with symptoms (91 men, 15 women) who had 67 significant stenoses, mainly types B and C, and 46-chronic occlusions. MAIN OUTCOME MEASURES--Mean change in diameter stenosis after rotational angioplasty alone and in combination with percutaneous transluminal coronary angioplasty immediately after treatment and 24 hours and six months later; restenosis rates at six months; complication of treatment. RESULTS--Rotational ablation could not be used in five stenoses and 16 chronic occlusions because of inability to reach or cross the lesion with the Rotablator guide wire. In four cases rotational ablation failed. Initial angiographic and clinical success by rotational ablation was achieved in 40 of the 67 stenoses (60%) and in 18 of the 46 chronic occlusions (39%). Additional balloon angioplasty was performed in 45 patients, increasing the success rates to 79% and 54%, respectively. In the 62 stenoses treated by rotational ablation the angiographic diameter stenoses were reduced from 76% (SD 14%) to 32% (14%) after Rotablator treatment alone and from 75% (11%) to 33% (17%) with additional balloon angioplasty. In the 30 chronic occlusions treated by rotational ablation the angiographic diameter stenoses were reduced to 38% (18%). At six months angiographic restenosis was evident in nine of the 25 (36%) stenoses treated with rotational ablation alone, in seven of the 22 (32%) stenoses treated with rotational and balloon angioplasty, and in 14 of the 24 (58%) chronic occlusions. There were no procedural deaths and two patients (2%) underwent emergency coronary artery bypass grafting. Although no transmural infarction occurred, there were five (6%) non-Q wave infarctions (two embolic side branch occlusions, two subacute occlusions, and one acute occlusion). Clinically insignificant slight increases in creatine kinase activity were seen in five patients (6%). Severe coronary artery spasm unresponsive to medical treatment was provoked in seven cases (8%). CONCLUSIONS--High frequency rotational ablation is a safe and effective method for treating type B and C coronary artery lesions with results comparable to percutaneous transluminal coronary balloon angioplasty. The combined use of rotational ablation and balloon angioplasty is feasible and is necessary in about half of all procedures, in most cases because the lumen created by the biggest burr is too small. Images PMID:8217440

Dietz, U; Erbel, R; Rupprecht, H J; Weidmann, S; Meyer, J

1993-01-01

338

Lipid-Induced Epigenomic Changes in Human Macrophages Identify a Coronary Artery Disease-Associated Variant that Regulates PPAP2B Expression through Altered C/EBP-Beta Binding  

PubMed Central

Genome-wide association studies (GWAS) have identified over 40 loci that affect risk of coronary artery disease (CAD) and the causal mechanisms at the majority of loci are unknown. Recent studies have suggested that many causal GWAS variants influence disease through altered transcriptional regulation in disease-relevant cell types. We explored changes in transcriptional regulation during a key pathophysiological event in CAD, the environmental lipid-induced transformation of macrophages to lipid-laden foam cells. We used a combination of open chromatin mapping with formaldehyde-assisted isolation of regulatory elements (FAIRE-seq) and enhancer and transcription factor mapping using chromatin immuno-precipitation (ChIP-seq) in primary human macrophages before and after exposure to atherogenic oxidized low-density lipoprotein (oxLDL), with resultant foam cell formation. OxLDL-induced foam cell formation was associated with changes in a subset of open chromatin and active enhancer sites that strongly correlated with expression changes of nearby genes. OxLDL-regulated enhancers were enriched for several transcription factors including C/EBP-beta, which has no previously documented role in foam cell formation. OxLDL exposure up-regulated C/EBP-beta expression and increased genomic binding events, most prominently around genes involved in inflammatory response pathways. Variants at CAD-associated loci were significantly and specifically enriched in the subset of chromatin sites altered by oxLDL exposure, including rs72664324 in an oxLDL-induced enhancer at the PPAP2B locus. OxLDL increased C/EBP beta binding to this site and C/EBP beta binding and enhancer activity were stronger with the protective A allele of rs72664324. In addition, expression of the PPAP2B protein product LPP3 was present in foam cells in human atherosclerotic plaques and oxLDL exposure up-regulated LPP3 in macrophages resulting in increased degradation of pro-inflammatory mediators. Our results demonstrate a genetic mechanism contributing to CAD risk at the PPAP2B locus and highlight the value of studying epigenetic changes in disease processes involving pathogenic environmental stimuli. PMID:25835000

Lin, Da; Soilleux, Elizabeth J.; Morris, Andrew J.; Smyth, Susan S.; O'Callaghan, Christopher A.

2015-01-01

339

[Coronary angioplasty in diabetic patients].  

PubMed

Increased thrombogenicity, endothelial dysfunction, proliferation of both the cells and the matrix in the vessel walls, dislipidemia and insulin-resistance are the main metabolic alterations in the diabetic scenario, with possible implications in terms of vessel restenosis after coronary angioplasty. The outcome of balloon coronary angioplasty in diabetics is poor. This is due to both increased restenosis and a high incidence of medium/long-term cardiac events; the use of stents in these patients has substantially improved the results, but the recurrence rate has not been abated to the level observed in the general population. Abciximab may be a helpful adjunct to coronary angioplasty in these patients, while coronary artery bypass grafting may still be preferable--as at present--in case of multivessel coronary artery disease. This viewpoint is likely to be substantially modified in the near future, if the promise of "zero restenosis" devices is kept. PMID:11899579

Steffenino, Giuseppe; La Scala, Eugenio; Riva, Lucilla; Menardi, Endrj

2002-01-01

340

Myocardial synthesis of prostaglandin-like substances and coronary reactions to cardiostimulation and to hypoxia.  

PubMed Central

1 Continuous recording of cardiac contractions and coronary flow from isolated perfused hearts of rats permitted the study of coronary reactions to: (a) cardiostimulation induced by single doses or slow infusions of noradrenaline, CaCl2, glucagon or electrically induced tachycardia; (b) short interruptions of coronary inflow (hypoxia). 2 Except during tachycardia the heart rate was kept constant at 210 beats/min by electrical pacing. 3 Metabolic coronary vasodilatation (MCD) resulting from cardiac hyperactivity induced by noradrenaline, Ca2+, tachycardia or glucagon was inhibited by administration of prostaglandin E2. Reactive hyperaemia response to hypoxia was unaffected by prostaglandin administration. 4 Inhibition of MCD could also be obtained by prolonged infusion with arachidonic acid (1.6 X 10(-7) M), presumably by its conversion into prostaglandin-like substance since arachidonic acid failed to block MCD in hearts from rats pretreated with non-steroidal anti-inflammatory drugs (indomethacin, naproxen, phenylbutazone). 5 Reactive hyperaemia was unaffected either by arachidonic acid or by blockade of the synthesis of prostaglandin-like substances by anti-inflammatory drugs. 6 Since prostaglandin synthetase inhibition does not prevent but may enhance MCD, we do not advocate prostaglandin-like substances as agents directly responsible for the coronary vasodilatation that follows cardiac hyperactivity. 7 We postulate that cardiac overproduction of prostaglandins may lead to a failure in the adaptive coronary flow response to cardiac hyperactivity (coronary insufficiency?). PMID:760893

Sunahara, F A; Talesnik, J

1979-01-01

341

Coronary Heart Disease, Hypertension, Stroke, and  

E-print Network

of P Ganz.. #12;Some Terminology · Heart failure ­ the pumping action of the heart is less efficientCoronary Heart Disease, Hypertension, Stroke, and Diabetes #12;Coronary Heart Disease: Overview by atherosclerosis ­ Narrowing of coronary arteries, the vessels that supply the heart · Disease process: coronary

Meagher, Mary

342

Upregulation of Nav1.8 in demyelinated facial nerves might be relevant to the generation of hemifacial spasm.  

PubMed

Our previous studies demonstrated that the abnormal muscle response could vanish when the ipsilateral superior cervical ganglion was removed and reappear when norepinephrine was dripped at the neurovascular conflict site. Evidentially, we believed that the mechanism of hemifacial spasm should involve emersion of ectopical action potential in the compressed facial nerve fibers. As the action potential is ignited by ion channel opening, we focused on Nav1.8 that has been found overexpressed in peripheral nerve while damaged. In this study, Moller model was adopted, 20 Sprague-Dawley rats underwent drip of norepinephrine, and the abnormal muscle response wave was monitored in 14 rats. Antibodies against unique epitopes of the ? subunit of sodium channel isoforms were used to detect the Nav1.8 neuronal isoforms, and the immunohistochemistry showed strong staining in 13 rats, which were all in the abnormal muscle response positive group (P < 0.05). Accordingly, we concluded that the substance of hemifacial spasm is an ectopic action potential that emerged on the damaged facial nerve, which might be coupled by Nav1.8. PMID:24892416

Xia, Lei; Dou, Ning-Ning; Zhong, Jun; Zhu, Jin; Wang, Yong-Nan; Liu, Ming-Xing; Visocchi, Massimiliano; Li, Shi-Ting

2014-07-01

343

Myocardial ischaemia in a case of a solitary coronary ostium in the right aortic sinus with retroaortic course of the left coronary artery: documentation of the underlying pathophysiological mechanisms of ischaemia by intracoronary Doppler and pressure measurements  

PubMed Central

Only a few cases of a single coronary ostium and retroaortic course of the coronary artery have been described. Almost all cases reported so far had additional coronary artery or valvar disease. However, myocardial ischaemia may be caused by the coronary malformation alone. A 40 year old woman with severe myocardial ischaemia in the absence of clinically relevant coronary atherosclerosis is described. To clarify the origin and mechanisms of ischaemia, intracoronary Doppler, pressure and ultrasound studies were performed using microtransducers. In its outer portion along the course behind the ascending aorta, coronary blood flow velocities were increased, there was an external elliptical compression, and distal coronary flow reserve was reduced. Furthermore, an overshoot in diastolic pressure above aortic pressure was detectable within this portion. Dobutamine stimulation exaggerated the observed intracoronary haemodynamics and induced myocardial ischaemia. The intracoronary diagnostic procedures performed were helpful in clarifying the pathophysiological mechanisms of functional coronary obstruction and ischaemia in this malformation. Bypass surgery was successfully performed with symptomatic improvement.?? Keywords: coronary anomaly;  Doppler;  intravascular ultrasound;  single coronary ostium;  congenital disorders PMID:9875097

