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Coronary Artery Spasm Induced in Atherosclerotic Miniature Swine
Hiroaki Shimokawa; Hitonobu Tomoike; Shozo Nabeyama; Hideo Yamamoto; Haruo Araki; Motoomi Nakamura; Yutaka Ishi; Kenzo Tanaka
Angiographically demonstrable coronary artery spasm could be provoked repeatedly by giving intracoronary or intravenous injections of histamine to miniature swine with experimentally induced atherosclerotic lesions of the coronary artery. The spasm induced in this way subsided either spontaneously or after the administration of nitroglycerin and was prevented by a calcium antagonist or an agent that blocks histamine H1 receptors. This
[A case of ventricular tachycardia that was probably caused by coronary artery spasm induced by pericardial manipulation].
Kimura, Hiroko; Ogawa, Sae; Koga, Yukari; Mishima, Yasunori; Ushijima, Kazuo
We present a case of ventricular tachycardia (VT) that was probably caused by coronary artery spasm. A 74-year-old man was scheduled to undergo right lower lobectomy for lung cancer. Although he had never suffered from any episodes of ischemic heart disease, he had several risk factors for coronary artery disease (CAD); i. e., a history of smoking, a low high-density lipoprotein cholesterol level, and diabetes mellitus type 2. Anesthesia for one-lung ventilation was maintained by inhalation of sevoflurane (1-1.5%), the continuous intravenous infusion of remifentanil (0.1-0.15 ?g x kg(-1) x min(-1)), and the intermittent administration of epidural (T4-5) 2% mepivacaine (4 ml) and 0.75% ropivacaine (5 ml). During manipulation of the pericardium, the patient's systolic blood pressure suddenly increased to 200 mmHg, followed by an ST elevation on his electrocardiogram. Despite the immediate infusion of nitroglycerin (1 mg), he developed non-sustained VT, lasting for about 30 seconds. Then, diltiazem (0.5 ?g x kg(-1) x min(-1)) was continuously administered, and the infusion rate of remifentanil was increased to 0.3 ?g x kg(-1) x min(-1). The patient recovered smoothly from anesthesia and his postoperative course was uneventful. Anesthesiologists should be aware of the possibility of coronary artery spasms induced by sudden modulation of the autonomic nervous system, particularly in patients who are at high risk of CAD. PMID:25731063
[Coronary artery spasm induced by neuroleptic malignant syndrome during off-pump coronary artery bypass grafting; report of a case].
Mori, Akiko; Yamaya, Kazuhiro; Nitta, Yoshio; Yoshida, Seijiro
A 61-year-old woman with a left main lesion and coronary spastic angina was scheduled for off-pump coronary artery bypass grafting (OPCAB). She had been orally receiving selective serotonin reuptake inhibitor( SSRI) for the treatment of depression. OPCAB to left anterior discending artery( LAD) and left circumflex branch (LCX) was performed using the bilateral internal thoracic arteries assisted by intra-aortic balloon pumping. When the sternotomy was going to be closed, ST elevation of electrocardiogram (ECG) occurred and was followed by complete atrio-ventricular (AV) block. After returning to intensive care unit (ICU), the patient showed rapid elevation of the body temperature, excessive sweating, progressive metabolic acidosis, and abnormal high levels in white blood cell count and creatine phosphokinase. On suspicion of neuroleptic malignant syndrome(NMS) onset, dantrolene sodium hydrate was administered, resulting in marked improvement of the symptoms. We have concluded that this case was an NMS combined with coronary artery spasm during OPCAB treated successfully with dantrolene sodium hydrate. PMID:24743539
Coronary artery and graft spasm after off-pump coronary artery bypass grafting.
Fukui, Toshihiro; Takanashi, Shuichiro; Hosoda, Yasuyuki
We report a case of a 52-year-old man with severe coronary artery and graft spasm after triple-vessel off-pump coronary artery bypass grafting. Emergent coronary angiography was performed to identify the location and severity of the spasm. Intracoronary injections of several vasodilators failed to relieve the spasm. Observational treatments including intra-aortic balloon pump and inotropic drugs to increase coronary flow were performed until the spasm resolved. The patient recovered and was discharged. A follow-up coronary angiography revealed patent native coronary artery and bypass grafts without evidence of residual spasm. PMID:15782575
Coronary artery and graft spasm after off-pump coronary artery bypass grafting
Toshihiro Fukui; Shuichiro Takanashi; Yasuyuki Hosoda
We report a case of a 52-year-old man with severe coronary artery and graft spasm after triple-vessel off-pump coronary artery\\u000a bypass grafting. Emergent coronary angiography was performed to identify the location and severity of the spasm. Intracoronary\\u000a injections of several vasodilators failed to relieve the spasm. Observational treatments including intra-aortic balloon pump\\u000a and inotropic drugs to increase coronary flow were
Klippel-Trenaunay syndrome and radial artery coronary graft spasm.
Yaqub, Yasir; Suarez, Jose; Perez-Verdia, Alejandro; Arvandi, Aliakbar; Nugent, Kenneth M
A 75-year-old woman with known diagnosis of Klippel-Trenaunay syndrome presented with acute onset of chest pain, dyspnea and elevated cardiac enzymes. She had triple vessel coronary artery disease on subsequent coronary angiography. Given the unavailability of venous conduits secondary to lower extremity varicosities, coronary artery bypass grafting with radial and internal mammary arterial grafts was carried out. The radial artery graft went into spasm two days later and required intracoronary vasodilators to relieve the spasm. The patient remained hypotensive and finally expired. PMID:19811720
Postoperative coronary artery spasm after mitral valve replacement?
Pragliola, Claudio; Gaudino, Mario; Farina, Piero; Massetti, Massimo
Introduction Postoperative coronary artery spasm is an infrequent life-threatening event after cardiac surgery which can occur without an underlying coronary disease Presentation of case We report a documented case of a 67-year-old man with normal coronary arteries submitted to mitral valve replacement. Immediately after surgery he had a ST elevation in the inferior leads, and an inferior wall hypokinesia at the trans-oesophageal echo. A coronary angiography demonstrated a focal spasm in the right coronary artery which was successfully treated by intracoronary injection of nitrates. The following postoperative course was uneventful and the left ventricular function returned to normal. Discussion A coronary artery spasm should be suspected whenever a postoperative infarction occurs after valvular surgery especially in absence of associated coronary artery disease. In this cases postoperative coronary angiography allows both the diagnosis and the treatment. Conclusion This case-report summarizes the findings of this rare and potentially life-threatening cause of early postoperative ischemia and highlights the role of early coronary angiography in the cases of suspected myocardial infarction after cardiac surgery PMID:25680533
Association between type a behavior pattern and coronary artery spasm in japanese patients
Reiko Hori; Takahiko Suzuki; Junichiro Hayano
The relations between the Jenkins Activity Survey (JAS) Type A score and coronary atherosclerosis and spasm were examined\\u000a in 192 patients (115 men and 77 women) undergoing coronary angiography. Thirty-nine men (34%) and 12 women (16%) had significant\\u000a (>- 75%) coronary stenosis. In 97 patients (54 men and 43 women) with no significant coronary stenosis, a coronary spasm provocation\\u000a test
Severity of myocardial fatty acid dysmetabolism induced by coronary spasm does not differ with Thrombolysis in Myocardial Infarction (TIMI) grade during intracoronary acetylcholine provocation tests.
Yoneyama, Kihei; Akashi, Yoshihiro J; Ashikaga, Kohei; Kida, Keisuke; Sato, Yukio; Tsukahara, Maya; Yamada, Marika; Takagi, Yasushi; Kamijima, Ryo; Suzuki, Kengo; Musha, Haruki; Harada, Tomoo
Whether additional intracoronary acetylcholine (ACH) injections are required for severe coronary spasm without limited coronary flow in the ACH provocation test remains unclear. We used (123)I-?-methyl-iodophenyl pentadecanoic acid ((123)I-BMIPP) to identify myocardial ischemic memory to compare the severity of myocardial fatty acid dysmetabolism among Thrombolysis in Myocardial Infarction (TIMI) grade flow.Thirteen hypertensive volunteers (mean age, 69.5 years) and 37 patients with VSA (mean age, 62.8 years) were enrolled. The patients with VSA were stratified according to TIMI flow grades of 3 (90% luminal narrowing; n = 12) or TIMI 0-2 (? 99% or total occlusion; n = 25) during ACH provocation tests. Two weeks after cardiac catheterization, (123)I-BMIPP myocardial scintigraphic images were obtained at 15 minutes (early) and at 4 hours (delayed) after tracer injection. The heart-to-mediastinum (H/M) ratio and washout rates (WR) were calculated from planar images.The TIMI 3 and TIMI 0-2 groups had significantly lower early and delayed H/M ratios than controls but the difference did not reach significance between the two groups (Early: 2.7 � 0.5 versus 2.3 � 0.4 and 2.2 � 0.3, P = 0.024; Delayed: 2.4 � 0.4 versus 1.8 � 0.3 and 1.8 � 0.3, P = 0.001). The washout rate was greater for TIMI 0-2 than the controls.The severity of myocardial fatty acid dysmetabolism did not differ between TIMI 3 and TIMI 0-2 coronary spasms. Additional ACH might not be required considering safety and the severity of coronary spams with TIMI 3 grade flow. PMID:25088582
Coronary Artery Spasm Related to Thiol Oxidation and Senescence Marker Protein-30 in Aging
Yamada, Shinya; Machii, Hirofumi; Mizukami, Hiroyuki; Hoshino, Yasuto; Misaka, Tomofumi; Ishigami, Akihito; Takeishi, Yasuchika
Abstract Background: Senescence marker protein-30 (SMP30) decreases with aging, and SMP30 knockout (KO) mice show a short life with increased oxidant stress. Aims: We assessed the effect of oxidant stress with SMP30 deficiency in coronary artery spasm and clarify its underlying mechanisms. Results: We measured vascular responses to acetylcholine (ACh) and sodium nitroprusside (SNP) of isolated coronary arteries from SMP30 KO and wild-type (WT) mice. In SMP30 KO mice, ACh-induced vasoconstriction occurred, which was changed to vasodilation by dithiothreitol (DTT), a thiol-reducing agent. However, N?-nitro-l-arginine-methyl ester, nitric oxide (NO) synthase inhibitor, or tetrahydrobiopterin did not change the ACh response. In isolated coronary arteries of WT mice, ACh-induced vasodilation occurred. Inhibition of glutathione reductase by 1, 3-bis(2-chloroethyl)-1-nitrosourea decreased ACh-induced vasodilation (n=10, p<0.01), which was restored by DTT. To evaluate the thiol oxidation, we measured the fluorescence of monochlorobimane (MCB) in coronary arteries, which covalently labels the total. The fluorescence level to MCB decreased in SMP30 KO mice, but with DTT treatment restored to a level comparable to that of WT mice. The reduced glutathione and total thiol levels were also low in the aorta of SMP30 KO mice compared with those of WT mice. Administration of ACh into the aortic sinus in vivo of SMP30 KO mice induced coronary artery spasm. Innovation: The thiol redox state is a key regulator of endothelial NO synthase activity, and thiol oxidation was associated with endothelial dysfunction in the SMP30 deficiency model. Conclusion: These results suggest that chronic thiol oxidation by oxidant stress is a trigger of coronary artery spasm, resulting in impaired endothelium-dependent vasodilation. Antioxid. Redox Signal. 19, 1063�1073. PMID:23320823
ST-elevation myocardial infarction secondary to coronary artery spasm provoked by food.
