Acute myocardial ischemia

Cisplatin (300 Da) Hypertension, myocardial ischemia, acute coronary syndromes, LV dysfunction... 

Fluorouracil (130 Da) Myocardial ischemia, acute heart failiue, hypotension, electrocardiographic changes, acute coronary syrndromes... 

Wang W, Schulze CJ, Suarez-Pinzon WL et al (2002) Intracellular action of matrix metaUoproteinase-2 accounts for acute myocardial ischemia and reperfusion injury. Circulation 106 1543-1549... 

Combination GP Ilb/IIIa and rt-PA Therapy for Acute Stroke The combination of antiplatelet and thrombolytic drugs has proven efficacy in the setting of myocardial ischemia where an additive effect is seen. In acute stroke thrombolysis with a very narrow time window and less than 50% optimal reperfusion rates,adjunctive therapy with antiplatelets may be a promising approach. However, MAST-I concluded that the group of patients receiving streptokinase plus aspirin had a marked increase in 10-day mortality. 

Electrocardiogram (ECG) May be normal or could show numerous abnormalities including acute ST-T-wave changes from myocardial ischemia, atrial fibrillation, bradycardia, and LV hypertrophy. 

The major goals for the treatment of ischemic heart disease are to prevent acute coronary syndromes and death, alleviate acute symptoms of myocardial ischemia, prevent recurrent symptoms of myocardial ischemia, and avoid or minimize adverse treatment effects. 

Acute coronary syndromes is a term that includes all clinical syndromes compatible with acute myocardial ischemia resulting from an imbalance between myocardial oxygen demand and supply.3 In contrast to stable angina, an ACS results primarily from diminished myocardial blood flow secondary to an occlusive or partially occlusive coronary artery thrombus. Acute coronary syndromes are classified according to electrocardiogram (ECG) changes into STE ACS (STE MI) or NSTE ACS (NSTE MI and unstable angina) (Fig. 5-1). An STE MI, formerly... 

Current data suggest little benefit on clinical outcomes beyond symptom relief for calcium channel blockers in the setting of ACS.43 Moreover, the use of first-generation shortacting dihydropyridines, such as nifedipine, should be avoided because they appear to worsen outcomes through their negative inotropic effects, induction of reflex sympathetic activation, tachycardia, and increased myocardial ischemia.43 Therefore, calcium channel blockers should be avoided in the acute management of MI unless there is a clear symptomatic need or a contraindication to p-blockers. 

While the role of PHD inhibitors in the treatment of anemia is now validated, therapeutic validation is less certain in other HIF-associated pathologies such as wound healing, ulcerative colitis, therapeutic angiogenesis, and treatment of acute ischemic events such as myocardial ischemia and stroke. All of these indications are supported by a compelling array of in vitro and in vivo preclinical studies but their utility in the clinical setting remains to be evaluated and represents exciting possibilities for the future of small-molecule inhibitors of PHD enzymes. 

Acute coronary syndromes (ACSs) include all clinical syndromes compatible with acute myocardial ischemia resulting from an imbalance between myocardial oxygen demand and supply. 

If severe symptoms are present, synchronized DCC should be instituted immediately to restore sinus rhythm. Precipitating factors should be corrected if possible. If VT is an isolated electrical event associated with a transient initiating factor (e.g., acute myocardial ischemia, digitalis toxicity), there is no need for long-term antiarrhythmic therapy after precipitating factors are corrected. 

The nitrovasodilator sodium nitroprusside (SNP) has been used for decades to manage acute hypertensive crises and congestive heart failure complicating myocardial ischemia [99]. However, prolonged SNP administration is limited by tolerance, the... 

The sudden deaths of workers in the explosives industry have been attributed to a series of cardiovascular events that occur after repeated occupational exposures (Carmichael and Lieben 1963). Acute exposures result in a depression of both the systolic and diastolic blood pressure. Continued exposure to low concentrations of nitrate esters produces a progressive rise in the diastolic blood pressure from the previously depressed level without a comparable rise in the systolic blood pressure. This narrowing of the pulse pressure combined with an increased diastolic pressure and high pulse rate, which occurs following cessation of exposure, may contribute to acute myocardial ischemia. 

Endothelin eta Human cDNA Acute pancreatitis, artherosderosis, cancer, hypertension, congestive heart failure, diabetes, obesity, inflammation, myocardial ischemia, prostatic hypertrophy, pulmonary fibrosis, stroke, ulcer, pain Vasoconstriction, bronchoconstriction, positive cardiac inotropy, proliferative responses, aldosterone secretion, neuroprotection... 

Ocular Narrow-angle glaucoma adhesions (synechiae) between the iris and lens. Carc//ovascw/ar Tachycardia unstable cardiovascular status in acute hemorrhage myocardial ischemia. 

Fig. 7.13 Electromechanical map of the left ventricle performed with the NOGA XP platform in an acute ovine model of myocardial ischemia (anteroapical myocardial...

Waters D, Schwartz GG, Olsson AG. The Myocardial Ischemia Reduction with Acute Cholesterol Lowering... 

Eliminate the cause. Precipitating factors must be recognized and eliminated if possible. These include not only abnormalities of internal homeostasis, such as hypoxia or electrolyte abnormalities (especially hypokalemia or hypomagnesemia), but also drug therapy and underlying disease states such as hyperthyroidism or cardiac disease. It is important to separate this abnormal substrate from triggering factors, such as myocardial ischemia or acute cardiac dilation, which may be treatable and reversible. 

There are two forms of arrhythmia in acute myocardial ischemia. Type-la arrhythmias occur 2-10 min after the onset of ischemia with a peak at 5-6 min. These arrhythmias are often of the reentrant type and are caused by diastolic bridging (details see chapter 1). It is also possible that premature ventricular depolarizations occur in this phase and initiate reentry. 

Coronel R Distribution of Extracellular Potassium during Acute Myocardial Ischemia thesis, Amsterdam,... 

Janse MJ, van Capelle FJL Electrotonic interactions across an inexcitable region as a cause of ectopic activity in acute regional myocardial ischemia. Circ Res 1982 50 527-537. 

Janse MJ, van Capelle FJL, Morsink H, Kleber AG, Wilms-Schopman F, Cardinal R, Naumann d Alnon-court C, Durrer D Flow of injury current and patterns of excitation during early ventricular arrhythmias in acute myocardial ischemia in isolated porcine and canine hearts. Circ Res 1980 47 151-165. 

Kleber AG, Janse MJ, van Capelle FJL, Durrer D Mechanism and time course of ST and TQ segment changes during acute regional myocardial ischemia in the pig heart determined by extracellular and intracellular recordings. Circ Res 1978 42 603-613. 

Kiewitz R, Acklin C, Minder E, Huber PR, Schafer BW, Heizmann CW. 2000a. S100A1, a new marker for acute myocardial ischemia. Biochem Biophys Res Commun 274(3) 865-871. 

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