Schwarz, E; Hager, P; Uebis, R; Hanrath, P; Klues, H

1998-01-01

344

Hyperinsulinemia during oral glucose tolerance test is associated with increased neointimal tissue proliferation after coronary stent implantation in nondiabetic patients  

Microsoft Academic Search

OBJECTIVESThe purpose of this study was to determine whether hyperinsulinemia during the oral glucose tolerance test is associated with increased neointimal tissue proliferation after coronary stent implantation in nondiabetic patients.BACKGROUNDAlthough hyperinsulinemia induces increased vascular smooth muscle cell proliferation in experimental models, it has not been determined whether hyperinsulinemia is associated with increased neointimal tissue proliferation after coronary stent implantation.METHODSSerial (postintervention

Tsutomu Takagi; Kiyoshi Yoshida; Takashi Akasaka; Shuichiro Kaji; Takahiro Kawamoto; Yasuhiro Honda; Atsushi Yamamuro; Takeshi Hozumi; Shigefumi Morioka

2000-01-01

345

Localization of coronary artery disease with exercise electrocardiography: correlation with thallium-201 myocardial perfusion scanning  

SciTech Connect

In 61 patients with single vessel coronary artery disease (70 percent or greater obstruction of luminal diameter in only one vessel) and no previous myocardial infarction, the sites of ischemic changes on 12 lead exercise electrocardiography and on thallium-201 myocardial perfusion scanning were related to the obstructed coronary artery. The site of exercise-induced S-T segment depression did not identify which coronary artery was obstructed. In the 37 patients with left anterior descending coronary artery disease S-T depression was most often seen in the inferior leads and leads V4 to V6, and in the 18 patients with right coronary artery disease and in the 6 patients with left circumflex artery disease S-T depression was most often seen in leads V5 and V6. Although S-T segment elevation was uncommon in most leads, it occurred in lead V1 or a VL, or both, in 51 percent of the patients with left anterior descending coronary artery disease. A reversible anterior defect on exercise thallium scanning correlated with left anterior descending coronary artery disease (probability (p) less than 0.0001) and a reversible inferior thallium defect correlated with right coronary or left circumflex artery disease (p less than 0.0001). In patients with single vessel disease, the site of S-T segment depression does not identify the obstructed coronary artery; S-T segment elevation in lead V1 or aVL, or both, identifies left anterior descending coronary artery disease; and the site of reversible perfusion defect on thallium scanning identifies the site of myocardial ischemia and the obstructed coronary artery.

Dunn, R.F.; Freedman, B.; Bailey, I.K.; Uren, R.F.; Kelly, D.T.

1981-11-01

346

Coronary Collateral Circulation in Patients of Coronary Ectasia with Significant Coronary Artery Disease  

PubMed Central

Objectives Patients with coronary ectasia (CE) usually have coexisting coronary stenosis resulting in myoischemia. Coronary collateral plays an important role in protecting myocardium from ischemia and reducing cardiovascular events. However, limited studies investigate the role of CE in coronary collaterals development. Methods We evaluated 1020 consecutive patients undergoing coronary angiography and 552 patients with significant coronary artery disease (SCAD), defined as diameter stenosis more than 70%, were finally analyzed. CE is defined as the ectatic diameter 1.5 times larger than adjacent reference segment. Rentrop collateral score was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group. Results 73 patients (13.2%) had CE lesions which were most located in the right coronary artery (53.4%). Patients with CE had a lower incidence of diabetes (43.8% vs 30.1%, p?=?0.03), higher body mass index (25.4±3.5 vs 26.7±4.6, p?=?0.027) and poorer coronary collateral (58.2% vs 71.2%, p?=?0.040). Patients with poor collateral (n?=?331) had a higher incidence of CE (15.7% vs 9.5%, p?=?0.040) and fewer diseased vessels numbers (1.96±0.84 vs 2.48±0.69, p<0.001). Multivariate analysis showed diabetes (odd ratio (OR) 0.630, p?=?0.026), CE (OR?=?0.544, p?=?0.048), and number of diseased vessels (OR?=?2.488, p<0.001) were significant predictors of coronary collaterals development. Conclusion The presence of CE was associated with poorer coronary collateral development in patients with SCAD. PMID:24475209

Hsu, Po-Chao; Su, Ho-Ming; Lee, Hsiang-Chun; Juo, Suh-Hang; Lin, Tsung-Hsien; Voon, Wen-Chol; Lai, Wen-Ter; Sheu, Sheng-Hsiung

2014-01-01

347

Effect of programmed ventricular stimulation on myocardial lactate extraction in patients with and without coronary artery disease  

SciTech Connect

The arterial-coronary sinus lactate difference was measured in 17 patients after each step of a programmed ventricular stimulation protocol consisting of single, double, and triple extrastimuli, first at a basic drive cycle length of 600 msec, then at 400 msec, with an inter-train interval of 4 seconds. Four patients had no structural heart disease, four had an idiopathic dilated cardiomyopathy, and nine had coronary artery disease with a significant stenosis in at least one branch of the left coronary artery. Net myocardial lactate production during programmed ventricular stimulation was observed in three patients with coronary artery disease, but not in any patient without coronary artery disease. Among the patients who had coronary artery disease, net myocardial lactate production generally occurred in the patients who had more severe coronary artery disease. Exercise-induced ischemia, as demonstrated by a stress thallium-201 test, did not correlate with myocardial lactate production during programmed ventricular stimulation. Programmed ventricular stimulation, with a stimulation protocol typically used in many electrophysiology laboratories, is capable of inducing myocardial ischemia in at least some patients who have coronary artery disease. This finding suggests that myocardial ischemia may potentially influence the results of programmed ventricular stimulation in some patients with coronary artery disease.

Morady, F.; DiCarlo, L.A. Jr.; Krol, R.B.; de Buitleir, M.; Nicklas, J.M.; Annesley, T.M.

1986-02-01

348

Is It Always Necessary to Apply Botulinum Toxin into the Lower Facial Muscles in Hemifacial Spasm? A Randomized, Single-Blind, Crossover Trial  

Microsoft Academic Search

Background: Botulinum toxin (BTX) injections are accepted as safe and efficacious in the treatment of hemifacial spasm (HFS), but it is still debated whether BTX treatment of lower facial muscles should be performed or not. Objective: The study aims to evaluate the necessity of BTX administration into lower facial muscles in patients with HFS. Methods: A randomized, single-blind, crossover, clinical

Beril Donmez Colakoglu; Raif Cakmur; Fatma Uzunel

2011-01-01

349

Coronary angiogram classification of spontaneous coronary artery dissection.  

PubMed

Spontaneous coronary artery dissection (SCAD) is under-diagnosed and the true prevalence is underestimated. Unfortunately, SCAD is frequently missed on coronary angiogram since the arterial wall is not imaged with this test. Optical coherence tomography or intravascular ultrasound should be the true gold-standard to diagnose SCAD. Given the elusive angiographic diagnosis of SCAD and the lack of familiarity with angiographic variants of SCAD, a diagnostic algorithm and angiographic classification for SCAD is proposed in this article. PMID:24227590

Saw, Jacqueline

2014-12-01

350

Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome: a study in a 33-patient series.  

PubMed

Lateral spread responses (LSR), an electrophysiological characteristic of hemifacial spasm (HFS), can be recorded during surgery. This work aims at evaluating the prognostic value of the persistence or suppression of the LSR at the end of the microvascular decompression (MVD) procedure of the facial nerve. Thirty-three patients with HFS, which had been evolving for 5.5 years, underwent MVD with intraoperative EMG. Monitoring required the placement of a needle in the frontalis and mentalis muscles. Responses were recorded after stimulation of inferior or superior branches of the facial nerve to search for abnormal ephaptic LSR. Preoperative abnormal LSRs were present in all patients. In 23 patients, LSR disappeared with vascular decompression and was not present upon closure. Among those patients, 20 were considered clinically cured and three still presented with mild/moderate spasm at 3-month follow-up. At late follow-up, 22 patients were free of spasm. One patient had recurrence of spasm at month 10. On the contrary, 10 patients had persistent abnormal LSR upon closure. Among those, seven were cured at early follow-up (3 months on average), whereas spasm disappeared at late follow-up (12 to 36 months) in the other three patients. The prognostic value of LSR monitoring is questionable; a good clinical result may be obtained in patients who presented with persistent LSR at the end of MVD. Delayed cure strongly supports the hypothesis that HFS is not only due to the mechanical pulsations of the elongated artery against the root exit zone of the facial nerve, but also to demyelination of the nerve and/or hyperactivity of the facial motornucleus generated by the neurovascular compression. PMID:11814001

Hatem, J; Sindou, M; Vial, C

2001-12-01

351

What Are the Signs and Symptoms of Coronary Heart Disease?  

MedlinePLUS

... What Are the Signs and Symptoms of Coronary Heart Disease? A common symptom of coronary heart disease ( ... narrow the coronary arteries. Signs and Symptoms of Heart Problems Related to Coronary Heart Disease Some people ...

352

Physiologic assessment of coronary artery fistula  

SciTech Connect

Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

1991-01-01

353

Pathogenesis of acute coronary syndromes.  

PubMed

Experimental models of atherogenesis have provided a growing body of information about molecular mechanisms of plaque growth; however, transition from coronary stability to instability is less well understood due to the lack of animal models reflective of human disease. The abrupt clinical presentation of acute coronary syndromes gives a strong signal of discontinuity in the natural history of atherothrombosis. The causes of such discontinuity are complex, probably multiple, and still largely unknown. A better knowledge of the causes of coronary instability might allow identification of new therapeutic targets aimed at the preservation of plaque stability in those subjects in whom primary prevention fails to prevent plaque growth. The goal of this review was to propose a pathogenetic classification of acute coronary syndromes that might help in the search of new diagnostic algorithms and therapeutic targets. PMID:23158526

Crea, Filippo; Liuzzo, Giovanna

2013-01-01

354

Percutaneous transluminal coronary angioplasty (PTCA)  

MedlinePLUS Videos and Cool Tools

... minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart ... area and putting a needle into the femoral artery, the blood vessel that runs down the leg. ...

