Myocardial ischemia reduction with

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

Patients enrolled early after acute coronary syndromes Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) (21), Fluvastatin On Risk... 

Abbreviations ACS. acute coronary syndrome AECG. ambulatory electrocardiogram FLORIDA, fluvastatin on risk diminishment after acute myocardial infarction Ml. myocardial infarction MIRACL, myocardial ischemia reduction with aggressive cholesterol lowering nfMI. nonfatal myocardial infarction PACT, pravastatin in acute coronary treatment PROVE-IT TIMI 22. pravastatin or atoivastatin evaluation and infection therapy—thrombolysis in myocardial infarction 22 UAP, unstable anginapectoris. 

Fraley AE, Schwartz GG, Olsson AG et al. Relationship of oxidized phospholipids and biomarkers of oxidized low-density hpoprotein with cardiovascular risk factors, inflammatory biomarkers, and effect of statin therapy in patients with acute coronary syndromes Results from the MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering) trial. Journal of the American CollMe of Cardiology 2009 53 2186-2196. 

Low-dose dopamine is not without adverse reactions and most studies have failed to evaluate its potential toxicities. Adverse reactions that may be associated with low-dose dopamine include tachycardia, arrhythmias, myocardial ischemia, depressed respiratory drive, and gut ischemia. Low-dose dopamine has also been postulated to impair resistance to infection through a reduction in prolactin concentrations.21 Furthermore, significant overlap in receptor activation occurs. Therefore, doses considered to activate only dopamine receptors may increase cardiac output and blood pressure through dopamine s effect on 3- or a-adrenergic receptors. 

Kent, K.M. Cleman, M.W. Cowley, M.J. Forman, M. Jaffe, C.C. Kaplan, M. King, S.B. Krucoff M. Lassar, T. McAuley, B. Smith, R. Wisdom, C. Wohlgelernter, D. Reduction of myocardial ischemia during percutaneous transluminal coronary angioplasty with oxygenated fluosol. Am. J. Cardiol. 1990, 66, 279-284. 

Myocardial hibernation is an adaptation caused by chronic or intermittent reduction in coronary flow characterized as reduced regional contractile function that recovers after removal of the artery stenosis. A subacute downregulation of contractile function in response to reduced regional myocardial blood flow can occur, which normalizes regional energy and substrate metabolism but does not persist more than 12-24 h. Chronic hibernation develops in response to episodes of myocardial ischemia and reperfusion, progressing from repetitive stunning with normal blood flow to hibernation with reduced blood flow, reviewed by Heusch.80... 

The myocardium preferentially oxidizes fatty acids to fulfill the energy requirements necessary for efficient pump function. However, during myocardial ischemia, decreased cellular oxygen content, in conjunction with reduction of the redox potential, result in the inhibition of fatty acid P-oxidation leading to the accumulation of fatty acyl metabolites, including acylCoA and acylcamitine (cf, Neely and Morgan, 1974). 

Patients with diastolic heart failure are typically dependent upon preload to maintain adequate cardiac output. While patients with symptomatic volume overload will benefit from careful modulation of intravascular volume, volume reduction should be accomplished gradually and treatment goals reassessed frequently. In addition to cautious volume management, it is important to maintain synchronous atrial contraction in such patients, which maintains adequate left ventricular filling during the latter phase of diastole. Cardiac function is often severely impaired if patients with diastolic heart failure develop atrial fibrillation, particularly in the context of sub-optimal ventricular rate control. Meticulous control of the ventricular rate with drugs that slow AV conduction is mandatory (see Chapter 34) and restoration of sinus rhythm should be considered. It is also important to evaluate and treat conditions that are associated with dynamic abnormalities of diastolic function, such as myocardial ischemia and poorly controlled systemic hypertension. 

In the decompensated patient who presents with heart failure and normal systemic vascular resistance, afterload reduction may be contraindicated, and treatment with a parenteral agent such as dobutamine may be preferable. The risk attendant to treatment with sympathomimetic drugs is related to the increase in myocardial Oj consumption that may occur this is of particular concern in patients with left heart failure that occurs as a direct consequence of myocardial ischemia. This clinical quandary has become less common in the era of aggressive myocardial revascularization when it is encountered, coadministration of dobutamine with parenteral nitroglycerin should be considered. 

Cui J, Cordis GA, Tosaki A, Maulik N, Das DK (2002) Reduction of myocardial ischemia reperfusion injury with regular consumption of grapes. Ann N Y Acad Sci 957 302-307... 

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