Young, William; Bhichhyan, Rai; Kabir, Alamgir; Hussain, Wajid
We describe a patient with recurrent episodes of inferior ST elevation, secondary to coronary artery spasm. Each episode appeared to be provoked by the ingestion of rice and accompanied by a troponin T rise. An inpatient coronary angiogram immediately following an episode of pain demonstrated a focal area of spasm affecting the right coronary artery, which resolved with intracoronary nitrate injection. Although these episodes were self-limiting, cardiac MRI confirmed an acute subendocardial infarct. An association between food substances and coronary artery spasm with subsequent infarction has not been documented previously. Following appropriate advice and titration of antispasmodic medication, the patient has been pain free. PMID:25225191
Thyrotoxicosis and coronary artery spasm: case report and review of the literature.
Al Jaber, Jihad; Haque, Saiful; Noor, Hassam; Ibrahim, Buthina; Al Suwaidi, Jassim
A 51-year old Middle-Eastern man presented with recurrent chest pain associated with ST-segment elevation. The patient was treated with placement of a stent in the right coronary artery. He was subsequently diagnosed with severe hyperthyroidism secondary to Graves disease, which is thought to be the cause of the coronary spasm. The patient was treated with neomercazole and potassium iodide solution, and diltiazem, and nitrates with resolution of his symptoms. This unusual case highlights the importance of considering hyperthyroidism in the differential diagnosis of recurrent chest pain and coronary artery spasm. We suggest routine thyroid function testing in patients with coronary spasm. PMID:20498149
Ventricular fibrillation due to coronary spasm at the site of myocardial bridge -A case report-
Choi, Jung Gi; Lee, Cheol Seung; Choi, June Seog
Myocardial bridge is a congenital anomaly characterized by narrowing of some of the epicardial coronary arterial segments running in the myocardium during systole. Occasionally, the compression of a coronary artery by a myocardial bridge can be associated with the clinical manifestations of myocardial ischemia, and might even trigger a myocardial infarction or malignant ventricular arrhythmias. We report a case of ventricular fibrillation due to coronary spasm at the site of myocardial bridge. A 56-year-old man who had suffered from bronchial asthma was given remifentanil combined with sevoflurane in general anesthesia for endoscopic sinus surgery. During the surgery, ventricular fibrillation occurred following coronary spasm with bradycardia, hypotension, bronchospasm. we found myocardial bridge that coincided with an area of coronary spasm after coronary angiography. PMID:20498820
A missense Glu298Asp variant in the endothelial nitric oxide synthase gene is associated with coronary spasm in the Japanese
Michihiro Yoshimura; H. Yasue; Masafumi Nakayama; Yukio Shimasaki; Hitoshi Sumida; Seigo Sugiyama; Kiyotaka Kugiyama; Hisao Ogawa; Yoshihiro Ogawa; Yoshihiko Saito; Yoshihiro Miyamoto; Kazuwa Nakao
Coronary spasm plays an important role in the pathogenesis of not only variant angina but also ischemic heart disease in\\u000a general. However, the precise mechanism(s) by which coronary spasm occurs remains to be elucidated. Coronary spasm may arise\\u000a from interactions between environmental and genetic factors. Endothelial derived nitric oxide (NO) has been implicated in\\u000a the control of vascular tone. We
Simultaneous multivessel coronary artery spasm demonstrated by quantitative analysis of thallium-201 single photon emission computed tomography
Kugiyama, K.; Yasue, H.; Okumura, K.; Minoda, K.; Takaoka, K.; Matsuyama, K.; Kojima, A.; Koga, Y.; Takahashi, M.
Thallium-201 myocardial scintigraphy with quantitative analysis of emission computed tomography was performed during episodes of angina in 19 patients with variant angina and nearly normal coronary arteriographic findings. Eleven patients (group I) were shown by arteriography to have spasm in 2 or more large coronary arteries. Eight patients (group II) had spasm in only 1 coronary artery. In 7 patients in group I, significant diffuse perfusion defects simultaneously appeared in multiple coronary artery regions on the scintigram (group IA). The extent and severity of the perfusion defect as measured by thallium-201 tomography were significantly greater in group IA than in group II (p less than 0.001 and p less than 0.01, respectively). The duration of transient ST-segment elevation during the attack in group IA was significantly longer than in group II (p less than 0.001). The incidence of ventricular arrhythmias, including ventricular tachycardia, or complete atrioventricular block during the anginal attack was significantly higher (p less than 0.05) in group IA than in group II. In all study patients, neither attack nor scintigraphic perfusion defect appeared on the repeat test after oral administration of nifedipine. In conclusion, multivessel coronary artery spasm simultaneously appears and causes the attack in many patients with variant angina and nearly normal coronary arteriographic findings, and myocardial ischemia due to simultaneous multivessel coronary spasm is likely to be more extensive and severe, persist longer and have a higher frequency of potentially dangerous arrhythmias than that due to spasm of only 1 coronary artery.
Case of angina pectoris at rest and during effort due to coronary spasm and myocardial bridging
Teragawa, Hiroki; Fujii, Yuichi; Ueda, Tomohiro; Murata, Daiki; Nomura, Shuichi
We present a case of a 71-year-old male who had chest symptoms at rest and during effort. He had felt chest oppression during effort for 1 year, and his chest symptoms had recently worsened. One month before admission he felt chest squeezing at rest in the early morning. He presented at our institution to evaluate his chest symptoms. Electrocardiography and echocardiography failed to show any specific changes. Because of the possibility that his chest symptoms were due to myocardial ischemia, he was admitted to our institution for coronary angiography (CAG). An initial CAG showed mild atherosclerotic changes in the proximal segment of the left anterior descending coronary artery (LAD) and mid-segment of the left circumflex coronary artery. Subsequent spasm provocation testing using acetylcholine revealed a bilateral coronary vasospasm, which was relieved after the intracoronary infusion of nitroglycerin. Finally, a CAG showed myocardial bridging (MB) of the mid-distal segments of the LAD. Fractional flow reserve using the intravenous administration of adenosine triphosphate was positive at 0.77, which jumped up to 0.90 through the myocardial bridging segments when the pressure wire was pulled back. Thus, coronary vasospasm and MB might have contributed to his chest symptoms at rest and during effort. Interventional cardiologists should consider the presence of MB as a potential cause of myocardial ischemia. PMID:26131343
Myocardial infarction induced by coronary vasospasm after self-administration of epinephrine.
Saff, R; Nahhas, A; Fink, J N
A case of a 30-year-old man who developed a myocardial infarction after self-administering an Epi-Pen for an episode of idiopathic anaphylaxis is reported. The patient had numerous risk factors for coronary artery disease, and it was suspected that epinephrine-induced coronary spasm caused the infarct. The Epi-Pen Junior may be indicated in such adults with numerous risk factors for coronary artery disease who are at risk for recurrent anaphylaxis. PMID:8498731
Krystkowiak, P
Hemifacial spasm is one of the two most common craniofacial movement disorders (blepharospasm is the second one). It is characterised by unilateral involuntary contractions of muscles involved in facial expression that are innervated by the facial nerve. Most of the time, hemifacial spasm is a peripherally-induced movement disorder caused by vascular compression of the facial nerve near its origin from the brainstem. Although it is a benign condition, it can cause significant cosmetic and functional disability. It is a chronic disease and spontaneous recovery is very rare. The two treatments that are really efficient and routinely available are microvascular decompression and botulinum toxin muscular injections. PMID:19576481
Spasm provocation tests performed under medical therapy: a new approach for treating patients with refractory coronary spastic angina on emergency admission.
Sueda, Shozo; Kohno, Hiroaki; Miyoshi, Toru; Sasaki, Yasuhiro; Sakaue, Tomoki; Habara, Hirokazu
Objective There are no objective methods for evaluating the severity of vasospasms in patients with refractory coronary spastic angina (R-CSA) under adequate medical therapy. We examined whether spasm provocation tests performed under adequate medication are useful for evaluating the severity of disease in R-CSA patients on emergency admission. Methods and Results We performed spasm provocation tests before and after the administration of medical therapy in eight R-CSA patients, including one ventricular fibrillation survivor (VF-S) and seven patients with unstable angina (UAP) on emergency readmission. We also performed these tests only after medical therapy on urgent admission in four R-CSA patients, including two patients with UAP, one patient with VF-S and one patient with acute coronary syndrome. All 12 R-CSA patients had been medicated with ? 2 vasodilator drugs. Positive coronary spasms were defined as >99% transient narrowing. The coronary artery spasms disappeared in three patients under medication, and mitigation of vasospasticity was observed in three patients. In these six cases we continued the same medications. Meanwhile in two patients, we recommended a consultation for psychosomatic medicine. In contrast, the remaining six R-CSA patients exhibited higher levels of vasospasticity, irrespective of the administration of aggressive medical therapy, in which the doses of vasoactive drugs were increased in order to suppress coronary artery spasms. Conclusion In some R-CSA patients on emergency admission, performing spasm provocation tests under medical therapy is useful for determining the subsequent treatment strategy. Therefore, this test may become a new tool in the treatment of R-CSA. PMID:25130103
T27863C Mutation in the 5*-Flanking Region of the Endothelial Nitric Oxide Synthase Gene Is Associated With Coronary Spasm
Masafumi Nakayama; Hirofumi Yasue; Michihiro Yoshimura; Yukio Shimasaki; Kiyotaka Kugiyama; Hisao Ogawa; Takeshi Motoyama; Yoshihiko Saito; Yoshihiro Ogawa; Yoshihiro Miyamoto; Kazuwa Nakao
Conclusions�Taken together, these findings strongly suggest that the T 27863 C mutation in the eNOS gene reduces the endothelial NO synthesis and predisposes the patients with the mutation to coronary spasm. (Circulation. 1999;99:2864-2870.)
Diffuse esophageal spasm; Spasm of the esophagus; Distal esophageal spasm ... Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap ...
Basal and Ischemia-Induced Transcardiac Troponin Release into the Coronary Circulation in Patients with Suspected Coronary Artery Disease
Konishi, Masaaki; Sugiyama, Seigo; Sugamura, Koichi; Nozaki, Toshimitsu; Ohba, Keisuke; Matsubara, Junichi; Sakamoto, Kenji; Nagayoshi, Yasuhiro; Sumida, Hitoshi; Akiyama, Eiichi; Matsuzawa, Yasushi; Sakamaki, Kentaro; Morita, Satoshi; Kimura, Kazuo; Umemura, Satoshi; Ogawa, Hisao
Background Cardiac troponin is a specific biomarker for cardiomyocyte necrosis in acute coronary syndromes. Troponin release from the coronary circulation remains to be determined because of the lower sensitivity of the conventional assay. We sought to determine basal and angina-induced troponin release using a highly sensitive troponin assay. Methods and Results The cardiac troponin T levels in serum sampled from the peripheral vein (PV), the aortic root (AO), and the coronary sinus (CS) were measured in 105 consecutive stable patients with coronary risk factor(s) and suspected coronary artery disease (CAD) and in 33 patients without CAD who underwent an acetylcholine provocation test. At baseline, there was a significant increase in the troponin levels from AO [9.0 (6.4, 13.1) pg/mL for median (25th, 75th percentiles)] to CS [10.3 (7.3, 15.5) pg/mL, p<0.001] in 96 (91.4%) patients and the difference was 1.1 (0.4, 2.1) pg/mL, which reflected basal transcardiac troponin release (TTR). TTR was positively correlated with PV levels (r?=?0.22, p?=?0.03). Male sex, left ventricular hypertrophy determined by echocardiography, T-wave inversion, and CAD correlated with elevated TTR defined as above: median, 1.1 pg/mL. A significant increase in TTR was noted in 17 patients with coronary spasms [0.6 (0.2, 1.2) pg/mL, p<0.01] but not in 16 patients without spasms [0.0 (?0.5, 0.9) pg/mL, p?=?0.73] after the acetylcholine provocation. Conclusion Basal TTR in the coronary circulation was observed in most of the patients with suspected CAD and risk factor(s). This sensitive assay detected myocardial ischemia-induced increases in TTR caused by coronary spasms. PMID:23565198
Characterization of the Oxybutynin Antagonism of Drug-Induced Spasms in Detrusor
Gordon F. Anderson; Christopher M. Fredericks
Oxybutynin chloride exerts a moderate anticholinergic effect on rabbit detrusor in vitro, which is reversible and competitive in nature (Kg = 4.7 � 10�9), and midway in potency between atropine and papaverine. In addition, oxybutynin strongly antagonizes BaCl2-induced spasms of detrusor with a potency equivalent to that of papaverine and 10 times that of atropine. This musculotropic spasmolytic effect is
Foot spasms; Carpopedal spasm; Spasms of the hands or feet; Hand spasm ... Cramps or spasms in the muscles often have no clear cause. Possible causes of hand or foot spasms include: Abnormal levels ...
