Infarct hemodynamic

Carotid artery disease is one of the major causes of ischemic stroke. The predominant mechanisms by which it causes stroke are (a) arterial embolism from atherosclerotic plaques (b) hemodynamic changes, leading to watershed infarcts and (c) distal propagation of thrombus originating from acute carotid occlusion. ... 

Acute Ml - In hemodynamically stable patients within 24 hours of the onset of symptoms of acute Ml, the first dose is 5 mg, followed by 5 mg after 24 hours, 10 mg after 48 hours and then 10 mg once daily. Continue dosing for 6 weeks. Patients with a low systolic BP (120 mm Hg or less) when treatment is started or during the first 3 days after the infarct should be given a lower 2.5 mg dose. If hypotension occurs (systolic BP 100 mm Hg or less), a daily maintenance dose of 5 mg may be given with temporary reductions to 2.5 mg if needed. If prolonged hypotension occurs (systolic BP less than 90 mm Hg for more than 1 hour), withdraw lisinopril. 

Marchionni N, Schneeweiss A, Di Bari M, Ferrucci L, Moschi G, Salani B et al. Age-related hemodynamic effects of intravenous nitroglycerin for acnte myocardial infarction and left ventricular failure. Am J Cardiol... 

All agents are also effective in the control of variant (Prinzmetal s) angina, in which spasm of the coronary arteries is the main factor. Their usefulness in the more complex unstable (preinfarction) angina is less definite, depending on the hemodynamic status and the susceptibility of the patient to infarction. 

ACE inhibitors have a particularly useful role in treating patients with chronic kidney disease because they diminish proteinuria and stabilize renal function (even in the absence of lowering of blood pressure). This effect is particularly valuable in diabetes, and these drugs are now recommended in diabetes even in the absence of hypertension. These benefits probably result from improved intrarenal hemodynamics, with decreased glomerular efferent arteriolar resistance and a resulting reduction of intraglomerular capillary pressure. ACE inhibitors have also proved to be extremely useful in the treatment of heart failure, and after myocardial infarction, and there is recent evidence that ACE inhibitors reduce the incidence of diabetes in patients with high cardiovascular risk (see Chapter 13). 

Measurements of arterial pressure, cardiac output, stroke work index, and pulmonary capillary wedge pressure are particularly useful in patients with acute myocardial infarction and acute heart failure. Such patients can be usefully characterized on the basis of three hemodynamic measurements arterial pressure, left ventricular filling pressure, and cardiac index. One such classification and therapies that have proved most effective are set forth in Table 13-4. When filling pressure is greater than 15 mm Hg and stroke work index is less than 20 g-m/m2, the mortality rate is high. Intermediate levels of these two variables imply a much better prognosis. 

Auchampach JA, Rizvi A, Qiu Y, Tang XL, Maldonado C, Teschner S, Bolli R (1997b) Selective activation of A3 adenosine receptors with N6-(3-iodobenzyl)adenosine-5 -N-methyluronamide protects against myocardial stunning and infarction without hemodynamic changes in conscious rabbits. Circ Res 80(6) 800-809... 

Knock-out Increased synaptic plasticity, spatial memory and fear memory Chronic gliosis Decreased susceptibility to hypoxia-ischemia Enhanced epileptogenesis Enhanced Ca2+ transients Enhanced hypertrophy, decreased apoptosis and improved hemodynamics after myocardial infarction... 

Sildenafil was the first oral treatment for ED and is the most extensively evaluated (35). Overall success rates in patients with cardiovascular disease of 80% or greater have been recorded with no evidence of tolerance, Patients with diabetes with or without additional risk factors, with their more complex, and extensive pathophysiology, have an average success rate of 60%. In randomized trials to date, open-label or outpatient monitoring studies the use of sildenafil is not associated with any excess risk of myocardial infarction, stroke, or mortality (38-40), In patients with stable angina pectoris there is no evidence of an ischemic effect due to coronary steal, and in one large, double-blind, placebo-controlled, exercise study sildenafil 100 mg increased exercise time and diminished ischemia (41), A study of the hemodynamic effects in men with severe CAD identified no adverse cardiovascular effects and a potentially beneficial effect on coronary blood flow reserve (42), Studies in patients with and without diabetes have demonstrated improved endothelial function acutely and after long-term oral dose administration, which may have implications beyond... 

I Veselka J, Prochazkova S, Duchonova R et al. Alcohol septal ablation for hypertrophic obstructive cardiomyopathy Lower alcohol dose reduces size of infarction and has comparable hemodynamic and clinical outcome. Catheter Cardiovasc Interv 2004 63 231-235. 

Hossmann KA (1997) Reperfusion of the brain after global ischemia hemodynamic disturbances. Shock 8 95-101 Hossmann K-A (1987) Pathophysiology of cerebral infarction. In Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology. Elsevier, Amsterdam, pp 107-153 Hossmann K-A (1991) Animal models of cerebral ischemia. 1. 

In the past, two different basic mechanisms have been proposed to account for ischemic events in ICA occlusive disease (1) intracranial embolism and (2) a low-perfusion state also referred to as hemodynamic insufficiency. In the post-mortem arteriographic and pathologic study by Rodda and Path (1986), massive infarcts involving two major cerebral artery territories were associated with distal ICA occlusion, middle cerebral artery (MCA) territory infarcts were seen when the ICA was occluded or stenosed, and borderzone infarcts were characterized by ICA disease and limited circle of Willis anastomosis. 

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