Coronary artery infarction

Another example is the use of Tc-sestamibi, approved for use in the evaluation of coronary artery disease and myocardial infarction, in patients with breast cancer. Use in breast cancer is under investigation by a number of physicians. The data are not yet sufficient to determine the efficacy of this agent in this setting. Its safety, of course, has already been demonstrated as part of its initial evaluation for heart disease. 

There can be a number of underlying causes of CHE. The most prevalent is the lack of oxygenated blood reaching the heart muscle itself because of coronary artery disease with myocardial infarction (111). Hypertension and valvular disease can contribute to CHE as well, but to a lesser extent in terms of principal causes for the disease. 

Several clinical trials have been conducted with streptokinase adrninistered either intravenously or by direct infusion into a catheterized coronary artery. The results from 33 randomized trials conducted between 1959 and 1984 have been examined (75), and show a significant decrease in mortaUty rate (15.4%) in enzyme-treated patients vs matched controls (19.2%). These results correlate well with an ItaUan study encompassing 11,806 patients (76), in which the overall reduction in mortaUty was 19% in the streptokinase-treated group, ie, 1.5 million units adrninistered intravenously, compared with placebo-treated controls. The trial also shows that a delay in the initiation of treatment over six hours after the onset of symptoms nullifies any benefit from this type of thrombolytic therapy. Conversely, patients treated within one hour from the onset of symptoms had a remarkable decrease in mortaUty (47%). The benefits of streptokinase therapy, especially in the latter group of patients, was stiU evident in a one-year foUow-up (77). In addition to reducing mortahty rate, there was an improvement in left ventricular function and a reduction in the size of infarction. Thus early treatment with streptokinase is essential. 

Meticulous care needs to be used in the application of this tissue adhesive. Only a very thin layer of adhesive should be used to assist with reapproximation of the intima and adventitia. It is important to remember that the material should not be allowed to drip into or onto critical areas such as the ostium of the coronary arteries. Inadvertent placement of this agent in such areas can result in blockage of a critical artery and a potentially fatal myocardial infarction. In addition. 

Acute coronary syndromes most often result from a physical disruption of the fibrous cap, either frank cap fracture or superficial endothelial erosion, allowing the blood to make contact with the thrombogenic material in the lipid core or the subendothelial region of the intima. This contact initiates the formation of a thrombus, which can lead to a sudden and dramatic blockade of blood flow through the affected artery. If the thrombus is nonocclusive or transient, it may either be clinically silent or manifest as symptoms characteristic of unstable angina. Importantly, if collateral vessels have previously formed, for example, due to chronic ischemia produced by multi vessel disease, even total occlusion of one coronary artery may not lead to an acute myocardial infarction. 

YuXC et al. (2001) Cardiac effects of the extract and active components of Radix stephaniae tetrandrae II. Myocardial infarct, arrhythmias, coronary arterial flow and heart rate in the isolated perfused rat heart. Life Sci 68(25) 2863-2872... 

Maroko, P.R., Kjeksus, J.K., Sobel, B.E., Watanabe, T., Covell, J.W., Ross, J., Jr and Braunwald, E. (1971). Factors influencing infarct size following experimental coronary artery occlusions. Circulation 43, 67-82. 

Ascher, E.K. Stauffer, J-C.E. and Gaasch, W.H. Coronary artery spasm, cardiac arrest, transient electrocardiographic Q waves and stunned myocardium in cocaine-associated acute myocardial infarction. 

Prior to myocardial infarction, coronary artery bypass graft (CABG), peripheral artery disease, cerebrovascular accident, or aspirin use... 

Heart (angina, coronary artery disease, myocardial infarction, or heart failure)... 

Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease Trial... 

Father with coronary artery disease, had a myocardial infarction at age 50 years Mother alive and well... 

Short-term desired outcomes in a patient with ACS are (1) early restoration of blood flow to the infarct-related artery to prevent infarct expansion (in the case of MI) or prevent complete occlusion and MI (in unstable angina) (2) prevention of death and other complications (3) prevention of coronary artery reocclusion and (4) relief of ischemic chest discomfort. 

Hypertension x 15 years Coronary artery disease x 10 years Myocardial infarction 1998 Heart failure x 3 years... 

Coronary artery disease Myocardial infarction Heart failure... 

Moderate risk Has three or more risk factors for coronary artery disease Has moderate, stable angina Had a recent myocardial infarction or stroke within the past 6 weeks Has moderate congestive heart failure (NYHA Class 2) Fbtient should undergo a complete cardiovascular work-up and treadmill stress testing to determine tolerance to increased myocardial energy consumption associated with increased sexual activity... 

Acute coronary syndromes Ischemic chest discomfort at rest, most often accompanied by ST-segment elevation, ST-segment depression, or T-wave inversion on the 12-lead electrocardiogram. Furthermore, it is caused by plaque rupture and partial or complete occlusion of the coronary artery by thrombus. Acute coronary syndromes include myocardial infarction and unstable angina. Former terms used to describe types of acute coronary syndromes include Q-wave myocardial infarction, non-Q-wave myocardial infarction, and unstable angina. 

WlNKELMANN BR, NAUCK M, KlEIN B, Russ AP, Bohm BO, Siekmeier R, Ihn-ken K, Verho M, Gross W, Marz W. Deletion polymorphism of the angiotensin I-converting enzyme gene Is associated with increased plasma angiotensin-con-verting enzyme activity but not with increased risk for myocardial infarction and coronary artery disease. Ann Intern Med 1996 125 19-25. 

Ischemia occurs when the blood supply to the heart muscle is temporarily or permanently reduced. The events which may cause ischemia include occlusion of a coronary artery, cardiac arrest, heart failure, a variety of arrhythmias, cardiopulmonary bypass, and aortic clamping during various cardiac operations. Such ischemia can possibly lead to infarction of the heart muscle and impairing of the heart [127],... 

Goal BP values are <140/90 for most patients, but <130/80 for patients with diabetes mellitus, significant chronic kidney disease, known coronary artery disease (myocardial infarction [MI], angina), noncoronary atherosclerotic vascular disease (ischemic stroke, transient ischemic attack, peripheral arterial disease [PAD], abdominal aortic aneurysm), or a 10% or greater Framingham 10-year risk of fatal coronary heart disease or nonfatal MI. Patients with LV dysfunction have a BP goal of <120/80 mm Hg. 

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