... research institutions across the country. Much of this research focuses on better ways to prevent, treat, and ultimately cure neurological disorders, such as hemifacial spasm. NIH Patient Recruitment for Hemifacial Spasm Clinical Trials At NIH Clinical Center Throughout the U.S. ...
Hemodynamics of cerebrovascular spasm.
Aaslid, R
An understanding of the hemodynamics of cerebrovascular spasm following subarachnoid hemorrhage is important for the diagnosis and treatment of this potentially dangerous condition. An overview model is presented which includes the main elements determining the overall effect of vasospasm. The model included realistic pressure-flow-velocity-diameter relationship encountered in a geometry resembling that of vasospasm of the middle cerebral artery. Viscosity was adjusted to that expected of human blood. Furthermore, a realistic model the cerebral autoregulation was included. The effects of induced hypertension as well as hypotension were studied. It was found that the friction pressure loss in the spastic segment was 3.5 times as high as that predicted by using the Hagen-Poiseuille formula. The reason for this discrepancy was probably the 'inlet length effect' considerably increasing the friction. Furthermore, including the Bernoulli kinetic pressure energy, a formula was proposed that accurately described the experimental data. From this hemodynamic perspective, strong support was found for the present trend to use aggressive hypertensive therapy in patients with vasospasm. The results also confirmed that TCD velocity measurements in the spastic segment when taken alone may not be a good index of the degree and effect of the spasm. These measurements must be combined with other techniques such as extracranial Doppler or CBF to assess the degree of spasm. PMID:10337412
Proteomic analysis of adrenocorticotropic hormone treatment of an infantile spasm model induced by N-methyl-D-aspartic acid and prenatal stress.
Wang, Jing; Wang, Juan; Zhang, Ying; Yang, Guang; Zhou, Wen-Jing; Shang, Ai-Jia; Zou, Li-Ping
Infantile spasms is an age-specific epileptic syndrome associated with poor developmental outcomes and poor response to nearly all traditional antiepileptic drugs except adrenocorticotropic hormone (ACTH). We investigated the protective mechanism of ACTH against brain damage. An infantile spasm rat model induced by N-methyl-D-aspartate (NMDA) in neonate rats was used. Pregnant rats were randomly divided into the stress-exposed and the non-stress exposed groups, and their offspring were randomly divided into ACTH-treated spasm model, untreated spasm model, and control groups. A proteomics-based approach was used to detect the proteome differences between ACTH-treated and untreated groups. Gel image analysis was followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometric protein identification and bioinformatics analysis. Prenatal stress exposure resulted in more severe seizures, and ACTH treatment reduced and delayed the onset of seizures. The most significantly up-regulated proteins included isoform 1 of tubulin ?-5 chain, cofilin-1 (CFL1), synaptosomal-associated protein 25, malate dehydrogenase, N(G),N(G)-dimethylarginine dimethylaminohydrolase 1, annexin A3 (ANXA3), and rho GDP-dissociation inhibitor 1 (ARHGDIA). In contrast, tubulin ?-1A chain was down-regulated. Three of the identified proteins, ARHGDIA, ANXA3, and CFL1, were validated using western blot analysis. ARHGDIA expression was assayed in the brain samples of five infantile spasm patients. These proteins are involved in the cytoskeleton, synapses, energy metabolism, vascular regulation, signal transduction, and acetylation. The mechanism underlying the effects of ACTH involves the molecular events affected by these proteins, and protein acetylation is the mechanism of action of the drug treatment. PMID:23028951
Proteomic Analysis of Adrenocorticotropic Hormone Treatment of an Infantile Spasm Model Induced by N-Methyl-d-Aspartic Acid and Prenatal Stress
Wang, Jing; Wang, Juan; Zhang, Ying; Yang, Guang; Zhou, Wen-Jing; Shang, Ai-Jia; Zou, Li-Ping
Infantile spasms is an age-specific epileptic syndrome associated with poor developmental outcomes and poor response to nearly all traditional antiepileptic drugs except adrenocorticotropic hormone (ACTH). We investigated the protective mechanism of ACTH against brain damage. An infantile spasm rat model induced by N-methyl-d-aspartate (NMDA) in neonate rats was used. Pregnant rats were randomly divided into the stress-exposed and the non-stress exposed groups, and their offspring were randomly divided into ACTH-treated spasm model, untreated spasm model, and control groups. A proteomics-based approach was used to detect the proteome differences between ACTH-treated and untreated groups. Gel image analysis was followed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometric protein identification and bioinformatics analysis. Prenatal stress exposure resulted in more severe seizures, and ACTH treatment reduced and delayed the onset of seizures. The most significantly up-regulated proteins included isoform 1 of tubulin ?-5 chain, cofilin-1 (CFL1), synaptosomal-associated protein 25, malate dehydrogenase, N(G),N(G)-dimethylarginine dimethylaminohydrolase 1, annexin A3 (ANXA3), and rho GDP-dissociation inhibitor 1 (ARHGDIA). In contrast, tubulin ?-1A chain was down-regulated. Three of the identified proteins, ARHGDIA, ANXA3, and CFL1, were validated using western blot analysis. ARHGDIA expression was assayed in the brain samples of five infantile spasm patients. These proteins are involved in the cytoskeleton, synapses, energy metabolism, vascular regulation, signal transduction, and acetylation. The mechanism underlying the effects of ACTH involves the molecular events affected by these proteins, and protein acetylation is the mechanism of action of the drug treatment. PMID:23028951
Vigabatrin for infantile spasms.
Pesaturo, Kimberly A; Spooner, Linda M; Belliveau, Paul
Infantile spasms describe a pediatric epilepsy syndrome characterized by frequent clusters of brief symmetric muscle contractions; the condition is often associated with developmental delay. When infantile spasms are accompanied by hypsarrhythmia on electroencephalogram, the condition is labeled West syndrome. The mainstay of treatment for infantile spasms is adrenocorticotropic hormone; however, vigabatrin, a vinyl derivative of ?-aminobutyric acid, has been used for the treatment of infantile spasms in Europe since 1989. In 2009, vigabatrin was approved by the United States Food and Drug Adminstration (FDA) for use as monotherapy in the treatment of infantile spasms in patients aged 1 month-2 years when the benefits of treatment outweigh the risks. Results from numerous trials examining the role of vigabatrin in infantile spasms have been published; many of these trials were small, open-label, or noncontrolled. Although clinical trials have provided some insight into the utility of vigabatrin for the treatment of infantile spasms, these studies have notable limitations. In addition, vigabatrin is associated with a black-box warning that describes the potential for permanent bilateral concentric visual field defects. Currently, vigabatrin is available through a manufacturer-sponsored program in accordance with its FDA-approved Risk Evaluation and Mitigation Strategy. Although several guidelines recommend vigabatrin as a first-line therapy for infantile spasms, specifically infantile spasms related to tuberous sclerosis, it is still unclear whether vigabatrin should supersede hormone therapy as first-line therapy. Further research comparing the two therapies is needed. PMID:21361740
Multivessel coronary vasospasm mimicking triple-vessel obstructive coronary artery disease.
Ahooja, Vineeta; Thatai, Deepak
Spontaneous coronary artery spasm is an important cause of morbidity both in patients with atherosclerotic coronary artery disease and in those with Prinzmetal's angina. Coronary vasospasm tends to occur in focal areas in the coronary tree and can be readily induced by the use of various agents. Spontaneous severe multivessel spasm, mimicking severe obstructive coronary artery disease, has been infrequently described. The therapeutic dilemma in such a clinical situation is highlighted in our current case where an unnecessary coronary artery bypass graft surgery (CABG) was performed due to the lack of clinical suspicion of spasm. This patient presented 5 years after triple-vessel CABG with an episode of rest angina, and was initially found to have severe obstruction of all three native coronary arteries with patent grafts to the right coronary and left anterior descending arteries. After nitroglycerin injection, all three native vessels appeared large and normal. This report raises the question of whether the routine use of intracoronary nitroglycerin, largely abandoned over the past 20 years, should be revisited, at least for certain patient populations such as those with rest angina. PMID:17620681
Acute ST-segment elevation myocardial infarction after amoxycillin-induced anaphylactic shock in a young adult with normal coronary arteries: a case report
Gikas, Aristofanis; Lazaros, George; Kontou-Fili, Kalliopi
Background Acute myocardial infarction (MI) following anaphylaxis is rare, especially in subjects with normal coronary arteries. The exact pathogenetic mechanism of MI in anaphylaxis remains unclear. Case presentation The case of a 32-year-old asthmatic male with systemic anaphylaxis, due to oral intake of 500 mg amoxycillin, complicated by acute ST-elevation MI is the subject of this report. Following admission to the local Health Center and almost simultaneously with the second dose of subcutaneous epinephrine (0.2 mg), the patient developed acute myocardial injury. Coronary arteriography, performed before discharge, showed no evidence of obstructive coronary artery disease. In vivo allergological evaluation disclosed strong sensitivity to amoxycillin and the minor (allergenic) determinants of penicillin. Conclusion Acute ST-elevation MI is a rare but potential complication of anaphylactic reactions, even in young adults with normal coronary arteries. Coronary artery spasm appears to be the main causative mechanism of MI in the setting of "cardiac anaphylaxis". However, on top of the vasoactive reaction, a thrombotic occlusion, induced by mast cell-derived mediators and facilitated by prolonged hypotension, cannot be excluded as a possible contributory factor. PMID:15733315
Lindberg, Laura
Spasm of accommodation refers to prolonged contraction of the ciliary muscle, most commonly causing pseudomyopia to varying degrees in both eyes by keeping the lens in a state of short sightedness. It may also be manifested as inability to allow the adaptation spasticity prevailing in the ciliary muscle relax without measurable myopia. As a rule, this is a functional ailment triggered by prolonged near work and stress. The most common symptoms include blurring of distance vision, varying visual acuity as well as pains in the orbital region and the head, progressing into a chronic state. Cycloplegic eye drops are used as the treatment. PMID:24605432
Anticoagulation for acute coronary syndromes and percutaneous coronary intervention in patients with heparin-induced thrombocytopenia.
Mahaffey, K W
Heparin-induced thrombocytopenia (HIT) is not uncommon in clinical practice, and may go unrecognized in a substantial number of patients. The pathophysiology of HIT has only recently been better understood. Patients with HIT may require anticoagulation for thrombotic complications that result in severe morbidity and mortality. These patients may also require anticoagulation for acute coronary syndromes (ACS), or during percutaneous coronary interventions (PCIs). The direct thrombin inhibitors are currently the anticoagulant of choice in HIT patients with ACS or those undergoing PCI, based on data from several large clinical trials in ACS and PCI populations, and data from smaller experiences, specifically in patients with HIT. PMID:11504572
Vascular spasm complicates continuous wave but not pulsed laser irradiation.