355

The Impact of Subclinical Hypothyroidism or Thyroid Autoimmunity on Coronary Vasospasm in Patients without Associated Cardiovascular Risk Factors  

PubMed Central

Background and Objectives Subclinical hypothyroidism is associated with endothelial dysfunction and impaired coronary flow reserve. However, the effect of subclinical hypothyroidism or thyroid autoimmunity on variant angina has yet to be determined. Subjects and Methods Among 385 consecutive patients without associated cardiovascular risk factors who underwent coronary angiography with the ergonovine provocation test (EPT), 165 had a positive EPT {EPT(+)} and 220 had a negative EPT {EPT(-)}. The relationship between coronary artery spasm and the presence of subclinical thyroid dysfunction as well as serum thyroid peroxidase autoantibody (TPO Ab) was evaluated. Results The proportion of patients with subclinical hypothyroidism among those who were EPT(+) was significantly higher than that in those who were EPT(-) (18% vs. 11%, p=0.001). However, there was no significant difference in the proportion of patients with subclinical hyperthyroidism between the groups. Moreover, EPT(+) patients showed significantly more positive TPO Ab (33% vs. 14%, p<0.001) than those with EPT(-). There was a positive correlation between EPT(+) and TPO positivity (r=0.226, p<0.001), subclinical hypothyroidism (r=0.112, p=0.033), and body mass index (r=0.123, p=0.018). Binary logistic regression analysis revealed that the significant predictors of EPT(+) were body mass index {adjusted odds ratio (OR)=1.042, 95% confidence interval (CI)=1.005-1.080}, presence of subclinical hypothyroidism (OR=3.047, 95% CI=1.083-8.572), TPO Ab titer (OR=1.028, 95% CI=1.015-1.041), and the presence of TPO Ab (OR=4.904, 95% CI=1.544-15.567). Conclusion Subclinical hypothyroidism and the presence of TPO Ab are significantly associated with coronary vasospasm in patients without cardiovascular risk factors. PMID:25810734

Lee, Sea-Won; Kim, Hyun-Su; Heo, Jung-Ho; Cha, Tae-Joon

2015-01-01

356

Relation between regional function and coronary blood flow reserve in multivessel coronary artery stenosis.  

PubMed

In the setting of chronic coronary stenoses, percent wall thickening (%WT) both at rest and during catecholamine stimulation can be abnormal despite normal resting myocardial blood flow (MBF). We hypothesized that this phenomenon is related to abnormal MBF reserve. Accordingly, 15 dogs were studied between 7 and 10 days after placement of Ameroid constrictors around the proximal coronary arteries and their major branches, at a time when collateral development had not yet occurred. %WT and MBF were measured at rest, after 0.56 mg/kg of dipyridamole, and at incremental doses of dobutamine (5-40 microgram. kg(-1). min(-1)). Resting %WT and MBF were normal in all four sham dogs. Resting transmural MBF was normal in all segments in the 11 study dogs, despite reduced (-2 SD of normal) %WT (<30%) in 40 of 82 segments. MBF reserve was reduced (<3) in segments with reduced %WT, and a close coupling was noted between resting %WT and MBF reserve. All segments showed an increase in %WT with dobutamine up to a dose of 20 microgram. kg(-1). min(-1), above which those with abnormal endocardial MBF reserve showed a "biphasic" response. It is concluded that, in the presence of chronic coronary stenoses, abnormalities in resting %WT as well as inducible reduction in %WT during pharmacological stress are related to the degree of abnormal MBF reserve. PMID:11087264

Bin, J P; Pelberg, R A; Wei, K; Coggins, M; Goodman, N C; Kaul, S

2000-12-01

357

Coronary Angiography and Angioplasty  

NSDL National Science Digital Library

This patient education program explains the benefits and risks of coronary angiography and angioplasty. It also reviews the anatomy of the cardiovascular system, the causes and symptoms of blocked arteries, and what the procedure involves. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.

Patient Education Institute

358

MRI of subclinical coronary atherosclerosis  

Microsoft Academic Search

Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the Western world. Whereas atherosclerosis\\u000a alone is rarely fatal, sudden luminal thrombosis precipitates life-threatening clinical events such as acute coronary syndromes\\u000a and stroke. Plaques assumed to cause luminal thrombosis are referred to as vulnerable plaques, which tend to preserve a normal\\u000a vessel lumen. Today’s clinical assessment of

Christian H. P. Jansen; Marcus R. Makowski; Andrea J. Wiethoff; René M. Botnar

2009-01-01

359

Combined anatomical and functional imaging using coronary CT angiography and myocardial perfusion SPECT in symptomatic adults with abnormal origin of a coronary artery.  

PubMed

There has been a lack of standardized workup guidelines for patients with congenital abnormal origin of a coronary artery from the opposite sinus (ACAOS). We aimed to evaluate the use of cardiac hybrid imaging using multi-detector row CT (MDCT) for coronary CT angiography (Coronary CTA) and stress-rest myocardial perfusion SPECT (MPS) for comprehensive diagnosis of symptomatic adult patients with ACAOS. Seventeen symptomatic patients (12 men; 54 ± 13 years) presenting with ACAOS underwent coronary CTA and MPS. Imaging data were analyzed by conventional means, and with additional use of 3D image fusion to allocate stress induced perfusion defects (PD) to their supplying coronary arteries. An anomalous RCA arose from the left anterior sinus in eight patients, an abnormal origin from the right sinus was detected in nine patients (5 left coronary arteries, LCA and 4 LCx). Five of the 17 patients (29%) demonstrated a reversible PD in MPS. There was no correlation between the anatomical variants of ACAOS and the presence of myocardial ischemia. Image fusion enabled the allocation of reversible PD to the anomalous vessel in three patients (two cases in the RCA and the other in the LCA territory); PD in two patients were allocated to the territory of artery giving rise to the anomalies, rather than the anomalies themselves. In a small cohort of adult symptomatic patients with ACAOS anomaly there was no relation found between the specific anatomical variant and the appearance of stress induced myocardial ischemia using cardiac hybrid imaging. PMID:22147107

Uebleis, C; Groebner, M; von Ziegler, F; Becker, A; Rischpler, C; Tegtmeyer, R; Becker, C; Lehner, S; Haug, A R; Cumming, P; Bartenstein, P; Franz, W M; Hacker, M

2012-10-01

360

Changes in Doppler indices of cardiac function during and after percutaneous transluminal coronary angioplasty  

Microsoft Academic Search

OBJECTIVE--To assess the sensitivities of Doppler indices to changes in global cardiac function during and after controlled myocardial ischaemia induced by coronary angioplasty. DESIGN--Continuous wave Doppler signals of aortic flow were recorded during coronary angioplasty. The following Doppler indices of cardiac function were measured before, during, and after balloon inflation: V (peak velocity), MA (mean acceleration), V2\\/T (T = time

A C Hunt; S C Chow; J Escaned; R A Perry; A Seth; M F Shiu

1991-01-01

361

Early impairment of coronary flow reserve in young men with borderline hypertension  

Microsoft Academic Search

Objectives. The purpose of this study was to investigate whether functional abnormalities in coronary vasomotion are present in young healthy asymptomatic men fulfilling the World Health Organization (WHO) criteria for borderline hypertension.Background. Previous studies have reported reduced coronary flow reserve in middle-aged subjects with sustained hypertension and hypertension-induced microvascular heart disease or left ventricular hypertrophy.Methods. Myocardial blood flow was measured

Hanna Laine; Olli T Raitakari; Harri Niinikoski; Olli-Pekka Pitkänen; Hidehiro Iida; Jorma Viikari; Pirjo Nuutila; Juhani Knuuti

1998-01-01

362

New Noninvasive Method for Coronary Flow Reserve Assessment Contrast-Enhanced Transthoracic Second Harmonic Echo Doppler  

Microsoft Academic Search

Background—We tested the hypothesis that blood flow velocity could be recorded in the left anterior descending coronary artery (LAD) during transthoracic echocardiography by use of second harmonic echo Doppler modality along with contrast enhancement (intravenous Levovist) at rest and after pharmacologically induced maximal vasodilation to assess coronary flow reserve (CFR) with a totally noninvasive approach. Methods and Results—Fifty-six consecutive patients

Carlo Caiati; Cristiana Montaldo; Norma Zedda; Alessandro Bina; Sabino Iliceto

2010-01-01

363

Thin-slice T2 MRI imaging predicts vascular pathology in hemifacial spasm: a case-control study.  

PubMed

Hemifacial spasm (HFS) is a condition that may severely reduce patients' quality of life. We sought to determine the sensitivity and specificity of thin-slice T2 magnetic resonance imaging (MRI) for detecting vascular compression in HFS patients. Prospective information was collected on 28 patients with HFS who presented to our center between March 2011 and March 2012 with thin-slice T2 MR imaging. The sensitivity and specificity for differentiating patients from controls were calculated. Sensitivities were 78.6% and 92.9% for the blinded radiologists and 75% for the partially blinded neurosurgeon. Specificities were 42.9% and 28.6% for the blinded radiologists and 75% for the partially blinded neurosurgeon. Magnetic resonance imaging of the facial nerve can guide clinicians in selecting patients who are good surgical candidates. Thin-slice T2 MRI should be viewed as supportive rather than diagnostic. PMID:25044001

Sekula, Raymond F; Frederickson, Andrew M; Branstetter, Barton F; Oskin, James E; Stevens, Dale R; Zwagerman, Nathan T; Grandhi, Ramesh; Hughes, Marion A

2014-09-01

364

A validated predictive model of coronary fractional flow reserve.  

PubMed

Myocardial fractional flow reserve (FFR), an important index of coronary stenosis, is measured by a pressure sensor guidewire. The determination of FFR, only based on the dimensions (lumen diameters and length) of stenosis and hyperaemic coronary flow with no other ad hoc parameters, is currently not possible. We propose an analytical model derived from conservation of energy, which considers various energy losses along the length of a stenosis, i.e. convective and diffusive energy losses as well as energy loss due to sudden constriction and expansion in lumen area. In vitro (constrictions were created in isolated arteries using symmetric and asymmetric tubes as well as an inflatable occluder cuff) and in vivo (constrictions were induced in coronary arteries of eight swine by an occluder cuff) experiments were used to validate the proposed analytical model. The proposed model agreed well with the experimental measurements. A least-squares fit showed a linear relation as (?p or FFR)(experiment) = a(?p or FFR)(theory) + b, where a and b were 1.08 and -1.15 mmHg (r(2) = 0.99) for in vitro ?p, 0.96 and 1.79 mmHg (r(2) = 0.75) for in vivo ?p, and 0.85 and 0.1 (r(2) = 0.7) for FFR. Flow pulsatility and stenosis shape (e.g. eccentricity, exit angle divergence, etc.) had a negligible effect on myocardial FFR, while the entrance effect in a coronary stenosis was found to contribute significantly to the pressure drop. We present a physics-based experimentally validated analytical model of coronary stenosis, which allows prediction of FFR based on stenosis dimensions and hyperaemic coronary flow with no empirical parameters. PMID:22112650

Huo, Yunlong; Svendsen, Mark; Choy, Jenny Susana; Zhang, Z-D; Kassab, Ghassan S

2012-06-01

365

[Off-pump coronary artery bypass grafting using graft to coronary shunt for acute coronary syndrome].  

