Ischemic myocardial changes

The ECG may show increased T-wave amplitude, shortening of the S-T segment, third-degree heart block, supraventricular or ventricular tachycardias, A-V block, ischemic myocardial changes (DeBush and Seidel, 1969 Lee-Jones et al., 1970 Ballantyne et al., 2006). Plain chest radiography may demonstrate pulmonary edema. 

Not recommended for use in patients with a history of left ventricular hypertrophy, ischemic ECG changes, chest pain, arrhythmias, or recent myocardial infarction... 

The combination of cisplatin 100 mg/m with 5-fluorouracil 1000 mg/m for 7 days caused angina and ischemic electrocardiographic changes, suggesting synergistic cardiotoxicity (269). There have also been cases of arterial occlusive events (270) and myocardial infarction (271,272), in some cases with evidence of coronary vascular spasm (273,274). 

No significant difference in the degree of elevation of Mn-SOD was found between groups with successful and unsuccessful reperfusion. However, the early elevation occurred slightly later in the unsuccessful cases, compared to the successful cases. This indicates that the early elevation of Mn-SOD is affected slightly by reperfusion, as is observed for CK. The time of appearance of the late elevation of Mn-SOD in these patients did not change with reperfusion. The secondary elevation of Mn-SOD is, therefore, a more reliable marker for the assessment of ischemic myocardial damage. 

Drug-drag interactions Ethanol A 50-year-old man developed intractable hypotension, which led to ischemic electrocardiographic changes and myocardial damage as a result of a disulfiram-ethanol interaction [30 ]. 

The precise definition of a myocardial infarction is a subject of detailed discussion in the literature. Different definitions can be used in clinical practice, clinical trials, and registries (White et al. 2014). In an attempt to standardize definitions, the Third Universal Definition of myocardial infarction is based on troponin elevation together with ischemic symptoms, ischemic ECG changes, and imaging evidence myocardial infarctions are classified into several types according to whether they are spontaneous, secondary to imbalance between coronary artery blood supply and demand, related to sudden death, or related to revascularization procedures (White et al. 2014). 

E. Therapeutic response Activase, and other thrombolytic agents, used in a timely manner during an evolving myocardial infarction, decrease mortality and improve left ventricular function. Resolution of chest pain, resolution of baseline EKG changes, reduced total creatine phospho-kinase (CPK) release, and preserved left ventricular function are evidence of cardiac reperfusion. Activase, administered within the first 3 hours of ischemic stroke onset, has been shown to improve recovery. 

Flecainide Sodium channel (INa) blockade Dissociates from channel with slow kinetics no change in action potential duration Supraventricular arrhythmias in patients with normal heart do not use in ischemic conditions (post-myocardial infarction) Oral hepatic, and kidney metabolism half life 20 h Toxicity Proarrhythmic... 

The effects of coenzyme Q10 on coronary artery disease and chronic stable angina are modest but appear promising. A theoretical basis for such benefit could be metabolic protection of the ischemic myocardium. Double-blind, placebo-controlled trials have demonstrated that coenzyme Q10 supplementation improved a number of clinical measures in patients with a history of acute myocardial infarction (AMI). Improvements have been observed in lipoprotein a, high-density lipoprotein cholesterol, exercise tolerance, and time to development of ischemic changes on the electrocardiogram during stress tests. In addition, very small reductions in cardiac deaths and rate of reinfarction in patients with previous AMI have been reported (absolute risk reduction 1.5%). 

A subsequent investigation (6 ) studied the resolution and sensitivity of Mn-52m as a quantitative measurement of the size and location of myocardial ischemia. Comparison between microsphere distributions and Mn-52m images taken at 1.5 cm levels revealed that an ischemic area down to the size of 2.5 cm with 50% of the normal myocardial perfusion can be seen in the positron images. In addition, a relative change of 10% or more of the normal perfusion in the ischemic area can also be observed. Large clinical studies with the Fe-52m/Mn-52m generator have recently been initiated at the National Heart and Lung and Institute, National Institutes of Health, Bethesda, Maryland ... 

Decreased cardiac performance. Any number of factors that affect cardiac pumping ability may be responsible for initiating a change in myocardial performance. Factors such as ischemic heart disease, myocardial infarction, valve dysfunction, and hypertension may all compromise the heart s pumping ability.29 53 71 Also, cardiomyopathy may result from other diseases and infections.13... 

O2 transport values and hemodynamics and may increase adverse cardiac effects. Infusion rates should be guided by clinical end points and mixed venous oxygen saturation/central venous oxygen saturation. Decreases in partial pressure of O2, as well as myocardial adverse effects such as tachycardia, ischemic changes on ECG, tachydysrhythmias, and hypotension, are seen. 

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