Gal, D; Steg, P G; Rongione, A J; DeJesus, S T; Clarke, R H; Isner, J M
Preliminary clinical experience with laser angioplasty has suggested that arterial spasm may complicate attempts to employ laser light to accomplish vascular recanalization. The present study was designed to investigate the role of energy profile on the development of arterial spasm during laser angioplasty. Laser irradiation was delivered percutaneously in vivo to New Zealand white rabbits and to Yucatan microswine with or without atherosclerotic lesions induced by a combination of balloon endothelial denudation and atherogenic diet. Continuous wave (CW) laser irradiation from an argon ion gas laser (wavelength 488 to 514 nm) was applied to 23 arteries, while 16 arteries were irradiated using a pulsed xenon chloride (308 nm) or xenon fluoride (351 nm) excimer laser. Arterial spasm, defined as greater than 50% reduction in luminal diameter narrowing, complicated delivery of laser light to 17 (74%) of the 23 arteries irradiated with the CW argon laser. Spasm was consistently observed at powers greater than 2 W, at cumulative exposures greater than 200 seconds, and at total energy greater than 200 joules. Spasm was typically diffuse (including the length of the vessel) and protracted (lasting up to 120 minutes). Intra-arterial nitroglycerin (up to 300 micrograms) produced only temporary and incomplete resolution of laser-induced spasm. In contrast, spasm was never observed in any of the 16 arteries in which laser angioplasty was performed using a pulsed laser (0.95 to 6.37 joules/cm2, 10 to 50 Hz, 48 to 370 seconds). Thus CW but not pulsed laser angioplasty may be complicated by arterial spasm.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2510488
Ghosh, Abhishek; Padhy, Susanta K; Gupta, Gourav; Goyal, Manoj K
Convergence spasm (CS) means intermittent episodes of convergence, miosis and accommodation with disconjugate gaze mimicking abducens palsy. The organic causes range from metabolic to host of neurological and ophthalmic diseases that we describe. It was first described as a presentation of psychogenic disorders by von Graefe as early as in 1856. Nonetheless, patients exhibiting this sign are often subjected to plethora of unnecessary, sophisticated and invasive diagnostic procedures. Such functional cases were treated with either cycloplegic/placebo eye drop or amytal abreaction. Though epidemiological studies suggest that conversion disorder is equally prevalent in industrialized nations and developing countries, a few cases of functional CS are reported from West including Asia, that to, decade(s) before and none from India, to the best of our knowledge. We illustrate a case of functional CS with photograph after consent from patient and its successful treatment. PMID:25035565
[Infantile spasms and modified hypsarrhythmia].
Halevy, Ayelet; Kiviti, Sara; Goldberg-Stern, Hadassa; Shuper, Avinoam
The West syndrome was described by the physician West in his own son in 1841 and is defined as a triad of myoclonic seizures called "infantile spasms", electrographic abnormalities called "hypsarrhythmia" and arrest of psychomotor development and mental retardation. These symptoms are so pathognomonic that the impression is that the syndrome is caused by a single mechanism, but actually there is heterogeneity of etiologies, different recommendations of treatment and prognosis. The West syndrome was established as an infantiLe epileptic syndrome (ILAE Task Force, 1989). Infantile spasm is the most common epileptic syndrome during infancy and entails 50% of all epilepsies between ages one month to one year. Its incidence is 1:3200-3500 live births. Despite its absolute definition, the variability of etiologies, clinical presentation and electrographic make it difficult to set rigid, clear treatment guidelines and research methodology. This review aims to present modified hypsarrhythmia, the etiologies and prognosis of symptomatic infantile spasms, and emphasize the importance of early recognition of modified hypsarrhythmia by surveillance of electroencephalograms. PMID:22164920
An unusual cause of hemifacial spasm.
Doherty, Carolynne M; Briggs, Gavin; Quigley, D Gavin; McCarron, Mark O
Hemifacial spasm is not an infrequent presentation and a vascular loop is commonly implicated. Cerebellopontine angle (CPA) lesions are uncommon but can be excluded with appropriate imaging. There have been only around 150 case reports of CPA lipoma; hemifacial spasm has been associated only in eight cases. We present an additional case and discuss the literature and management. PMID:25058594
Satoyoshi's syndrome related muscle spasms: functional study
J. M. Pardal-Fern�ndez; J. Solera-Santos; I. Iniesta-L�pez; M Rodr�guez-V�zquez
Satoyoshi syndrome is a rare disease presumed to be immunologically mediated, characterized by muscle spasms, alopecia and diarrhea. We describe the case of a female in whom the muscle spasms were the predominant feature and we analyze the changes in cortical and in spinal excitability under the paired pulses paradigm. Hyperexcitability was present in the H-reflex study thus suggesting that
Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris.
Ong, Peter; Aziz, Ahmed; Hansen, Henrik Steen; Prescott, Eva; Athanasiadis, Anastasios; Sechtem, Udo
Coronary spasm is involved in many clinical scenarios, such as stable angina, acute coronary syndrome, sudden cardiac death, non-ischemic cardiomyopathy, arrhythmia and syncope. In recent years, imaging tools such as computerized tomographic angiography, intravascular ultrasound or optical coherence tomography have been applied to study the coronary pathology in patients with vasospastic angina. Patients with vasospastic angina represent a heterogeneous cohort of patients with regard to the extent of concomitant coronary atherosclerosis. They share the common pathophysiological phenomenon of vascular smooth muscle hyperreactivity leading to spasm caused by various factors that may also overlap. Focal coronary spasm is related to epicardial atherosclerosis and in the presence of obstructive coronary artery disease it may be useful to treat the lesion to prevent further spasm. The aim of this article is to review structural and functional coronary artery abnormalities in patients with vasospastic angina. (Circ J 2015; 79: 1431-1438). PMID:26084380
Imaging of cocaine-induced global and regional myocardial ischemia
Oster, Z.H.; Som, P.; Wang, G.J.; Weber, D.A. (Brookhaven National Laboratory, Medical Department, Upton, New York (USA))
Severe and often fatal cardiac complications have been reported in cocaine users with narrowed coronary arteries caused by atherosclerosis as well as in young adults with normal coronaries. The authors have found that in normal dogs cocaine induces severe temporary hypoperfusion of the left ventricle as indicated by a significantly lower 201Tl concentration compared to the baseline state. The most significant decrease in uptake occurred 5 min after injection and was more pronounced in the septal and apical segments. Following intravenous administration of cocaine, instead of gradual disappearance of 201Tl from the left ventricle, there was continuous increase in 201Tl concentration in the left ventricle. These imaging experiments indicate that the deleterious effects of cocaine on the heart are probably due to spasm of the coronaries and decreased myocardial perfusion. Since spasm of the large subpericardial vessels does not seem to explain the magnitude of the increased coronary resistance and decreased coronary flow after cocaine as described in the literature, it is suggested that microvascular spasm of smaller vessels plays a major role in the temporary decrease in perfusion. The data may also suggest that severe temporary myocardial ischemia is probably the initiating factor for the cardiac complications induced by cocaine.
Placental Induced Growth Factor (PIGf) in Coronary Artery Disease
NASA Technical Reports Server (NTRS)
Sundaresan, Alamelu; Carabello, Blaise; Mehta, Satish; Schlegel, Todd; Pellis, Neal; Ott, Mark; Pierson, Duane
Our previous studies on normal human lymphocytes have shown a five-fold increase (p less than 0.001) in angiogenic inducers such as Placental Induced Growth Factor (PIGf) in physiologically stressful environments such as modeled microgravity, a space analog. This suggests de-regulation of cardiovascular signalling pathways indicated by upregulation of PIGf. In the current study, we measured PIGf in the plasma of 33 patients with and without coronary artery disease (CAD) to investigate whether such disease is associated with increased levels of PIGf. A control consisting of 31 sex matched apparently healthy subjects was also included in the study. We observed that the levels of PIGf in CAD patients were significantly increased compared to those in healthy control subjects (p less than 0.001) and usually increased beyond the clinical threshold level (greater than 27ng/L). The mechanisms leading to up-regulation of angiogenic factors and the adaptation of organisms to stressful environments such as isolation, high altitude, hypoxia, ischemia, microgravity, increased radiation, etc are presently unknown and require further investigation in spaceflight and these other physiologically stressed environments.
Coronary vasoconstriction induced by mental stress (simulated public speaking)
Clifton R. Lacy; Richard J. Contracta; Mark L Robbins; Alan K. Tannenbaum; Abel E. Moreyra; Sandra Chelton; John B. Kostis
The present study demonstrates that potent mental stress, such as that produced in response to the simulated public speaking task, results in an increase in heart rate and blood pressure, and vasoconstriction of normal coronary artery segments in patients with and without angiographically demonstrable coronary artery disease.
Immunosuppressive therapy induced coronary vasospasm and acute myocardial infarction in a patient undergoing new renal transplantation
Akturk, Ibrahim Faruk; Yalcin, Ahmet Arif; Celik, Omer; Oner, Ender
Immunosuppressant agents such as calcineurin inhibitors (CNI) used after solid organ transplantation may cause endothelial dysfunction, and coronary and renal arterial vasospasm. We report a patient presenting acute ST segment elevation myocardial infarction (STEMI) at the second week of renal transplantation. In the case of STEMI in patients with solid organ transplants under immunosuppressive therapy with CNI, coronary vasospasm associated with these drugs should be kept in mind before starting any interventional procedure. High dose nitroglycerine may immediately resolve tacrolimus or cyclosporine A induced coronary vasospasm. Calcium channel blockers should immediately be added to treatment because of the short half-life of nitroglycerine.
Caring for muscle spasticity or spasms
High muscle tone - care; Increased muscle tension - care; Upper motor neuron syndrome - care; Muscle stiffness - care ... Muscle spasticity, or spasms, causes your muscles to become stiff or rigid. It can also cause exaggerated, ...
Recurrent angina after coronary angioplasty: mechanisms, diagnostic and therapeutic options
Izzo, Paolo; Macchi, Andrea; De Gennaro, Luisa; Gaglione, Antonio; Di Biase, Matteo
Recurrent angina in patients who underwent percutaneous coronary intervention is defined as recurrence of chest pain or chest discomfort. Careful assessment is recommended to differentiate between non-cardiac and cardiac causes. In the case of the latter, recurrent angina occurrence can be related to structural (�stretch pain�, in-stent restenosis, in-stent thrombosis, incomplete revascularization, progression of coronary atherosclerosis) or functional (coronary micro-vascular dysfunction, epicardial coronary spasm) causes. Even though a complete diagnostic algorithm has not been validated, ECG exercise testing, stress imaging and invasive assessment of coronary blood flow and coronary vaso-motion (i.e. coronary flow reserve, provocation testing for coronary spasm) may be required. When repeated coronary revascularization is not indicated, therapeutic approaches should aim at targeting the underlying mechanism for the patient�s symptoms using a variety of drugs currently available such as beta-blockers, calcium-channel blockers, ivabradine or ranolazine. PMID:24062904
Estrogen-induced contraction of coronary arteries is mediated by superoxide generated in vascular smooth muscle
White, Richard E.; Han, Guichun; Dimitropoulou, Christiana; Zhu, Shu; Miyake, Katsuya; Fulton, David; Dave, Shaylee; Barman, Scott A.