PubMed

We developed graft to coronary shunt during off-pump anastomosis. Proximal anastomosis of saphenous vein graft (SVG) was done formerly, and vinyl chloride tube, 5 cm long and 2 mm in diameter, was inserted into SVG. Another end was inserted into coronary artery, and continuous suture around the tube was performed before removing the tube. This technique is fit to use for the anastomosis between SVG and #3. Because the tube is easily inserted into those parts without injury of intima, and distal right coronary artery needs enough blood supply. After the revascularization of left anterior descending artery and #3, the heart can be displaced to expose circumflex artery. We adopted this technique to 3 patients with acute coronary syndrome (ACS). Though this technique is not adopted for the patients having stenosis on #4, we conclude that SVG to coronary shunt could be a important part of the strategies of off-pump coronary artery bypass grafting (OPCAB) for ACS patients. PMID:15957421

Iida, H; Mori, H; Yamada, Y; Eda, K; Inoue, Y; Mochizuki, Y

2005-06-01

366

Surgical management of right coronary artery-coronary sinus fistula causing severe mitral and tricuspid regurgitation.  

PubMed

Coronary arteriovenous (AV) fistula is a rare congenital anomaly, mostly diagnosed incidentally during routine coronary angiography. We report a symptomatic patient with right coronary artery to coronary sinus (RCA-CS) fistula, complicated by aneurysmal dilatation and thrombosis of the CS, causing severe mitral regurgitation (MR) and tricuspid regurgitation (TR). PMID:19815568

El Watidy, Ahmed M; Ismail, Huda H; Calafiore, Antonio M

2010-01-01

367

Coronary flow reserve in patients with chest pain and normal coronary arteries  

Microsoft Academic Search

BACKGROUND--Many studies have shown that coronary flow reserve is reduced in patients with chest pain and angiographically normal coronary arteries. The methods used to assess coronary blood flow have varied, but in nearly all reports dipyridamole has been used to bring about vasodilatation. This study was designed to assess whether the apparent impairment of coronary flow reserve seen with dipyridamole

D R Holdright; D C Lindsay; D Clarke; K Fox; P A Poole-Wilson; P Collins

1993-01-01

368

Effect of percutaneous transluminal coronary angioplasty on coronary reserve  

SciTech Connect

This study was done to assess the effect of percutaneous transluminal coronary angioplasty (PTCA) on regional myocardial perfusion (RMP) in the region distal to a stenosis in 48 patients. Quantitative RMP in ml/100g/min was measured from the washout of Xe-133 following selective injection into the involved coronary artery. After successful dilation, determined by a reduction in %stenosis to a less than or equal to 50% lesion and in pressure gradient across the lesion, the RMP measurement was repeated. In these patients, means %stenosis was 85% pre PTCA and 29% post PTCA with mean pressure gradient of 60 Hg pre PTCA and 21 mm Hg post PTCA. 21 of these 48 patients also had RMP measured after isoproterenol (ISO) both pre and post PTCA to increase myocardial oxygen demand to assess coronary reserve. Heart rate (HR) and systolic blood pressure (SBP) were constant pre and post PTCA which allowed a valid comparison. The results are presented. A group of 13 patients with normal coronary arteries and ventricular function showed a mean control RMP of 78 +- 15 and a mean ISO RMP of 140 +- 26. The data demonstrate that following successful PTCA quantitative RMP improves both at rest and with an ISO challenge and is similar to RMP in normal coronary arteries.

Lassar, T.; Hendrix, L.; Ray, G.; Schmidt, D.

1984-01-01

369

POST CORONARY ARTERY BYPASS GRAFT STUDY (CABG)  

EPA Science Inventory

Relative effectiveness of moderate versus more aggressive lipid lowering, and of low dose anticoagulation versus placebo, in delaying saphenous vein coronary bypass graft atherosclerosis and preventing occlusion of saphenous grafts of patients with saphenous vein coronary bypass ...

370

Assessment of coronary hemodynamics and vascular function.  

PubMed

Coronary blood flow closely matches to metabolic demands of heart and myocardial oxygen consumption and is conditioned by function of coronary resistance vessels. The microvascular endothelium of coronary resistance vessels is exposed to a spatially and temporally regulated input from cardiomyocytes and the haemodynamic forces of the cardiac cycle. Functional measurements of coronary pressure and flow are important approaches that provide complementary information on the function of coronary vessel function that could not be assessed by the methods utilized for the anatomic characterization of coronary disease, such as coronary angiography. The goal of this paper is to review the methodologies for assessment of coronary vascular function and haemodynamics which are utilized in research and to discuss their potential applicability in the clinical settings. PMID:25460847

Drenjancevic, Ines; Koller, Akos; Selthofer-Relatic, Kristina; Grizelj, Ivana; Cavka, Ana

2015-01-01

371

Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrast-induced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial  

Microsoft Academic Search

Background Several protective therapies have been developed to prevent contrast-induced nephropathy (CIN). We aimed to investigate the efficacy of sodium bicarbonate by comparing 2 other regimens, including combination of N- acetylcysteine (NAC) plus sodium chloride and sodium chloride alone, to prevent CIN in patients undergoing cardiovascular procedures. Methods We prospectively enrolled 264 patients who were scheduled for cardiovascular procedures and

Emin E. Ozcan; Sema Guneri; Bahri Akdeniz; Z. Akylldlz; Omer Senaslan; Nezihi Baris; Ozgur Aslan; Ozer Badak

2007-01-01

372

Impaired coronary flow reserve immediately after coronary angioplasty in patients with acute myocardial infarction  

Microsoft Academic Search

OBJECTIVE--To examine coronary flow reserve immediately after emergency coronary angioplasty in patients with acute myocardial infarction. DESIGN--A 3 F coronary Doppler catheter was used to measure coronary blood flow velocity in the infarct artery and in the non-infarct artery. Maximal hyperaemia was produced by 10 mg of intracoronary papaverine and coronary flow reserve was calculated. PATIENTS--11 patients with acute myocardial

M Ishihara; H Sato; H Tateishi; T Kawagoe; M Yoshimura; Y Muraoka

1993-01-01

373

Coronary artery anomalies detected by MSCT-coronary angiography in the adult  

Microsoft Academic Search

\\u000a Abstract  Background. Before coronary evaluation by modern imaging techniques was feasible, premorbid diagnoses of coronary artery anomalies (CAAs)\\u000a were usually made fortuitously by invasive coronary angiography (ICA). However, this technique is limited by its invasive\\u000a and projectional nature. Coronary magnetic resonance angiography (CMRA) and multi-slice computed tomography (MSCT) broadened\\u000a clinical information by enabling visualisation of the coronary arteries in their anatomical

G. J. R. ten Kate; A. C. Weustink; P. J. de Feyter

2008-01-01

374

Magnetic resonance coronary angiography  

NASA Astrophysics Data System (ADS)

MR imaging was performed using a superconducting 1.5 Tesla Siemen's Magnetom SP whole body imaging system with a standard planar elliptical spine coil used as an rf receiver. The imaging sequence consisted of a gradient-echo sequence with incremented flip angle series and k-space segmentation such that 6 or 8 phase-encoding steps were acquired in rapid sequence, constituting one segment. Sixteen or 20 interleaved segments were acquired so as to complete the 120, 128, or 160 X 256 matrix. A fat saturation pulse was applied prior to each segment so as to null signal from epicardial fat and thus enhance signal from coronary flow. A repetition time (TR) of 13 msec and an echo time (TE) of 8 msec were used with a slice thickness of 4 or 5 mm and 230 mm field-of-view (in-plane resolution of 1.4 - 1.9 mm X 0.9 mm). All imaging was performed within a single breath-hold.

Manning, Warren J.; Edelman, Robert

1993-09-01

375

Coronary Heart Disease, Hypertension, Stroke, and  

E-print Network

Coronary Heart Disease, Hypertension, Stroke, and Diabetes #12;Coronary Heart Disease: Overview to illnesses caused by atherosclerosis ­ Narrowing of coronary arteries, the vessels that supply the heart that radiates across the chest and arms Ř Myocardial infarction - heart attack, ischemia - local blood supply

Meagher, Mary

376

Interactions of sildenafil with various coronary vasodilators in isolated porcine coronary artery.  

PubMed

There are reports of serious hypotension or circulatory shock when sildenafil citrate, a selective cyclic nucleotide phosphodiesterase type 5 inhibitor, which was developed for the treatment of erectile dysfunction, is given to patients taking certain coronary vasodilators. We thus examined the interaction of sildenafil with various coronary vasodilators including nitric oxide (NO) donors in isolated porcine coronary artery. Sildenafil caused concentration-dependent relaxations of the artery precontracted with U46619 (9,11-dideoxy-9 alpha,11 alpha-methanoepoxy-prostaglandin F(2alpha)). Incubation with the NO synthase inhibitor NG-nitro-L-arginine or the soluble guanylate cyclase inhibitor ODQ (1H-[1,2,4]oxadiazolo[4,3-alpha]quinoxalin-1-one) significantly shifted the concentration-response curve for sildenafil to the right without affecting the maximum response, indicating that some part of the relaxant response to sildenafil may be the result of the inhibition of phosphodiestrase type 5-induced degradation of cyclic GMP (cGMP) that is produced through guanylate cyclase activation by NO released spontaneously. The relaxant effects of the vasodilators with an NO donor property, isosorbide dinitrate, sodium nitroprusside, nicorandil and nipradilol, were significantly enhanced by sildenafil, as shown by a significant leftward shift of their concentration-response curves. In contrast, the relaxant responses to the drugs without a property as an NO donor, diltiazem, celiprolol and pinacidil, were not affected by sildenafil. The cGMP level of the tissue was elevated after adding sildenafil, and the cGMP-generating effect of a combination of sildenafil and sodium nitroprusside was higher than that of each drug alone. The cyclic AMP level determined simultaneously was not changed by sildenafil. These results suggest that sildenafil potentiates specifically the relaxant responses of porcine coronary artery to the drugs which behave as an NO donor, providing basic evidence that the benefit of sildenafil in the treatment of erectile dysfunction can be limited by a risk of marked vasodilation when used together with NO-related coronary vasodilators. PMID:11890904

Sakuma, Ichiro; Akaishi, Yasuhiro; Tomioka, Hiroshi; Sato, Atsushi; Kitabatake, Akira; Hattori, Yuichi

2002-02-22

377

Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis?  

