Of ischemic heart disease

Technetium-9 9m sestamibi is used in myocardial perfusion imaging for the evaluation of ischemic heart disease. It is prepared from a lyophilized kit containing tetrakis(2-methoxy isobutyl isonittile) copper(I) tetrafluoroborate stored under nitrogen. Upon reconstitution with up to 5.6 GBq (150 mCi) of 99mTc pertechnetate, the product is formed by boiling for 10 minutes. 

Identify risk factors for the development of ischemic heart disease. 

Recognize the symptoms and diagnostic criteria of ischemic heart disease in a specific patient. 

Identify the treatment goals of ischemic heart disease and appropriate lifestyle modifications and pharmacologic therapy to address each goal. 

Design an appropriate therapeutic regimen for the management of ischemic heart disease based on patient-specific information. 

O Ischemic heart disease results from an imbalance between myocardial oxygen demand and oxygen supply that is most often due to coronary atherosclerosis. Common clinical manifestations of ischemic heart disease include chronic stable angina and the acute coronary syndromes of unstable angina, non-ST-segment elevation myocardial infarction, and ST-segment elevation myocardial infarction. 

Patients with chest pressure or heaviness that is provoked by activity and relieved with rest should be assessed for ischemic heart disease. Sharp pain is not a typical symptom of ischemic heart disease. Some patients may experience discomfort in the neck, jaw, shoulder, or arm rather than, or in addition to, the chest. Pain may be accompanied by nausea, vomiting, or diaphoresis. 

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. 

Clinical Presentation and Diagnosis of Ischemic Heart Disease... 

In an attempt to determine whether the carcinogenicity observed in animal studies was predictive for humans, the mortality experience of ammunitions workers with opportunity for substantial DNT exposure was examined. No evidence of carcinogenic effect was found, but an unsuspected excess of ischemic heart disease was noted. Additional analyses showed evidence of a 15 -year latency period and suggested a relationship with duration and intensity of exposure. ... 

A cohort study of 5668 NG-exposed workers found an increased standardized mortality ratio for deaths from ischemic heart disease. The increase was more pronounced for those with 10 or more years of exposure and was statistically significant for the 40- to 49-year age group, whereas a deficit of cardiovascular mortality had been anticipated because of preplacement and annual medical examinations designed to exclude persons with cardiovascular abnormalities. These results were confirmed in a retrospective cohort mortality study that found a significant excess of ischemic heart disease mortality among workers actively exposed to NG and under the age of 45. ° (Note this study failed to detect a chronic cardiovascular effect as excess risk was only associated with workers actively exposed to NG.)... 

Atherosclerosis is a condition of the organism characterized by elevated levels of atherogenic lipoproteins in blood plasma, lipid deposits (including cholesterol) in the form of esters inside walls of the arterial system, and it is expressed by a gradual difficulty of blood circulation. The most appropriate name for this disease is lipoproteinemia. Clinically, it is manifested in the form of ischemic heart disease, stroke, abnormal cerebral blood flow, and peripheral ischemia. 

Vascular disease-A positive association is observed between the amount of estrogen and progestin in OCs and the risk of vascular disease. A decline in serum high-density lipoproteins (HDL) has occurred with progestins and has been associated with an increased incidence of ischemic heart disease. Because estrogens increase HDL cholesterol, the net effect depends on a... 

If anything, the burdens that cardiovascular disease impose on our society are only going to get worse over the next few decades. Our population is getting older, has more risk factors, more disease, and more effective therapeutic options. We are caught between the Scylla of an emerging epidemic of ischemic heart disease as we get older, and the Charybdis of better therapies to reduce premature events and keep our patients alive longer. 

Clinical research with bone marrow-derived stem cells has focused on the period immediately after an AMI and on the chronic phase of ischemic heart disease. In these clinical scenarios, therapy has been targeted to viable myocardium with or without systolic heart failure. On the other hand, skeletal myoblast therapy has been used to treat ischemic heart failure involving nonviable myocardium or scar... 

The low incidence of ischemic heart disease in the black population of Africa may mitigate the seriousness of the consequence of the metabolic effects of thiazide diuretics, for example hyperlipidemia and hypo-kalemia. 

Guidelines for the treatment of ischemic heart disease have become very sophisticated and even incorporate advice for the psychological treatment of the patient to improve outcome. They are very useful at the present day. However, in the acmal clinical... 

GaUa JM, Lincoff AM. The role of clopidogrel in the management of ischemic heart disease. Curr Opin Cardiol 2007 22(4) 273-9. 

As an example, bis(trifluoromethyl) carbinols have been described as strong inhibitors of malonyl-CoA decarboxylase, an enzyme involved in the metabolism of fatty acids, a possible target for the treatment of ischemic heart disease and diabetes (Figure 7.24)." Although few enzymological data are available, it is reasonable to... 

Exacerbation of ischemic heart disease following abrupt withdrawal due to rebound sensitivity to catecholamines possible... 

Depressive disorders can lead to death in other ways (Table 6-9). For example, depressed individuals are more prone to accidents that result from their impaired concentration and attention. They also often attempt to self-medicate, particularly with alcohol or other sedative agents, which may lead to death as a result of organ toxicity, as well as accidents. Psychotic depressive patients may act irrationally, putting themselves at greater physical risk. Although rare today, patients have died of severe malnutrition secondary to catatonic symptoms that precluded the ability to care for their basic needs. Depression can also contribute to a higher morbidity and mortality rate in patients with co-morbid medical disorders. For example, a large database indicates that depression may predispose to the development of ischemic heart disease and increase the risk of cardiac-related death ( 51). 

Homocysteine Studies Collaboration (2002) Homocysteine and risk of ischemic heart disease and stroke a meta-analysis. JAMA 288 2015-2022... 

Questions of possible long-term toxicity remain. Since 1976 there has been a greater than 25% decrease in the incidence of ischemic heart disease in the United States.)) Increased exercise, a decreased severity of influenza epidemics, and fluoridation of waterkk have been suggested as explanations. 

Estrogen replacement therapy was until recently widely recommended for the prevention of osteoporosis in middle-aged and older women (1). Long-term estrogen therapy also reduces the incidence of ischemic heart disease in such women (2). However, it has always been difficult to know in which women such prophylactic use is likely to be needed, and this dilemma is compounded by the prospect of adverse reactions, which can include any of the acute effects listed in the estrogen monograph, but also in some cases long-term effects such as tumors. 

Morato Hernandez MDL, Del Sagrario Ichazo Cerro M, Alvarado Vega AG, Zamora Gonzalez J, Cardoso Saldana GC, Posadas Romero C. Immediate release niacin in the treatment of ischemic heart disease. Arch Inst Cardiol Mex 2000 70 367-76. 

The importance of these effects for the long-term management of patients with hypertension or ischemic heart disease is unknown, but it is recognized that a high serum total cholesterol and a low HDL cholesterol are associated with an increased risk of ischemic heart disease. However, a significant reduction in HDL cholesterol after... 

In the Caerphilly cohort (UK) of elderly men, for example, an inverse, but not statistically significant, relationship was reported between a higher milk intake (0.5 1 vs. no milk intake) and the risk of both ischemic stroke and ischemic heart disease. This study included 2512 men of whom 493 had an event of ischemic heart disease and 185 had an ischemic stroke during 20-24 years of follow-up. In this study, information on milk drinking was obtained in a semiquantitive food frequency questionnaire (Elwood et al., 2004a) which may have been a limitation. 

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