Although previous studies demonstrated beneficial effects of estrogen on cardiovascular function, the Women's Health Initiative has reported an increased incidence of coronary heart disease and stroke in postmenopausal women taking hormone replacement therapy (HRT). The objective of the present study was to identify a molecular mechanism whereby estrogen, a vasodilatory hormone, could possibly increase the risk of cardiovascular disease. Isometric contractile force recordings were performed on endothelium-denuded porcine coronary arteries, while molecular and fluorescence studies identified estrogen signaling molecules in coronary smooth muscle. Estrogen (1-1000nM) relaxed arteries in an endothelium-independent fashion; however, when arteries were pretreated with agents to uncouple NO production from nitric oxide synthase (NOS), estrogen contracted coronary arteries with an EC50 of 7.3 � 4nM. Estrogen-induced contraction was attenuated by reducing superoxide (O2?). Estrogen-stimulated O2? production was detected in NOS-uncoupled coronary myocytes. Interestingly, only the Type 1 NOS isoform (nNOS) was detected in myocytes, making this protein a likely target mediating both estrogen-induced relaxation and contraction of endothelium-denuded coronary arteries. Estrogen-induced contraction was completely inhibited by 1?M nifedipine or 10?M indomethacin, indicating involvement of dihydropyridine-sensitive calcium channels and contractile prostaglandins. We propose that a single molecular mechanism can mediate the dual and opposite effect of estrogen on coronary arteries: by stimulating Type 1 (n)NOS in coronary arteries, estrogen produces either vasodilation via NO or vasoconstriction via superoxide. PMID:16162867
Abciximab-induced alveolar hemorrhage after percutaneous coronary intervention
Conley, Maria; Patino, Gilberto; Romick, Benjamin; Almaleh, Michael; Campbell, Charles; Hawkins, Karin; Moore, Scott; Allan, Patrick
Abciximab, a platelet glycoprotein (GP) IIb/IIIa inhibitor, has been shown to improve clinical outcomes in patients undergoing percutaneous coronary intervention. However, there is a well-documented increase in bleeding risk associated with the use of this agent. Spontaneous pulmonary hemorrhage is a particularly rare and easily misdiagnosed complication that requires early diagnosis to ensure patient survival. A 61-year-old man presented to the emergency department with chest pain and inferolateral ST elevation on electrocardiogram. A paclitaxel drug-eluting stent was then placed in the left circumflex artery, without complications. Abciximab (a bolus of 0.25 mg/kg followed by an infusion of 10 mg/min for 12 h) was given. Approximately 20 min later, the patient developed dyspnea and hemoptysis. A chest radiograph revealed new bilateral diffuse interstitial infiltrates, and the patient was started on empirical antibiotics for pneumonia. Because of increasing dyspnea and somnolence, the patient was intubated and bronchoscopy was performed, revealing serial hemorrhagic returns from the left lower lobe, diagnostic of diffuse alveolar hemorrhage and judged to be secondary to abciximab, given the time course. All antiplatelet and antithrombotic agents were stopped. The patient stabilized over the next several days, with some recurrent hemoptysis, and was successfully extubated seven days later. Prognosis remains poor in GP IIb/IIIa inhibitor-induced pulmonary hemorrhage, and early diagnosis is critical so that antithrombotic and antiplatelet agents may be discontinued in a timely manner. A high degree of suspicion is required when treating a patient who presents with dyspnea and new radiological infiltrates after receiving a GP IIb/IIIa inhibitor. PMID:18273491
Atorvastatin and prevention of contrast induced nephropathy following coronary angiography
Bidram, Peyman; Roghani, Farshad; Sanei, Hamid; Hedayati, Zahraparin; Golabchi, Allahyar; Mousavi, Mehdi; Hajiannejad, Alireza; Pourheidar, Behrouz; Badalabadi, Mehdi Mohseni; Gharaati, Maryam; Akhbari, Mohammadreza; Salesi, Asieh
Background: Contrast induced nephropathy (CIN) is one of the most common complications after radiographic procedures using intravascular radiocontrast media. The aim of the current study was to assess the effect of atorvastatin on prevention of CIN in patients undergoing coronary angiography. Materials and Methods: In a clinical trial study, 200 patients referred for angiography were randomly divided into two groups of using 80 mg atorvastatin and placebo before the procedure. Furthermore, 100 patients who were under chronic treatment of statins were included as the third group. Serum creatinine (Scr) levels before and after the procedure were evaluated and incidence of CIN (post-procedural Scr of >0.5 mg/dl or >25% from baseline) was assessed. Results: Mean age of the participants was 60.06 � 0.69 years and 276 (92%) were male. There were no significant differences between group with respect to age and gender. In pre-operation atorvastatin, placebo and long term statin groups, the incidence of CIN was 1%, 2% and 1%, and mean changes of Glomerular filtration rate (GFR) was 3.68 � 1.32, ?0.77 � 1.21 and 1.37 � 0.86; and mean changes of creatinine (Cr) was ?0.05 � 0.02, 0.02 � 0.02 and ?0.01 � 0.01 respectively. (P = 0.776, 0.026 and 0.041 respectively). In pre-operation atorvastatin group, Cr decreased, and GFR increased significantly (P = 0.019 and 0.007 respectively). Conclusion: pre-operation short term high dose atorvastatin use was associated with a significant decrease in serum Cr level and increase in GFR after angiography. PMID:25767514
Hemifacial spasm and neurovascular compression.
Lu, Alex Y; Yeung, Jacky T; Gerrard, Jason L; Michaelides, Elias M; Sekula, Raymond F; Bulsara, Ketan R
Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve. PMID:25405219
Hemifacial Spasm and Neurovascular Compression
Lu, Alex Y.; Yeung, Jacky T.; Gerrard, Jason L.; Michaelides, Elias M.; Sekula, Raymond F.; Bulsara, Ketan R.
Hemifacial spasm (HFS) is characterized by involuntary unilateral contractions of the muscles innervated by the ipsilateral facial nerve, usually starting around the eyes before progressing inferiorly to the cheek, mouth, and neck. Its prevalence is 9.8 per 100,000 persons with an average age of onset of 44 years. The accepted pathophysiology of HFS suggests that it is a disease process of the nerve root entry zone of the facial nerve. HFS can be divided into two types: primary and secondary. Primary HFS is triggered by vascular compression whereas secondary HFS comprises all other causes of facial nerve damage. Clinical examination and imaging modalities such as electromyography (EMG) and magnetic resonance imaging (MRI) are useful to differentiate HFS from other facial movement disorders and for intraoperative planning. The standard medical management for HFS is botulinum neurotoxin (BoNT) injections, which provides low-risk but limited symptomatic relief. The only curative treatment for HFS is microvascular decompression (MVD), a surgical intervention that provides lasting symptomatic relief by reducing compression of the facial nerve root. With a low rate of complications such as hearing loss, MVD remains the treatment of choice for HFS patients as intraoperative technique and monitoring continue to improve. PMID:25405219
Neonatal Estradiol Stimulation Prevents Epilepsy in Arx Model of X-Linked Infantile Spasms Syndrome
Olivetti, Pedro R.; Maheshwari, Atul; Noebels, Jeffrey L.
Infantile spasms are a catastrophic form of pediatric epilepsy with inadequate treatment. In patients, mutation of ARX, a transcription factor selectively expressed in neuronal precursors and adult inhibitory interneurons, impairs cell migration and causes a major inherited subtype of the disease X-linked infantile spasms syndrome. Using an animal model, the Arx(GCG)10+7 mouse, we determined that brief estradiol (E2) administration during early postnatal development prevented spasms in infancy and seizures in adult mutants. E2 was ineffective when delivered after puberty or 30 days after birth. Early E2 treatment altered mRNA levels of three downstream targets of Arx (Shox2, Ebf3, and Lgi1) and restored depleted interneuron populations without increasing GABAergic synaptic density. Postnatal E2 treatment may induce lasting transcriptional changes that lead to enduring disease modification and could potentially serve as a therapy for inherited interneuronopathies. PMID:24452264
Time-resolved laser-induced fluorescence of normal and atherosclerotic coronary artery
NASA Astrophysics Data System (ADS)
Marcu, Laura; Maarek, Jean-Michel I.; Fishbein, Michael C.; Grundfest, Warren S.
This study investigates the spectro-temporal fluorescence emission of normal and diseased coronary arteries with graded levels of atherosclerosis. Fluorescence emission of 58 excised human coronary artery samples was induced with N2 laser pulses and detected with a MCP-PMT connected to a digital oscilloscope. The samples were H and E and Movat stained and histologically classified in accordance with AHA classification. An algorithm based on Laguerre expansion of kernels was used to deconvolve the intrinsic fluorescence impulse response function from the measured transient pulse. A biexponential function depicted the fluorescence decay characteristics. We noticed 1) in spectral domain: peak fluorescence intensity was at 380 nm for normal and initial lesions samples and blue-shifted for advanced lesions; intensity at 450-480 nm decreased from approximately 65 percent peak intensity for normal samples to approximately 30 percent for Type V lesions; 2) in time domain: longer lasting emission for the advanced lesions. The decay constants varied as a function emission wavelength and lesion type. For instance the time constants for Type V lesions measured at 390 nm were significantly larger that those measured on normal arterial wall. The fast term decay contributed to a higher degree to the impulse response function for normal tissue. These results reveal that the analysis of the temporal characteristics of fluorescence can be used to differentiate between coronary lesion and normal coronary wall. The time domain information complements the spectral domain intensity data for improved differentiation between graded levels of coronary lesions.
ACTH therapy in infantile spasms: side effects
R Riikonen; M Donner
162 children with infantile spasms were treated with ACTH at the Children's Hospital, Helsinki, and at the Aurora Hospital, Helsinki, during 1960--76. In a large proportion (37%) of the children the treatment caused pronounced side effects, and the mortality was 4.9%. The most common complications were infections: septic infections, pneumonias, and urinary and gastrointestinal infections. Other side effects were arterial
Serotonin, atherosclerosis, and collateral vessel spasm
NASA Technical Reports Server (NTRS)
Hollenberg, N.
Studies on animal models demonstrate that platelet products contribute to vascular spasm in ischemic syndromes and that this is reversible with administration of ketanserin and thromboxane synthesis inhibitors. Laboratory animals (dogs, rabbits, and rats) that had femoral artery ligations exhibited supersensitivity to serotonin within days in their collateral blood vessels. This supersensitivity lasted at least 6 months. The response to serotonin was reversed by ketanserin, but not by 5HT-1 antagonists. Supersensitivity does not extend to norepinephrine, and alpha blockers do not influence the response to serotonin. It appears that platelet activation by endothelial injury contributes to ischemia through blood vessel occlusion and vascular spasm. When platelet activation occurs in vivo, blood vessel occlusion and vascular spasm are reversible in part by using ketanserin or agents that block thromboxane synthesis or its action. Combining both classes of agents reverses spasm completely. These findings support existing evidence that platelet products contribute to vascular disease, and provide an approach to improved management with currently available pharmacologic agents.
Myocardial infarction in young people with normal coronary arteries
Williams, M; Restieaux, N; Low, C
Myocardial infarction occurring in young people with angiographically normal coronary arteries is well described but the pathophysiology of this condition remains unknown. Coronary artery spasm in association with thrombus formation and minimal atheromatous disease or spontaneous coronary artery dissection are possible causes. Two young men presented with severe chest pain after acute alcohol intoxication and each sustained an extensive anterior myocardial infarction. Investigations including intravascular ultrasound showed no evidence of atherosclerotic coronary artery disease. Coronary artery spasm associated with acute alcohol intoxication as well as a prothrombotic state and endothelial damage related to cigarette smoking may be mechanisms leading to acute myocardial infarction in these cases. Acute myocardial infarction occurs in young persons with normal coronary arteries and the diagnosis should be considered in young patients presenting with severe chest pain, particularly those abusing cocaine or alcohol, so that reperfusion therapy can be initiated promptly.?? Keywords: myocardial infarction;� coronary vasospasm;� alcohol;� intravascular ultrasound PMID:9538315
Coronary pressure-flow autoregulation protects myocardium from pressure-induced changes in oxygen consumption.