PubMed

To study the relationship between the quantitatively assessed coronary artery dimensions and the regional coronary flow reserve as measured by digital subtraction cineangiography, we investigated 17 coronary arteries with a single discrete proximal stenosis and 12 normal coronary arteries before and after intracoronary administration of papaverine. Coronary flow reserve was found to be curvilinearly related to minimal luminal cross-sectional area (r = .92, SEE = 0.73) and to percentage area stenosis (r = .92, SEE = 0.74). Normal coronary arteries had a coronary flow reserve of 5.0 (+/- 0.8 [SD]), which differed significantly from the coronary flow reserve of the coronary arteries with obstructive disease, in which values ranging from 0.5 to 3.9 were found. Coronary arteries with a percentage area stenosis between 50% and 70% and a minimal luminal cross-sectional area between 2 and 4.5 mm2 differed significantly (p = .001), with respect to the coronary flow reserve, from coronary arteries with a percentage area stenosis in excess of 70% and a minimal luminal cross-sectional area less than 2 mm2. With the use of hemodynamic equations that describe the pressure loss over a stenosis, a theoretical pressure-flow relationship can be inferred that characterizes the severity of the stenosis. Based on this theoretical pressure-flow relationship, coronary arteries that have a limited coronary flow reserve and critical stenosis (distal coronary perfusion pressure below 40 mm Hg at coronary flow of 3 ml/sec) can be identified with high sensitivity (83%) and specificity (82%). Thus, in coronary artery disease the consequent reduction in coronary flow reserve can be predicted with reasonable accuracy by quantitative assessment of coronary artery dimensions. PMID:3552308

Zijlstra, F; van Ommeren, J; Reiber, J H; Serruys, P W

1987-06-01

378

A 45-year old man with recurrent syncope: an unusual presentation of coronary artery disease  

PubMed Central

A 45-year old normotensive, euglycaemic, non-smoker was referred from a peripheral hospital to the Cardiology unit of the University College Hospital, Nigeria for evaluation of recurrent exercise induced syncope. Initial 12-lead electrocardiogram (ECG), 24-hr ambulatory ECG, trans-thoracic echocardiogram and electroencephalogram (EEG) were normal. A repeat episode of syncope warranted further investigation. Immediate post syncope ECG showed deeply inverted symmetrical T waves in the anterior leads. He underwent coronary angiogram which revealed distal left main disease and 70-80% stenosis of the proximal Left Anterior Descending Artery (LAD). The Circumflex artery was non dominant with normal Right Coronary artery. He subsequently had Percutaneous Transluminal Coronary Angioplasty (PTCA) of the LAD. Post-revascularisation course has been satisfactory with no recurrence of syncope. In view of the rising trend of cardiac death in the country, there is the need for high index of suspicion in making diagnosis of coronary artery disease in patients with syncope. PMID:23646207

Adeoye, Abiodun Moshood; Adekunle, Aina Nnodim; Adebiyi, Adewole Adesoji; Mullassari, Ajit; Vijayakumar, Subban; Nwafor, Chibuike Eze

2013-01-01

379

Ticagrelor for acute coronary syndromes.  

PubMed

Ticagrelor is a potent P2Y12 adenosine diphosphate receptor antagonist characterized by a rapid onset, consistent and reversible antiplatelet effect, and an acceptable safety profile compared with existing adenosine diphosphate receptor blockers. In the large Phase III trial, PLATO, ticagrelor significantly reduced the composite of cardiovascular death, myocardial infarction, or stroke as well as cardiovascular and all-cause mortality compared with clopidogrel in patients presenting with acute coronary syndromes. With its favorable impact on mortality, ticagrelor changes the landscape of anti-thrombotic therapy for patients with acute coronary syndromes. PMID:24147518

Bansilal, Sameer; Bonaca, Marc P; Sabatine, Marc S

2013-11-01

380

Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial).  

PubMed

Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. Four hundred seventy-five consecutive, unselected patients who underwent primary percutaneous coronary intervention were randomized to iopromide (n = 239) or iodixanol (n = 236). All patients received high-dose N-acetylcysteine and hydration. The primary end point was the proportion of patients with serum creatinine (sCr) increases ?25% from baseline to 72 hours. Secondary end points were Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, increase in sCr ?50%, increase in sCr ?0.5 or ?1 mg/dl, and 1-month major adverse cardiac events. The primary end point occurred in 10% of the iopromide group and in 13% of the iodixanol group (95% confidence interval -9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion grade of 0 or 1 was present in 14% of patients in the 2 groups. No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction who underwent primary percutaneous coronary intervention, iopromide was not inferior to iodixanol in the occurrence of CI-AKI; no significant differences were found in terms of tissue-level reperfusion and major adverse cardiac events between the 2 contrast agents. PMID:21943940

Bolognese, Leonardo; Falsini, Giovanni; Schwenke, Carsten; Grotti, Simone; Limbruno, Ugo; Liistro, Francesco; Carrera, Arcangelo; Angioli, Paolo; Picchi, Andrea; Ducci, Kenneth; Pierli, Carlo

2012-01-01

381

Percutaneous coronary intervention for acute myocardial infarction in a single coronary artery anomaly.  

PubMed

We report on a case of an adult male patient with previously unknown coronary anomaly and acute myocardial infarction in the territory of the left anterior descending artery (LAD). The coronary angiography showed a single coronary artery with intertruncal course, arising from the right coronary sinus, and thrombotic occlusion of the LAD. Successful transradial percutaneous coronary intervention was done with implantation of an intracoronary stent in the occluded artery. The postprocedural course was complicated by ventricular tachycardia, congestive heart failure, and mild transient renal failure. In conclusion, transradial percutaneous coronary intervention is safe and feasible in rare coronary artery anomalies even in an emergent setting. The finding of an anomalous coronary artery should not be a reason to decline performing coronary intervention. PMID:19816872

Shalganov, Tchavdar N

2009-11-01

382

Differential Sensitivities of Pulmonary and Coronary Arteries to Hemoglobin-Based Oxygen Carriers and Nitrovasodilators: Study in a Bovine Ex-Vivo Model of Vascular Strips  

PubMed Central

Vasoconstriction is a major adverse effect of first and second generation hemoglobin-based oxygen carriers (HBOCs) that hinders their development as blood substitute. However, intravenous infusion of HBOC-201 (second generation) to patients induces significant pulmonary hypertension without significant coronary vasoconstriction. We compared contractile responses of isolated bovine pulmonary and coronary arterial strips to HBOC-201 and HBOC-205LL.LT.MW600 (third generation), polymerized bovine hemoglobins of different molecular weight, and their attenuation by nitroglycerin, sodium nitroprusside (SNP), and sodium nitrite. Pulmonary arteries developed negligible basal tone, but exhibited HBOC-dependent amplification of phenylephrine-induced contractions. In contrast, coronary arteries developed significant basal tone, and exhibited HBOC-dependent constant force increment to serotonin-induced contractions. Therefore, relative to basal tone, HBOC-induced contractions were greater in pulmonary than coronary arteries. Furthermore, HBOC-205LL.LT.MW600 appeared to be less vasoactive than HBOC-201. Unexpectedly, pulmonary and coronary arteries exhibited differential sensitivities to nitrovasodilators in parallel with their differential sensitivities to HBOC. However, SNP and sodium nitrite induced significant methemoglobin formation from HBOC, whereas nitroglycerin did not. These results suggest that phenotypic differences between pulmonary and coronary vascular smooth muscle cells could explain the differential hypertensive effects of HBOC on pulmonary and coronary circulation in patients. Among the three nitrovasodilators investigated, nitroglycerin appears to be the most promising candidate for attenuating HBOC-induced pulmonary hypertension in older HBOCs. PMID:20026426

Fonseca, Vera; Avizinis, Jessica; Moon-Massat, Paula; Freilich, Daniel; Kim, Hae Won; Hai, Chi-Ming

2009-01-01

383

Secondary revascularization after coronary surgery.  

PubMed

World population is aging day after day and coronary atherosclerosis disease is becoming a worldwide pandemic disease. Whereas the number of patients with surgical or percutaneous coronary revascularization is increasing, a new revascularization procedure in a previously revascularized patient is a situation that is already being common in cath labs all over the world. Such patients present some special considerations, with a higher risk and worse prognosis than the usual patients and they require to take specific attitudes regarding prognosis, treatment and revascularization technique. At present, much has been achieved in this field, with new devices developed and many randomized clinical trials, but there is still sparse knowledge about this subject and some confusing points. The following article will discuss about the present-day knowledge of secondary coronary revascularization in patients previously operated, focusing in its indications and which are the technical considerations to keep in mind. Special attention will be paid to the percutaneous revascularization of saphenous vein grafts, the most complex and specific situation that we can find in such patients due to its special histopathology and behavior. Moreover, a mention will be made of the new advances that have been made in recent years, about all kind of devices, coronary stents, pharmacological treatment and new emerging revascularization strategies. PMID:21285932

Roura-Ferrer, G; Gómez-Hospital, J A; Cequier, A

2011-02-01

384

Percutaneous excimer laser coronary angioplasty  

NASA Astrophysics Data System (ADS)

Two hundred ten percutaneous excimer laser coronary angioplasty cases have been done using a XeC1 excimer laser system operating at 308 nanometers. The overall results of the cases are encouraging. The acute clinical success rate is approximately 85%,with a low rate of complications.

Goldenberg, Tsvi; Anderson, William B.; Litvack, Frank; Grundfest, Warren S.; Laudenslager, James B.