Bai, X J; Iwamoto, T; Williams, A G; Fan, W L; Downey, H F
Pressure-flow autoregulation minimizes changes in coronary blood flow (CBF) when coronary perfusion pressure (CPP) is altered. This investigation determined if autoregulation also minimizes CPP-induced changes in coronary vascular volume (CVV) and CVV-dependent changes in myocardial oxygen consumption (MVO2). In 11 anesthetized dogs, the left anterior descending coronary artery was cannulated, and responses to 20-mmHg changes in CPP were examined over a range of CPP from 60 to 180 mmHg. Changes in CPP had no significant effect on systemic hemodynamics or on left ventricular end-diastolic segment length, end-systolic segment length, or percent segment shortening. In hearts with effective pressure-flow autoregulation [closed-loop gain (GC) > 0.4], CVV increased 0.06%/mmHg change in CPP. For the same hearts, MVO2 increased 0.04%/mmHg change in CPP. In hearts with ineffective autoregulation (GC < 0.4), CVV increased 0.97%/mmHg (P < 0.001 vs. autoregulating hearts), and MVO2 increased 0.41%/mmHg (P < 0.001 vs. autoregulating hearts). MVO2 and CVV were correlated (r = 0.69, P < 0.0001) independently of autoregulatory capability, but only when autoregulation was poor and capacitance was elevated did CPP significantly affect MVO2. We conclude that pressure-flow autoregulation protects myocardium from CPP-induced changes in CVV, which in turn produces changes in oxygen consumption. PMID:8023997
Early Coronary Angiography and Induced Hypothermia are Associated with Survival and Functional Recovery after Out-of-Hospital Cardiac Arrest
Callaway, Clifton W.; Schmicker, Robert H.; Brown, Siobhan P.; Albrich, J. Michael; Andrusiek, Douglas L.; Aufderheide, Tom P.; Christenson, James; Daya, Mohamud R.; Falconer, David; Husa, Ruchika D.; Idris, Ahamed H.; Ornato, Joseph P.; Rac, Valeria E.; Rea, Thomas D.; Rittenberger, Jon C.; Sears, Gena; Stiell, Ian G.
Background The rate and effect of coronary interventions and induced hypothermia after out-of-hospital cardiac arrest (OHCA) are unknown. We measured the association of early (?24 hours after arrival) coronary angiography, reperfusion, and induced hypothermia with favorable outcome after OHCA. Methods We performed a secondary analysis of a multicenter clinical trial (NCT00394706) conducted between 2007 and 2009 in 10 North American regions. Subjects were adults (? 18 years) hospitalized after OHCA with pulses sustained ? 60 minutes. We measured the association of early coronary catheterization, percutaneous coronary intervention, fibrinolysis, and induced hypothermia with survival to hospital discharge with favorable functional status (modified Rankin Score ?3). Results From 16,875 OHCA subjects, 3,981 (23.6%) arrived at 151 hospitals with sustained pulses. 1,317 (33.1%) survived to hospital discharge, with 1,006 (25.3%) favorable outcomes. Rates of early coronary catheterization (19.2%), coronary reperfusion (17.7%) or induced hypothermia (39.3%) varied between hospitals, and were higher in hospitals treating more subjects per year. Odds of survival and favorable outcome increased with hospital volume (per 5 subjects/year OR 1.06; 95%CI: 1.04�1.08 and OR 1.06; 95%CI: 1.04, 1.08, respectively). Survival and favorable outcome were independently associated with early coronary angiography (OR 1.69; 95%CI 1.06�2.70 and OR 1.87; 95%CI 1.15�3.04), coronary reperfusion (OR 1.94; 95%CI 1.34�2.82 and OR 2.14; 95%CI 1.46�3.14), and induced hypothermia (OR 1.36; 95%CI 1.01�1.83 and OR 1.42; 95%CI 1.04�1.94). Interpretation Early coronary intervention and induced hypothermia are associated with favorable outcome and are more frequent in hospitals that treat higher numbers of OHCA subjects per year. PMID:24412161
Capecitabine can induce acute coronary syndrome similar to 5-fluorouracil.
Frickhofen, N; Beck, F J; Jung, B; Fuhr, H G; Andrasch, H; Sigmund, M
Capecitabine is a member of a new class of oral fluoropyrimidines. It is a 5-fluorouracil (5-FU) prodrug, activated by a series of enzymes. Activation has been demonstrated to occur preferentially in tumor tissue, which may explain the favorable balance of efficacy and toxicity of this drug. Cardiotoxicity, a rare but potentially serious adverse effect of 5-FU, has not been reported for capecitabine to date. Here we report a patient who experienced a severe and prolonged acute coronary syndrome during treatment with capecitabine. He had previously developed similar symptoms during treatment with infusional 5-FU. Capecitabine should thus be considered an agent with cardiotoxic potential. This adverse effect should be specifically monitored in all patients treated with capecitabine. Patients with symptoms suggestive of cardiotoxicity during previous treatment with a fluoropyrimidine should not be treated with capecitabine. PMID:12075751
Contrast Volume During Primary Percutaneous Coronary Intervention and Subsequent Contrast-Induced Nephropathy and Mortality
Giancarlo Marenzi; Emilio Assanelli; Jeness Campodonico; Gianfranco Lauri; Ivana Marana; Monica De Metrio; Marco Moltrasio; Marco Grazi; Mara Rubino; Fabrizio Veglia; Franco Fabbiocchi; Antonio L. Bartorelli
Background: Contrast-induced nephropathy (CIN) frequently oc- curs in patients with acute ST-segment elevation myocardial infarc- tion (STEMI) who are undergoing primary percutaneous coronary intervention, and CIN is associated with a more complicated clinical course and increased mortality. Objective: To investigate the association between absolute and weight- and creatinine-adjusted contrast volume, CIN incidence, and clinical outcome in the era of mechanical
Conformational Change in Coronary Artery Structure Assessed by Optical Coherence Tomography in Patients With Vasospastic Angina
Tanaka, Atsushi; Shimada, Kenei; Tearney, Guillermo J.; Kitabata, Hironori; Taguchi, Haruyuki; Fukuda, Shota; Kashiwagi, Manabu; Kubo, Takashi; Takarada, Shigeho; Hirata, Kumiko; Mizukoshi, Masato; Yoshikawa, Junichi; Bouma, Brett E.; Akasaka, Takashi
Objectives The aim of this study was to investigate the conformational change of arterial structure in the vasospastic lesion with optical coherence tomography. Background Coronary artery spasm plays an important role in the pathogenesis of ischemic heart diseases. The conformational change of each arterial layer during vasospasm has not been studied in detail. Methods We assessed 19 coronary arteries (10 spasm and 9 nonspasm lesions) with optical coherence tomography during the provocation test for coronary spasm. An intimal bump was defined as 1 or more intimal projections into the lumen that disappeared after the administration of nitroglycerine (NTG). Intimal gathering was defined as a folding/gathering of the intima, resulting in multiple kinks in the luminal contour that resolved after the administration of NTG. Results The spasm lesion more frequently showed an intimal bump at baseline and intimal gathering during spasm compared with the nonspasm lesion (spasm 80% vs. nonspasm 0%, p < 0.01, spasm 100% vs. nonspasm 0%, p < 0.01, respectively). The spasm lesion demonstrated a thicker maximum media thickness (spasm 0.24 � 0.04 mm vs. nonspasm 0.12 � 0.03 mm, p < 0.01) at baseline, whereas no differences were observed after the administration of NTG (spasm 0.13 � 0.03 mm vs. nonspasm 0.13 � 0.02 mm, p = 0.65). Conclusions Our results suggest that medial contraction occurs even in an asymptomatic state and facilitates the formation of an intimal bump in patients with vasospastic angina. Luminal narrowing during spasm is associated with intimal gathering without alteration of intimal area. PMID:21958888
Subthalamic lesion and paroxysmal tonic spasms.
Garcia-Ruiz, Pedro J; Villanueva, Vicente; Gutierrez-Delicado, Eva; Echeverr�a, Amaia; Perez-Higueras, Antonio; Serratosa, Jos� M
Paroxysmal dyskinesia due to a subthalamic lesion is a rare finding. We describe a patient with paroxysmal tonic spasms due to a well-defined lesion in the subthalamic area. In this case, we confirm the nonepileptic nature of the episode and collect with detail the clinical features by means of a video-electroencephalographic recording. We also report an excellent response to carbamazepine in subthalamic paroxysmal dyskinesias. PMID:14639695
The relationship between stress-induced myocardial ischemia and coronary artery atherosclerosis measured by hybrid SPECT\\/CT camera
Shinro Matsuo; Kenichi Nakajima; Koichi Okuda; Seigo Kinuya
Objective��The coronary artery calcium (CAC) score and myocardial perfusion imaging can now be detected simultaneously using a hybrid\\u000a SPECT\\/CT camera. However, there has been little evaluation on the relationship between stress-induced ischemia and coronary\\u000a artery calcification in a Japanese population. The aim of this study was to investigate the relationship between these parameters\\u000a and to elucidate the diagnostic value of
Therapeutic Trial of Vigabatrin in Refractory Infantile Spasms
Catherine Chiron; Olivier Dulac; Daniel Beaumont; Leonardo Palacios; Nicole Pajot; John Mumford
Infantile spasms usually start during the first year of life and constitute one of the most difficult types of epilepsy to treat. They carry a very poor prognosis for both epilepsy and mental development. Seventy children, including 47 infants, with intractable infantile spasms were entered into an open study with vigabatrin as add-on therapy to the usual anticonvulsant treatment. All
Pain, muscle spasms and twitching fingers following brachial plexus avulsion
Carlo Alberto Pagni; Sergio Canavero
Three patients who, following partial brachial plexus avulsion, experienced pain, involuntary finger twitching and muscular spasms are reported. Two exhibited cutaneous trigger zones, stimulation of which exacerbated their pain; changes in emotional tone aggravated both the pain and the spasms. Pain would appear to be due not only to deafferentation and scarring of the dorsal horn, but also to an
Painful muscle spasms complicating algodystrophy: central or peripheral disease?