1990-07-01

385

Contribution of sympathetic activation to coronary vasodilatation during the cold pressor test in healthy men: effect of ageing  

PubMed Central

The sympathetic nervous system is an important regulator of coronary blood flow. The cold pressor test (CPT) is a powerful sympathoexcitatory stressor. We tested the hypotheses that: (1) CPT-induced sympathetic activation elicits coronary vasodilatation in young adults that is impaired with advancing age and (2) combined ?- and ?-adrenergic blockade diminishes/abolishes these age-related differences. Vascular responses of the left anterior descending artery to the CPT were determined by transthoracic Doppler echocardiography before (pre-blockade) and during (post-blockade) systemic co-administration of ?- and ?-adrenergic antagonists in young (n= 9; 26 ± 1 years old, mean ± SEM) and older healthy men (n= 9; 66 ± 2 years old). Coronary vascular resistance (CVR; mean arterial pressure/coronary blood velocity) was used as an index of vascular tone. CPT decreased CVR (i.e. coronary vasodilatation occurred) in young (?–33 ± 6%), but not older men (?–3 ± 4%; P < 0.05 vs. young) pre-blockade. Adrenergic blockade abolished CPT-induced coronary vasodilatation in young men (?–33 ± 6%vs. ? 0 ± 6%, pre-blockade vs. post-blockade, respectively; P < 0.05) such that responses post-blockade mirrored those of older men (?–3 ± 4%vs. ? 8 ± 9%; both P > 0.05 compared to young pre-blockade). Impaired CPT-induced coronary vasodilatation could not be explained by a reduced stimulus for vasodilatation as group and condition effects persisted when CVR responses were expressed relative to myocardial oxygen demand (rate–pressure product). These data indicate that the normal coronary vascular response to sympathetic activation in young men is pronounced vasodilatation and this effect is lost with age as the result of an adrenergic mechanism. These findings may help explain how acute sympathoexcitation may precipitate angina and coronary ischaemic events, particularly in older adults. PMID:23478134

Monahan, Kevin D; Feehan, Robert P; Sinoway, Lawrence I; Gao, Zhaohui

2013-01-01

386

Autosomal recessive mutations in nuclear transport factor KPNA7 are associated with infantile spasms and cerebellar malformation.  

PubMed

Nuclear import receptors of the KPNA family recognize the nuclear localization signal in proteins and together with importin-? mediate translocation into the nucleus. Accordingly, KPNA family members have a highly conserved architecture with domains that contact the nuclear localization signal and bind to importin-?. Here, we describe autosomal recessive mutations in KPNA7 found by whole exome sequencing in a sibling pair with severe developmental disability, infantile spasms, subsequent intractable epilepsy consistent with Lennox-Gastaut syndrome, partial agenesis of the corpus callosum, and cerebellar vermis hypoplasia. The mutations mapped to exon 7 in KPNA7 result in two amino-acid substitutions, Pro339Ala and Glu344Gln. On the basis of the crystal structure of the paralog KPNA2 bound to a bipartite nuclear localization signal from the retinoblastoma protein, the amino-acid substitutions in the affected subjects were predicted to occur within the seventh armadillo repeat that forms one of the two nuclear localization signal-binding sites in KPNA family members. Glu344 is conserved in all seven KPNA proteins, and we found that the Glu354Gln mutation in KPNA2 is sufficient to reduce binding to the retinoblastoma nuclear localization signal to approximately one-half that of wild-type protein. Our data show that compound heterozygous mutations in KPNA7 are associated with a human neurodevelopmental disease, and provide the first example of a human disease associated with mutation of a nuclear transport receptor. PMID:24045845

Paciorkowski, Alex R; Weisenberg, Judy; Kelley, Joshua B; Spencer, Adam; Tuttle, Emily; Ghoneim, Dalia; Thio, Liu Lin; Christian, Susan L; Dobyns, William B; Paschal, Bryce M

2014-05-01

387

Immediate disappearance of hemifacial spasm after partial removal of ponto-medullary junction anaplastic astrocytoma: case report.  

PubMed

Hemifacial spasm (HFS) is generally caused by a neurovascular conflict (NC) at the root exit zone (REZ) of the facial nerve at the brainstem. Although a direct compression to the seventh cranial nerve (CN) by the anterior inferior cerebellar artery (AICA) is generally the most frequent cause, secondary HFS may be related to other pathological conditions. HFS due to an intracranial mass lesion is exceptionally rare and it has been reported in very few cases. The online database was searched for English-language articles reporting cases of HFS due to brainstem mass lesions and the possible pathophysiological mechanisms involved in its genesis. A 47-year-old man affected by an anaplastic astrocytoma of the brainstem at the level of the ponto-medullary junction developed right HFS. He underwent a subtotal surgical removal of the tumor with complete resolution of the HFS. This is the ninth reported case of HFS caused by an intrinsic brainstem tumor. The exceptional rarity of the relationship between intra-axial tumors and peripheral HFS was analyzed. PMID:25382264

Castiglione, Melina; Broggi, Morgan; Cordella, Roberto; Acerbi, Francesco; Ferroli, Paolo

2015-04-01

388

Clinical Implications of Intracoronary Findings Beyond Coronary Angiograms in Patients With Sudden Death and High Probability of Coronary Artery Disease  

Microsoft Academic Search

Of 12 patients with sudden death and a high probability of coronary artery disease who underwent cardiac catheterization, 4 (25%) showed coronary arteries without significant obstructive lesions or angiographic signs of instability. The study protocol included an invasive study of coronary vasoreactivity and an intracoronary imaging study with intravascular ultrasound. The coronary reactivity study showed coronary vasospasm in 1 patient.

Ángel Sánchez-Recalde; José L. Merino; Raúl Moreno; Santiago Jiménez-Valero; Guillermo Galeote; Luis Calvo; Esteban López de Sá; José L. López-Sendón

2011-01-01

389

Transcatheter coil embolization of a coronary artery-left ventricular fistula associated with single coronary artery anomaly.  

PubMed

Single coronary artery anomaly associated with coronary fistula is a rare entity. Transcatheter coil embolization is the treatment of choice for coronary artery fistulas. In this case report, we describe a patient with both single coronary artery anomaly and coronary fistula who was successfully treated with coil embolization. PMID:24744954

Celebi, Ozlem Ozcan; Canbay, Alper; Diker, Erdem; Cil, Barbaros; Aytemir, Kudret; Oto, Ali

2014-01-01

390

Transcatheter Coil Embolization of a Coronary Artery-Left Ventricular Fistula Associated with Single Coronary Artery Anomaly  

PubMed Central

Single coronary artery anomaly associated with coronary fistula is a rare entity. Transcatheter coil embolization is the treatment of choice for coronary artery fistulas. In this case report, we describe a patient with both single coronary artery anomaly and coronary fistula who was successfully treated with coil embolization. PMID:24744954

Celebi, Ozlem Ozcan; Canbay, Alper; Diker, Erdem; Çil, Barbaros; Aytemir, Kudret; Oto, Ali

2014-01-01

391

Comparison of Electron Beam Computed Tomography With Intracoronary Ultrasound and Coronary Angiography for Detection of Coronary Atherosclerosis  

Microsoft Academic Search

Objectives. This analysis compared the results of electron beam computed tomography (EBCT) with those of coronary angiography and intracoronary ultrasound (ICUS) for the in vivo detection of coronary atherosclerotic plaques.Background. EBCT is a new imaging modality for identification of coronary calcifications. Coronary angiography depicts advanced changes in coronary morphology, whereas ICUS is an established diagnostic tool that detects the early

Dietrich Baumgart; Axel Schmermund; Guenter Goerge; Michael Haude; Junbo Ge; Michael Adamzik; Cornelia Sehnert; Klaus Altmaier; Dietrich Groenemeyer; Rainer Seibel; Raimund Erbel

1997-01-01

392

Impact of continuous deterioration of kidney function 6 to 8 months after percutaneous coronary intervention for acute coronary syndrome.  

PubMed

Preprocedural chronic kidney disease and contrast-induced acute kidney injury are predictors of in-hospital death and long-term mortality. However, neither the time course of kidney function after percutaneous coronary intervention (PCI) nor the relation between the time course of kidney function and prognosis has been adequately studied. We studied 531 patients who underwent PCI for acute coronary syndrome. The continuous deterioration of kidney function (CDKF) was defined as a >25% increase in serum creatinine level or serum creatinine >0.5 mg/dl above baseline at 6 to 8 months after PCI. CDKF was observed in 87 patients (16.4%). Independent risk factors for CDKF were contrast-induced acute kidney injury, preprocedural hemoglobin level, and proteinuria. Patients with CDKF exhibited significant higher 5-year mortality rate than patients without CDKF (25% vs 9.4%, log-rank p = 0.0006). Independent risk factors for 5-year mortality were age >75 year, anemia, New York Heart Association class III or IV, low ejection fraction, and CDKF. CDKF is associated with an increased risk of all-cause mortality of 5 years in patients with acute coronary syndrome undergoing PCI. PMID:24656479

Nemoto, Naohiko; Iwasaki, Masaki; Nakanishi, Mami; Araki, Tadashi; Utsunomiya, Makoto; Hori, Masaki; Ikeda, Nobutaka; Makino, Kunihiko; Itaya, Hideki; Iijima, Raisuke; Hara, Hidehiko; Takagi, Takuro; Joki, Nobuhiko; Sugi, Kaoru; Nakamura, Masato

2014-05-15

393

Sudden death of an infant with coronary involvement due to Takayasu arteritis.  

PubMed

We present an unusual case of sudden death of an 8-month-old female infant with coronary involvement due to Takayasu arteritis. She had been thought to be healthy, but died after presenting to a hospital with complains of vomiting. At autopsy, the aorta and its main branches were thickened and stenotic, with the abdominal aorta below the level of the orifice of renal arteries most severely affected. The ascending aorta was thickened and showed ostial stenosis in the coronary arteries bilaterally. The proximal segment of the left and right coronary arteries showed approximately 60% and over 90% occlusion, respectively. Microscopically, the intima was thickened due to an increase of intimal cells and fibers, and the adventitia showed thickening with fibrosis. In addition, remarkable infiltration of inflammatory cells, including multinuclear giant cells phagocytosing fragmented elastic fibers, and destruction of elastic fibers were observed in the media. We diagnosed the cause of death as coronary insufficiency induced by coronary involvement due to Takayasu arteritis. Takayasu arteritis was not considered as a cause of sudden infant death, although this disease can affect the coronary artery. This report suggests that Takayasu arteritis can be a life-threatening condition even in infants. PMID:22717378

Wang, Elaine Lu; Sato, Yasunori; Takeichi, Toshiaki; Kitamura, Osamu

2013-01-01

394

Apical myocardial infarction with bizarre coronary images mimicking left ventricular apical ballooning syndrome: a case report  

PubMed Central

Introduction Although several etiopathogenetic mechanisms have been proposed, the causes of left ventricular apical ballooning syndrome are still controversial. Case presentation A 51-year-old Japanese woman consulted the emergency room complaining of the sudden onset of anterior chest pain while shopping. We initially suspected her disease as left ventricular apical ballooning syndrome based on her clinical background and laboratory examinations. However, the initial coronary angiogram demonstrated diffuse lesions in her distal left anterior descending coronary artery, and she was finally diagnosed with apical myocardial infarction. The blood flow in her distal left anterior descending coronary artery had markedly improved in the chronic phase. If the reduced blood flow in her distal left anterior descending coronary artery was induced by coronary vasospasm and the vasospasm was relieved before the coronary angiogram was performed, this case must be diagnosed as left ventricular apical ballooning syndrome. Conclusion We think this case may promote discussion regarding the pathophysiology of left ventricular apical ballooning syndrome. PMID:24716472

2014-01-01

395

Coronary Artery Disease | Coronary Artery Disease | NIH MedlinePlus the Magazine  

MedlinePLUS

... this page please turn Javascript on. Feature: Coronary Artery Disease Coronary Artery Disease Past Issues / Fall 2010 Table of Contents ... exercise routine produced a strong heart!" Fast Facts Arteries are blood vessels that carry oxygen-rich blood ...

396

Coronary Artery Responses to Physiological Stimuli Are Improved by Deferoxamine but not by L-Arginine in Non-Insulin-Dependent Diabetic Patients With Angiographically Normal Coronary Arteries and No Other Risk Factors  

Microsoft Academic Search

Background—Acetylcholine produces coronary artery (CA) constriction in diabetic patients, suggesting an impairment of endothelium-dependent dilation. In diabetes, multiple metabolic abnormalities may inactivate nitric oxide through oxygen free radical production. Methods and Results—To examine the mechanism of this abnormal response, two physiological tests (ie, a cold pressor test (CPT) and coronary flow increase induced by an injection of 10 mg papaverine

Alain Nitenberg; Frederic Paycha; Severine Ledoux; Regis Sachs; Jean-Raymond Attali; Paul Valensi

397

Who Is at Risk for Coronary Heart Disease?  

MedlinePLUS

... on Twitter. Who Is at Risk for Coronary Heart Disease? In the United States, coronary heart disease ( ... type of fat. Other Risks Related to Coronary Heart Disease Other conditions and factors also may contribute ...

398

Rosiglitazone inhibits vascular KATP channels and coronary vasodilation produced by isoprenaline  

PubMed Central

BACKGROUND AND PURPOSE Rosiglitazone is an anti-diabetic drug improving insulin sensitivity and glucose uptake in skeletal muscle and adipose tissues. However, several recent clinical trials suggest that rosiglitazone can increase the risk of cardiovascular ischaemia, although other studies failed to show such risks. Therefore, the effects of rosiglitazone on the coronary circulation and any potential vascular targets need to be elucidated. Here, we show that the vascular isoform of the ATP-sensitive K+ (KATP) channel is inhibited by rosiglitazone, impairing physiological regulation of the coronary circulation. EXPERIMENTAL APPROACH The KIR6.1/SUR2B channel was expressed in HEK293 cells and studied in whole-cell and inside-out patch configurations. The Langendorff heart preparation was used to evaluate rosiglitazone in the coronary circulation of wild-type (WT) and KIR6.1-null (Kcnj8?/?) mice. KEY RESULTS KIR6.1/SUR2B channels in HEK cells were inhibited by rosiglitazone in a membrane-delimited manner. This effect was markedly enhanced by sub-micromolar concentrations of glibenclamide and the IC50 for rosiglitazone fell to 2µM, a therapeutically achievable concentration. In the Langendorff heart preparation rosiglitazone inhibited, concentration-dependently, the coronary vasodilation induced by isoprenaline, without affecting basal coronary tone. Effects of rosiglitazone on coronary perfusion were attenuated by more than 50% in the Kcnj8?/? mice, supporting the involvement of KATP channels in this effect of rosiglitazone on the coronary circulation. CONCLUSIONS AND IMPLICATIONS These results indicate that the vascular KATP channel is one of the targets of rosiglitazone action, through which this drug may compromise coronary responses to circulating vasodilators and perhaps also to metabolic stress. PMID:21671900

Yu, Lei; Jin, Xin; Yang, Yang; Cui, Ningren; Jiang, Chun

2011-01-01

399

Successful percutaneous coronary intervention for severe stenosis of a double right coronary artery.  

PubMed

Anomalies of the coronary arteries are uncommon and often asymptomatic. Double right coronary artery (RCA) is a very rare coronary anomaly. So far, the number of reported cases of double RCA is low. We describe a case of a 50-year-old female patient hospitalised with the diagnosis of unstable angina pectoris. RCA injection showed filling of two separately originating RCA, coursing towards the right atrioventricular groove. Coronary angioplasty was successful. PMID:19784894

Sucu, Murat; Ozer, Orhan; San, Ibrahim; Davutoglu, Vedat

2009-08-01

400

Cardiovascular Disease: Coronary Artery Disease and Coronary Artery Calcification  

Microsoft Academic Search

\\u000a Coronary artery disease is common in chronic kidney disease (CKD) and dialysis patients. There is strong evidence that kidney\\u000a disease is an independent risk factor for atherosclerosis. In addition, traditional risk factors such as obesity, hypertension\\u000a and diabetes, as well as nontraditional factors such as inflammation and oxidative stress, likely contribute to the excess\\u000a risk of atherosclerosis in CKD. It

Srinivasan Beddhu

401

Giant Coronary Artery Aneurysms: Review and Update  

PubMed Central

Giant coronary artery aneurysms are rare, with a reported prevalence of 0.02% to 0.2%. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease, and percutaneous coronary intervention. Most giant coronary artery aneurysms are asymptomatic, but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. Clinical sequelae include thrombus formation, embolization, fistula formation, and rupture. Surgical correction is generally accepted as the preferred treatment for giant coronary artery aneurysms. We present an illustrative case of a giant 70 × 40-mm coronary artery aneurysm in a 56-year-old man who declined surgery and died one month later. In addition, we provide a review of the medical literature on giant coronary artery aneurysms. PMID:25593524

Crawley, Patricia D.; Huntsinger, D. Russell; Afiniwala, Swara; Wortham, Dale C.

2014-01-01

402

Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

Background: The comparative effectiveness of coronary artery by- pass graft (CABG) surgery and percutaneous coronary intervention (PCI) for patients in whom both procedures are feasible remains poorly understood. Purpose: To compare the effectiveness of PCI and CABG in pa- tients for whom coronary revascularization is clinically indicated. Data Sources: MEDLINE, EMBASE, and Cochrane databases (1966-2006); conference proceedings; and bibliographies of

Dena M. Bravata; Allison L. Gienger; Kathryn M. McDonald; Vandana Sundaram; Marco V. Perez; Robin Varghese; John R. Kapoor; Reza Ardehali; Douglas K. Owens; Mark A. Hlatky

2007-01-01

403

Drug therapy or coronary angioplasty for the treatment of coronary artery disease: New insights  

Microsoft Academic Search

Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy for the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the latest trials that compared percutaneous transluminal coronary angioplasty and medical therapy. Results We discuss the potentially

Giovanni Amoroso; Ad J. Van Boven; Harry J. G. M. Crijns

2001-01-01

404

Coronary flow reserve is impaired in patients with slow coronary flow  

Microsoft Academic Search

BackgroundSlow coronary flow (SCF) in a normal coronary angiogram is a well-recognized clinical entity, but its etiopathogenesis remains unclear. However, previous studies have suggested that microvascular abnormalities and endothelial dysfunction responsible for SCF. Accordingly, we hypothesized that SCF phenomenon may be a form, at least early phase, of atherosclerosis that involve both small vessels and epicardial coronary arteries, and therefore

Dogan Erdogan; Mustafa Caliskan; Hakan Gullu; Alpay Turan Sezgin; Aylin Yildirir; Haldun Muderrisoglu

2007-01-01

405

A comparison of coronary angioplasty and coronary artery bypass grafting outcomes in chronic dialysis patients  

Microsoft Academic Search

The objective of this study was to compare the outcomes of angina, myocardial infarction (MI), cardiac death, and all-cause death following percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG). The study design was based on retrospective, nonrandomized analysis and was set in referral teaching hospitals and community hospitals. Eighty-four chronic dialysis patients with symptomatic coronary artery disease

Ann L. Rinehart; Charles A. Herzog; Allan J. Collins; John M. Flack; Jennie Z. Ma; John A. Opsahl

1995-01-01

406

Effects of Testosterone on Coronary Vasomotor Regulation in Men With Coronary Heart Disease  

Microsoft Academic Search

Background—The increased incidence of coronary artery disease in men compared with premenopausal women suggests a detrimental role of male hormones on the cardiovascular system. However, testosterone has direct relaxing effects on coronary arteries in animals, as shown both in vitro and in vivo. The effect of testosterone on the human coronary circulation remains unknown. Methods and Results—We studied 13 men

Carolyn M. Webb; John G. McNeill; Christopher S. Hayward; Dominique de Zeigler; Peter Collins

2010-01-01

407

Sex Differences in Percutaneous Coronary Interventions  

Microsoft Academic Search

Cardiovascular disease is the leading cause of mortality in women, and women have a higher cardiovascular mortality and morbidity\\u000a associated with the treatment of cardiovascular disease compared to men. Percutaneous coronary intervention (PCI) is an important\\u000a therapy for women with coronary artery disease particularly in acute coronary syndromes; however, only 33% of all PCIs are\\u000a performed in women. The purpose

Juzar O. Lokhandwala; Kimberly A. Skelding

2009-01-01

408

Behavior patterns and coronary heart disease  

NASA Technical Reports Server (NTRS)

The relationships between two behavioral patterns, cardiac risk factors, and coronary heart disease are investigated. Risk factors used in the analysis were family history of coronary disease, smoking, cholesterol, obesity, systotic blood pressure, diastolic blood pressure, blood sugar, uric acid, erythrocyte sedimentation rate, and white blood unit. It was found that conventional, non-behavioral pattern risk factors alone were not significantly related to coronary heart disease.