W Robberecht; J Van Hees; H Adriaensen; H Carton
A 21 year old female patient developed S�deck's atrophy of the right foot secondary to a chronic Achilles tendinitis. The condition was complicated by the occurrence of painful muscle spasms in the right leg and incontinence of urine. The spasms had characteristics of both a tonic ambulatory foot response and a spinal flexor reflex. The movements disappeared during sleep. Regional
Vascular spasm complicates continuous wave but not pulsed laser irradiation
D. Gal; P. G. Steg; A. J. Rongione; S. T. DeJesus; R. H. Clarke; J. M. Isner
Preliminary clinical experience with laser angioplasty has suggested that arterial spasm may complicate attempts to employ laser light to accomplish vascular recanalization. The present study was designed to investigate the role of energy profile on the development of arterial spasm during laser angioplasty. Laser irradiation was delivered percutaneously in vivo to New Zealand white rabbits and to Yucatan microswine with
Part Two: Infantile Spasms--The New Consensus
ERIC Educational Resources Information Center
Pellock, John M.; O'Hara, Kathryn
This article presents the conclusion made by the consensus group regarding infantile spasms. The consensus group concluded that "infantile spasms are a major form of severe epileptic encephalopathy of early childhood that results in neurodevelopmental regression and imposes a significant health burden." The entire group agrees that the best�
Reduced coronary vasodilator responses to amlodipine in pacing-induced heart failure in conscious dogs: role of nitric oxide
Champagne, St�phane; Hittinger, Luc; H�loire, Fran�ois; Suto, Yukio; Sambin, Lucien; Crozatier, Bertrand; Su, Jin Bo
This study examined whether NO is involved in the in-vivo coronary vasodilator effects of amlodipine (a calcium channel blocker) and whether heart failure (HF) alters the coronary responses to amlodipine.Nine conscious dogs were chronically instrumented to measure circumflex coronary blood flow (CBF) and coronary diameter (CD). Drugs were administered directly into the circumflex artery through an indwelling catheter to avoid systemic changes. HF was induced by right ventricular pacing (240 b.p.m., 3 weeks).Compared with control (C), in HF, coronary responses to acetylcholine (1�10?ng?kg?1) were reduced while responses to nitroglycerin (0.1�0.5??g?kg?1) were unchanged. In C, amlodipine (30�150??g?kg?1), increased dose-dependently CBF and CD. After LNA (a NO synthase inhibitor, 2?mg?kg?1), amlodipine produced less increases in CBF and CD (+121�26?ml?min?1 and +76�35??m versus +196�40?ml?min?1 and +153�39??m respectively for 150??g?kg?1 amlodipine alone, both P<0.05). In HF, the coronary responses to amlodipine were reduced (150??g?kg?1 of amlodipine increased CBF and CD +121�23?ml?min?1 and +77�21??m respectively, both P<0.05). After LNA, the CBF responses to amlodipine tended to be reduced (+94�19?ml?min?1 at 150??g?kg?1) but CD responses were significantly reduced (+41�16??m, P<0.05). The supplementation with L-arginine did not enhance the coronary responses to amlodipine.These results indicate that, in conscious dogs, NO participates in the coronary responses to amlodipine and in HF, the coronary responses to amlodipine are reduced, which is related to a reduced NO production. PMID:12010775
Greater collagen-induced platelet aggregation following cyclooxygenase 1 inhibition predicts incident acute coronary syndromes.
Qayyum, Rehan; Becker, Diane M; Yanek, Lisa R; Faraday, Nauder; Vaidya, Dhananjay; Mathias, Rasika; Kral, Brian G; Becker, Lewis C
Greater ex vivo platelet aggregation to agonists may identify individuals at risk of acute coronary syndromes (ACS). However, increased aggregation to a specific agonist may be masked by inherent variability in other activation pathways. In this study, we inhibited the cyclooxygenase-1 (COX1) pathway with 2-week aspirin therapy and measured residual aggregation to collagen and ADP to determine whether increased aggregation in a non-COX1 pathway is associated with incident ACS. We assessed ex vivo whole blood platelet aggregation in 1,699 healthy individuals with a family history of early-onset coronary artery disease followed for 6�1.2 years. Incident ACS events were observed in 22 subjects. Baseline aggregation was not associated with ACS. After COX1 pathway inhibition, collagen-induced aggregation was significantly greater in participants with ACS compared with those without (29.0 vs. 23.6 ohms, p < 0.001). In Cox proportional hazards models, this association remained significant after adjusting for traditional cardiovascular risk factors (HR = 1.10, 95%CI = 1.06-1.15; p < 0.001). In contrast, ADP-induced aggregation after COX1 inhibition was not associated with ACS. After COX1 pathway inhibition, subjects with greater collagen-induced platelet aggregation demonstrated a significant excess risk of incident ACS. These data suggest that platelet activation related to collagen may play an important role in the risk of ACS. PMID:25066685
Behavior of right and left ventricles during episodes of variant angina in relation to the site of coronary vasospasm
Neglia, D.; Parodi, O.; Marzullo, P.; Sambuceti, G.; Marcassa, C.; Michelassi, C.; L'Abbate, A. (CNR Institute of Clinical Physiology, Pisa (Italy))
The effects of single-vessel coronary occlusion on simultaneously evaluated right (RV) and left ventricular (LV) performance were assessed and compared with LV perfusion patterns in 25 patients with variant angina. Coronary spasm involved the right coronary artery in 15 patients (group 1) and the left anterior descending coronary artery in 10 patients (group 2). Biventricular function was assessed by radionuclide angiography under basal conditions, during spontaneous or ergonovine-induced ischemia, and after resolution of the ischemic attack. Myocardial perfusion was assessed by thallium 201 scintigraphy in 21 patients of this series during superimposable ischemic episodes. In group 1, ischemia caused RV (14 of 15 patients) and LV (13 of 15 patients) regional dysfunction with significant reduction in RV and LV ejection fractions. The interventricular spetum was involved in six of 15 patients, causing a more pronounced LV impairment. In group 2, all patients showed septal dyssynergies associated with a reduction of LV ejection fraction; absent or trivial RV involvement was observed. In both groups, LV perfusion defects were present in all patients with LV wall motion abnormalities during ischemia, matching the site of regional dyssynergies. Thus, in a group of patients with variant angina and single-vessel disease, transient occlusion of the right coronary artery directly caused RV and LV impairment; in these patients, the extent of LV but not RV dysfunction appeared related to the presence of septal ischemia. Vasospasm of the left anterior descending coronary artery consistently caused LV dysfunction not associated with secondary effects on RV systolic function.
Balloon catheter coronary angioplasty
Angelini, P.
The author has produced a reference and teaching book on balloon angioplasty. Because it borders in surgery and is performed on an awake patient without circulatory assistance, it is a complex and demanding procedure that requires thorough knowledge before it is attempted. The text is divided into seven sections. The first section describes coronary anatomy and pathophysiology, defines the objectives and mechanisms of the procedure and lists four possible physiologic results. The next section describes equipment in the catheterization laboratory, catheters, guidewires and required personnel. The following section is on the procedure itself and includes a discussion of examination, testing, technique and follow-up. The fourth section details possible complications that can occur during the procedure, such as coronary spasms, occlusion, thrombosis, perforations and ruptures, and also discusses cardiac surgery after failed angioplasty. The fifth section details complex or unusual cases that can occur. The sixth and seventh sections discuss radiation, alternative procedures and the future of angioplasty.
Incidence and Main Determinants of Contrast-Induced Nephropathy following Coronary Angiography or Subsequent Balloon Angioplasty
Nough, Hossein; Eghbal, Fatemeh; Soltani, Mohammadhossein; Nejafi, Farzaneh; Falahzadeh, Hossein; Fazel, Habib; Sheikhvatan, Mehrdad
Background/Aims Patient assessment by imaging studies using contrast media is currently replacing open procedures, especially in high-risk patients. However, the use of such contrast media might result in acute events and injuries after the procedure. In the present study, we first determined the incidence of contrast-induced nephropathy (CIN) in a sample of Iranian patients who candidated for coronary angiography and/or angioplasty, and then assessed major risk factors predicting the appearance of CIN following these procedures. Methods Two hundred and fifty consecutive, eligible patients scheduled for coronary angiography and/or angioplasty at the Afshar Hospital in Yazd between January 2009 and August 2010 were considered for enrollment. Renal function was measured at baseline and 48 h after the intervention, and CIN was defined by an increase in creatinine of >0.5 mg/dl or 25% of the initial value. The predictive role of potential risk factors was determined in a multivariate model adjusted for comorbidities, preexisting renal impairment, and angiographic data. Results CIN following coronary angiography or angioplasty appeared in 12.8% of the cases. A myocardial infarction before the procedure (OR = 2.121, p = 0.036) and a prior history of hypertension (OR = 2.789, p = 0.025) predicted the appearance of acute renal failure following angiography or subsequent angioplasty. A low estimated glomerular filtration rate at baseline slightly predicted CIN after these interventions. Conclusion Transient acute renal dysfunction occurred in 12.8% of the patients within 48 h after angiography or subsequent angioplasty and could be predicted by a myocardial infarction before the procedure or by a prior history of systolic hypertension. PMID:23922553
Statin-Induced Increase in HDL-C and Renal Function in Coronary Heart Disease Patients�
Athyros, Vasilios G; Kakafika, Anna I; Papageorgiou, Athanasios A; Pagourelias, Efstathios D; Savvatianos, Savvas D; Elisaf, Moses; Karagiannis, Asterios; Tziomalos, Konstantinos; Mikhailidis, Dimitri P
Background Little is known about the potential of statin-induced high-density lipoprotein cholesterol (HDL-C) increase to improve renal function in coronary heart disease (CHD) patients. Methods and Results In thispost hocanalysis of the GREek Atorvastatin and Coronary heart disease Evaluation (GREACE) Study we investigated the effect of HDL-C increase after statin treatment on renal function. From a total of 1,600 patients, 880 were on various statins (mainly atorvastatin) and 720 were not. Other secondary prevention therapies were similar in the 2 groups. After a 3 year follow up, the lipid profile was unchanged in the statin untreated group and estimated glomerular filtration rate (eGFR) was reduced by 5.1% compared with baseline (P<0.0001). In contrast, in the statin treated group non-HDL-C was reduced by 43%, HDL-C was increased by 7% and there was a significant increase in eGFR compared with baseline by 9.8% (P<0.0001). In multiple regression analysis, the mean 7% increase in HDL-C in the treated arm during the entire study was associated with a 5.6% increase in eGFR recorded after the 6th week of treatment. The odds ratio of eGFR increase with every 5% statin-induced rise in HDL-C was 1.78 (95% confidence interval 1.19-3.34; P=0.001). Conclusions Statin treatment significantly improved renal function. Statin-induced HDL-C increase significantly and independently contributed to this improvement. This finding supports the concept that improving lipid variables other than low density lipoprotein cholesterol is also beneficial to preserving renal function. PMID:18949085
Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography
Hung, Yao-Min; Lin, Shoa-Lin; Hung, Shih-Yuan; Huang, Wei-Chun; Wang, Paul Yung-Pou
Radiocontrast-induced nephropathy (RCIN) is an acute and severe complication after coronary angiography, particularly for patients with pre-existing chronic kidney disease (CKD). It has been associated with both short- and long-term adverse outcomes, including the need for renal replacement therapy, increased length of hospital stay, major cardiac adverse events, and mortality. RCIN is generally defined as an increase in serum creatinine concentration of 0.5 mg/dL or 25% above baseline within 48 h after contrast administration. There is no effective therapy once injury has occurred, therefore, prevention is the cornerstone for all patients at risk for acute kidney injury (AKI). There is a small but growing body of evidence that prevention of AKI is associated with a reduction in later adverse outcomes. The optimal strategy for preventing RCIN has not yet been established. This review discusses the principal risk factors for RCIN, evaluates and summarizes the evidence for RCIN prophylaxis, and proposes recommendations for preventing RCIN in CKD patients undergoing coronary angiography. PMID:22655164
Laryngeal spasm mimicking asthma and vitamin d deficiency.
Masoero, Monica; Bellocchia, Michela; Ciuffreda, Antonio; Ricciardolo, Fabio Lm; Rolla, Giovanni; Bucca, Caterina
We present a woman with heterozygous carnitine palmitoyl transferase 2 (CPT-2) deficiency who in the last 6 months suffered from episodic dyspnea and choking. Symptoms could not be attributed to her muscular energy defect, since heterozygous CPT-2 deficiency is usually asymptomatic or causes only mild muscle fatigability. Myopathy is usually triggered by concurrent factors, either genetic (additional muscle enzymes defects) or acquired (metabolic stress). The patient was referred to our respiratory clinic for suspect bronchial asthma. Spirometry showed mild decrease in inspiratory flows. Methacholine challenge was negative. Dyspnea was triggered by hyperventilation-induced hypocapnia, which produced marked decrease in airflow rates, particularly in inspiratory flows, consistent with laryngospasm. Nutritional assessment of the patient showed low serum level of calcium and vitamin D, attributable to avoidance of milk and dairy products for lactose intolerance and to insufficient sunlight exposure. After calcium and vitamin D supplementation episodic laryngospasm disappeared and hypocapnic hyperventilation test induced very mild change in airflow rates. Calcium and vitamin D deficiency may favour laryngeal spasm mimicking asthma, particularly in subjects with underlying myopathy. PMID:24843804
Outcomes in Treatment of Infantile Spasms With Pulse Methylprednisolone
John R. Mytinger; Mark Quigg; William C. Taft; Marcia L. Buck; Robert S. Rust
The authors report their experience with intravenous methylprednisolone for the treatment of infantile spasms. A pulse dose of 20 mg\\/kg intravenous methylprednisolone on each of 3 successive days, followed by a 2-month oral prednisolone taper, led to the rapid remission (range, 2-6 days) of infantile spasms in 5 of 10 (50%) infants. In the subgroup of infants treated within 1
Thoracic spine spasms secondary to hemorrhagic intestinal ulcer.