Townsend, J. C.; Cronin, J. P.

1975-01-01

409

Radiation dose measurements in coronary CT angiography  

PubMed Central

Coronary computed tomography (CT) angiography is associated with high radiation dose and this has raised serious concerns in the literature. Awareness of various parameters for dose estimates and measurements of coronary CT angiography plays an important role in increasing our understanding of the radiation exposure to patients, thus, contributing to the implementation of dose-saving strategies. This article provides an overview of the radiation dose quantity and its measurement during coronary CT angiography procedures. PMID:24392190

Sabarudin, Akmal; Sun, Zhonghua

2013-01-01

410

Transthoracic echocardiographic visualization of coronary artery blood flow and assessment of coronary flow reserve in the right coronary artery: A first report of 3 patients  

Microsoft Academic Search

Assessment of coronary flow reserve (CFR) has proven to be an important diagnostic tool providing useful clinical and physiologic information about coronary artery function. In several studies, the transthoracic echocardiographic assessment of CFR, defined as a ratio of hyperemic to basal coronary flow velocity, was validated in the left anterior descending artery. But so far, the visualization of coronary flow

Hans-Peter Tries; Heinz Lambertz; Harald Lethen

2002-01-01

411

Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the right coronary artery by transthoracic doppler echocardiography: Comparison with intracoronary doppler guidewire  

Microsoft Academic Search

The aim of this study was to evaluate whether coronary flow velocity (CFV) and coronary flow velocity reserve (CFVR) in the posterior descending right coronary artery can be reliably measured by transthoracic Doppler echocardiography (TTDE). In 17 patients, CFV in the posterior descending right coronary artery was measured with TTDE at the time of Doppler guidewire examination. CFV was measured

Yoshiki Ueno; Yasuyuki Nakamura; Hiroyuki Takashima; Masahiko Kinoshita; Akira Soma

2002-01-01

412

Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography  

Microsoft Academic Search

Objectives. The purpose of this study was to evaluate whether transthoracic Doppler echocardiography (TTDE) can reliably measure coronary flow velocity (CFV) and coronary flow velocity reserve (CFVR) in the left anterior descending coronary artery (LAD) in the clinical setting.Background. Coronary flow velocity measurement has provided useful clinical and physiologic information. Advancement in TTDE provides noninvasive measurement of CFV and CFVR

Takeshi Hozumi; Kiyoshi Yoshida; Takashi Akasaka; Yoshio Asami; Yumiko Ogata; Tsutomu Takagi; Shuichiro Kaji; Takahiro Kawamoto; Yoshiaki Ueda; Shigefumi Morioka

1998-01-01

413

Cardiac CT: atherosclerosis to acute coronary syndrome  

PubMed Central

Coronary computed tomographic angiography (CCTA) is a robust non-invasive method to assess coronary artery disease (CAD). Qualitative and quantitative assessment of atherosclerotic coronary stenosis with CCTA has been favourably compared with invasive coronary angiography (ICA) and intravascular ultrasound (IVUS). Importantly, it allows the study of preclinical stages of atherosclerotic disease, may help improve risk stratification and monitor the progressive course of the disease. The diagnostic accuracy of CCTA in the assessment of coronary artery bypass grafts (CABG) is excellent and the constantly improving technology is making the evaluation of stents feasible. Novel techniques are being developed to assess the functional significance of coronary stenosis. The excellent negative predictive value of CCTA in ruling out disease enables early and safe discharge of patients with suspected acute coronary syndromes (ACS) in the Emergency Department (ED). In addition, CCTA is useful in predicting clinical outcomes based on the extent of coronary atherosclerosis and also based on individual plaque characteristics such as low attenuation plaque (LAP), positive remodelling and spotty calcification. In this article, we review the role of CCTA in the detection of coronary atherosclerosis in native vessels, stented vessels, calcified arteries and grafts; the assessment of plaque progression, evaluation of chest pain in the ED, assessment of functional significance of stenosis and the prognostic significance of CCTA. PMID:25610801

Munnur, Ravi Kiran; Cameron, James D.; Ko, Brian S.; Meredith, Ian T.

2014-01-01

414

Complex robotic-enhanced percutaneous coronary intervention.  

PubMed

A remote-controlled, robotic system was developed to address procedural challenges and occupational hazards associated with traditional percutaneous coronary intervention (PCI). The PRECISE (Percutaneous Robotically Enhanced Coronary Intervention) Study demonstrated the safety and feasibility of the robotic system. We report four cases of complex coronary interventions demonstrating the capabilities of robotic-enhanced PCI to treat multilesion, multivessel coronary disease, saphenous venous graft disease, and an ST-elevation myocardial infarction. The robotic system offers enhanced visibility, precise measurement, accurate stent positioning, improved ergonomics, and superior operator protection from radiation. PMID:24167108

Kapur, Vishal; Smilowitz, Nathaniel R; Weisz, Giora

2014-05-01

415

Coronary microvascular dysfunction: mechanisms and functional assessment.  

PubMed

Obstructive disease of the epicardial coronary arteries was recognized as the cause of angina pectoris >2 centuries ago, and sudden thrombotic occlusion of an epicardial coronary artery has been established as the cause of acute myocardial infarction for >100 years. In the past 2 decades, dysfunction of the coronary microvasculature emerged as an additional mechanism of myocardial ischaemia that bears important prognostic implications. The coronary microvasculature (vessels <300 ?m in diameter) cannot be directly imaged in vivo, but a number of invasive and noninvasive techniques, each with relative advantages and pitfalls, can be used to assess parameters that depend directly on coronary microvascular function. These methods include invasive or noninvasive measurement of Doppler-derived coronary blood flow velocity reserve, assessment of myocardial blood flow and flow reserve using noninvasive imaging, and calculation of microcirculatory resistance indexes during coronary catheterization. These advanced techniques for assessment of the coronary microvasculature have provided novel insights into the pathophysiological role of coronary microvascular dysfunction in the development of myocardial ischaemia in different clinical conditions. PMID:25311229

Camici, Paolo G; d'Amati, Giulia; Rimoldi, Ornella

2015-01-01

416

Primary percutaneous coronary intervention for acute myocardial infarction in a pediatric patient with giant coronary aneurysm due to Kawasaki disease.  

PubMed

We report a case of acute myocardial infarction in an 8-year-old boy with a history of Kawasaki disease and giant coronary aneurysms in the right and left coronary arteries. We performed coronary angiography and percutaneous coronary intervention 4 hours after the onset of symptoms. This case suggests that primary percutaneous coronary intervention might be safe and effective in the long-term treatment of acute myocardial infarction due to coronary sequelae of Kawasaki. PMID:23601472

Mongiově, Maurizio; Alaimo, Annalisa; Vernuccio, Federica; Pieri, Daniele

2014-01-01

417

Prevention of Coronary Heart Disease  

Microsoft Academic Search

Coronary heart disease (CHD) is a leading cause of death in the USA, and a burden that is estimated to overtake all other\\u000a causes of mortality worldwide by the year 2020 [1]. Marked advances have been made in recent years to better understand the\\u000a pathophysiology of CHD and to develop scoring systems that can integrate risk factors to estimate an

Firas A. Ghanem; Assad Movahed

418

Screening for Coronary Artery Calcium  

Microsoft Academic Search

\\u000a The striking improvement in cardiovascular therapies during the last several decades has caused a marked decrease in mortality\\u000a linked to atherosclerotic diseases in Western societies. Nonetheless, coronary artery disease (CAD) remains the main cause\\u000a of non-fatal events, and it is associated with substantial functional impairment in survivors of acute events, imposing a\\u000a very large economic burden on societies. The use

Nikolaos Alexopoulos; Dalton S. McLean; Stamatios Lerakis; Paolo Raggi

419

Anticoagulants in acute coronary syndromes  

Microsoft Academic Search

Antithrombotic and antiplatelet agents, particularly unfractionated heparin and aspirin, are longstanding therapeutic mainstays for acute coronary syndromes such as unstable angina and non–Q-wave myocardial infarction (MI). Early studies demonstrated that aspirin reduces the risk of mortality or nonfatal MI by 50–70% in patients presenting with unstable angina or non–Q-wave MI. Added to aspirin, heparin regimens further diminish the incidence of

Alexander G. G Turpie

1999-01-01

420

Nickel-free stainless steel avoids neointima formation following coronary stent implantation  

NASA Astrophysics Data System (ADS)

SUS316L stainless steel and cobalt-chromium and platinum-chromium alloys are widely used platforms for coronary stents. These alloys also contain nickel (Ni), which reportedly induces allergic reactions in some subjects and is known to have various cellular effects. The effects of Ni on neointima formation after stent implantation remain unknown, however. We developed coronary stents made of Ni-free high-nitrogen austenitic stainless steel prepared using a N2-gas pressurized electroslag remelting (P-ESR) process. Neointima formation and inflammatory responses following stent implantation in porcine coronary arteries were then compared between the Ni-free and SUS316L stainless steel stents. We found significantly less neointima formation and inflammation in arteries implanted with Ni-free stents, as compared to SUS316L stents. Notably, Ni2+ was eluted into the medium from SUS316L but not from Ni-free stainless steel. Mechanistically, Ni2+ increased levels of hypoxia inducible factor protein-1? (HIF-1?) and its target genes in cultured smooth muscle cells. HIF-1? and their target gene levels were also increased in the vascular wall at SUS316L stent sites but not at Ni-free stent sites. The Ni-free stainless steel coronary stent reduces neointima formation, in part by avoiding activation of inflammatory processes via the Ni-HIF pathway. The Ni-free-stainless steel stent is a promising new coronary stent platform.

Fujiu, Katsuhito; Manabe, Ichiro; Sasaki, Makoto; Inoue, Motoki; Iwata, Hiroshi; Hasumi, Eriko; Komuro, Issei; Katada, Yasuyuki; Taguchi, Tetsushi; Nagai, Ryozo

2012-12-01