Slipman, C W; Whyte Ii, W S; Lichtenstein, G R; Lenrow, D; Braverman, D; Ellen, M; Vresilovic, E J
A case of thoracic spine spasms secondary to a bleeding duodenal ulcer is presented. A 41-year-old male with 14-week history of thoracic spine spasm was treated with bed rest, spinal manipulation, physical therapy, medication, and a thoracolumbar brace. Subsequently, a provocative thoracic discogram performed at T9-T10 created periscapular pain and also reproduced the presenting thoracic spasms. Intradiscal electrothermal annuloplasty (IDET) was performed at the T9-T10 level, but without sustained relief. The patient presented to a spine center for evaluation. The diagnosis of thoracic discogenic disease was suspected. A second provocative thoracic discogram was performed and failed to reproduce his thoracic spasms. Three weeks after being referred to a chronic pain management physician, the patient presented to a local emergency room with hema-temesis. An endoscopic evaluation revealed a bleeding duodenal ulcer. Following medical treatment of the duodenal ulcer with a proton pump inhibitor the patient had complete resolution of his thoracic spasms. This represents the first reported case of thoracic spine spasms as an initial presenting symptom of a bleeding peptic ulcer. PMID:16906172
Cortical involvement in focal epilepsies with epileptic spasms.
de la Vaissi�re, Sabine; Milh, Mathieu; Scavarda, Didier; Carron, Romain; L�pine, Anne; Tr�buchon, Agnes; Gavaret, Martine; Hewett, Russell; Laguitton, Virginie; Daquin, G�raldine; Villeneuve, Nathalie; Bartolomei, Fabrice
The pathophysiological mechanisms of epileptic spasms are still poorly understood. The role of subcortical structures has been suggested on the basis of non-localized EEG features and from experimental data. The description of asymmetric spasms associated with lateralized EEG patterns has challenged this view and raises the possibility of a cortical origin. This study investigated the cortical organization of partial seizures associated with epileptic spasms in children undergoing intracerebral EEG recordings for presurgical evaluation. Eleven children with drug resistant epileptic spasms and for whom depth electrode recordings were performed were retrospectively studied. In all children several features suggested a focal origin. Cortical involvement was studied using the "Epileptogenicity Index" (EI). A focal origin was finally demonstrated in 10/11 patients. Seven patients demonstrated pre-ictal changes in the seizure onset zone area. EI analysis showed maximal values in the temporal (n=5), parietal (n=1) or frontal (n=5) cortices. EEG changes were also observed in the premotor cortex during spasms in patients with frontal or parietal seizures and in 3/5 patients with temporal lobe seizures. Good surgical outcome (class I or II) was obtained in 7/10 patients. Seizures associated with epileptic spasms may originate from various cortical regions. Premotor/motor cortices are probably involved in determining ictal clinical changes. PMID:25212728
Trimetazidine in the prevention of contrast?induced nephropathy after coronary procedures
Onbasili, Alper O; Yeniceriglu, Yavuz; Agaoglu, P?nar; Karul, Asl?han; Tekten, Tarkan; Akar, Harun; Discigil, Guzel
Objective To evaluate the efficacy of trimetazidine (TMZ) in the prevention of contrast?induced nephropathy (CIN) in patients with high serum creatinine levels undergoing coronary angiography/angioplasty. Methods TMZ (20?mg thrice daily) was administered orally for 72?h starting 48?h before the procedure. All patients were given intravenous saline (0.9%) at a rate of 1?ml/kg of body weight per hour for 24?h starting 12?h beforehand. Serum creatinine levels were measured before the procedure, 48?h and 7?days after the procedure. Increase in serum creatinine level exceeding 0.5?mg/day or one quarter of the basal value is considered as CIN. Venous blood samples for serum total antioxidant capacity (TAC) measurement were drawn before and after coronary angiography. Results Basal serum creatinine levels and TAC were similar in TMZ and control groups. Serum creatinine levels in the control group increased significantly 2?days after the procedure, and returned to the baseline values on the seventh day. However, it did not change significantly on the second day, and even significantly decreased on the seventh day in the TMZ group. CIN developed in 2.5% (1/40) of patients in the TMZ group and in 16.6% (7/42) of patients in the control group (p<0.05). TAC values were not different between treatment groups. Conclusion TMZ along with isotonic saline infusion is more effective than isotonic saline alone in reducing the risk of CIN in patients with pre?existing renal dysfunction. PMID:17065180
Hypoxia-induced vasodilation in the right coronary circulation of conscious dogs: role of adrenergic activation.
Setty, Srinath; Zong, Pu; Sun, Wei; Tune, Johnathan D; Downey, H Fred
The role of adrenergic activation in the right coronary (RC) flow response to hypoxia has not been previously delineated, and limited information from left coronary studies is inconsistent. Seven dogs were instrumented with catheters implanted in the aorta and in the right ventricle to measure aortic pressure and right ventricular (RV) pressure, respectively. A flow transducer was placed around the RC artery to measure RC flow. After recovery from surgery, the dogs were exposed to systemic hypoxia in a Plexiglas chamber ventilated with N(2). Percent O(2) in the chamber was monitored, and blood samples and hemodynamic data were collected as chamber O(2) was progressively reduced to approximately 6%. The chamber was then opened, and the dog breathed room air. Phentolamine, 1 mg/kg, and propranolol, 2 mg/kg, were then administered via the RV catheter to achieve adrenergic blockade, and the hypoxia protocol was repeated. During hypoxia, arterial PO(2) progressively fell from 87+/-3 to 25+/-1 mmHg during untreated control condition and from 90+/-4 to 23+/-1 mmHg during adrenergic blockade. In the unblocked condition, hypoxia caused increases in aortic pressure, heart rate, RV pressure, and RV dP/dt(max). After adrenergic blockade, normoxic aortic pressure was reduced; heart rate and RV dP/dt(max) tended to be lower. Aortic pressure rose during hypoxia, but to lesser values than before blockade. Heart rate and RV dP/dt(max) also increased, but only at more severe hypoxia, and these values were less than before blockade. Normoxic flow and hypoxia-induced increases in RC flow and conductance were not altered by blockade. The relationship between RC conductance and RV triple product, an index of RV O(2) demand, was steeper after blockade. These findings indicate that in the normal, unblocked condition, RC flow during hypoxia is restrained by an adrenergic-mediated increase in RC vasomotor tone. PMID:18055275
Compound Danshen Dripping Pill Pretreatment to Prevent Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention
Yang, Rong; Chang, Liang; Guo, Bing-yan; Wang, Yan-wei; Wang, Ya-ling; Jin, Xin; Liu, Su-yun; Li, Yong-jun
Background. Contrast-induced nephropathy (CIN) limits the outcome of percutaneous coronary intervention (PCI). Objective. To investigate whether pretreatment with Compound Danshen Dripping Pills (CDDP) will decrease the incidence of CIN after PCI. Methods. A total of 229 patients with acute coronary syndrome (ACS) undergoing PCI were divided into the control group (n = 114) and the CDDP (containing salvia miltiorrhiza and sanqi) group (n = 115; given 20 CDDP pills, three times daily before PCI). Serum creatinine, creatinine clearance (CrCl), high-sensitivity C-reactive protein (hsCRP), P-selectin, and intercellular adhesion molecule-1 (ICAM-1) were measured at admission and 24 and 48?h after PCI. Results. CrCl decreased after PCI but recovered after 48 h. In the CDDP group, CrCl recovered more rapidly (P < 0.05). The procedure increased the hsCRP, P-selectin, and ICAM-1 levels, but these levels were less in the CDDP group (P < 0.05). Conclusions. Pretreatment with CDDP can decrease the occurrence of CIN in patients undergoing PCI, suggesting that the early use of CDDP is an appropriate adjuvant pharmacological therapy before PCI. PMID:25386219
Prinzmetal's angina, normal coronary arteries and pericarditis.
Lewis, J. R.; Kisilevsky, R.; Armstrong, P. W.
A woman with Prinzmetal's variant angina had spontaneous attacks of myocardial ischemia characterized by severe chest pain, hypotension, inferior ST-segment elevation, transient complete heart block and selective right ventricular dysfunction. Despite initial improvement following intravenous administration of atropine and sublingual administration of nitroglycerin she died of cardiogenic shock. Autopsy showed normal coronary arteries and acute pericarditis, more pronounced over the right side of the heart. It is postulated that the pericardial inflammation elicited severe spasm of the subjacent right coronary artery. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4A FIG. 4B FIG. 5A FIG. 5B PMID:679098
Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis
NASA Astrophysics Data System (ADS)
Lee, Cheng-Hung; Jhong, Guan-Heng; Hsu, Ming-Yi; Liu, Shih-Jung; Wang, Chao-Jan; Hung, Kuo-Chun
The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P < 0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70� than at angle ?70� (P < 0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P < 0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.
Protective effect of total flavones from Elsholtzia blanda (TFEB) on myocardial ischemia induced by coronary occlusion in canines.
Haiyun, Ling; Yijia, Lou; Honggang, Lou; Honghai, Wu
This study was undertaken to determine the effect of total flavones from Elsholtzia blanda (Benth.) Benth. (TFEB), a traditional Chinese medicine, on myocardial ischemia induced by coronary occlusion in Beagle dogs. Infarct size of left ventricle, serum activity of creatine kinase-MB (CK-MB) and malondialdehyde (MDA), hemorrheologic variables and homodynamic parameters including mean arterial pressure (MAP), coronary blood flow (CBF), coronary vascular resistance (CVR), end-diastolic pressure of left ventricle (LVEDP), rate of rise and decline of left ventricular pressure (+/-dp/dtmax) were measured in this study. Administration with TFEB produced a dose-dependent reduction in infarct size. TFEB 100 mg/kg exerted notable inhibition in the elevation of serum CK-MB and MDA activity. TFEB significantly reduced MAP and CVR. The decrease in CBF also tended to be smaller in treated dogs. TFEB improved the recovery of myocardial function by depressing the degree of reduction in +/-dp/dtmax and LVEDP. TFEB also showed a capacity to resist ischemic damage through lowering blood viscosity. The results indicated that TFEB kept heart from ischemic damage due to coronary occlusion in Beagle dogs. PMID:15261969
Effect of force-induced mechanical stress at the coronary artery bifurcation stenting: Relation to in-stent restenosis
Lee, Cheng-Hung [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China); Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Jhong, Guan-Heng [Graduate Institute of Medical Mechatronics, Chang Gung University, Tao-Yuan, Taiwan (China); Hsu, Ming-Yi; Wang, Chao-Jan [Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Tao-Yuan, Taiwan (China); Liu, Shih-Jung, E-mail: firstname.lastname@example.com [Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, Taiwan (China); Hung, Kuo-Chun [Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan (China)
The deployment of metallic stents during percutaneous coronary intervention has become common in the treatment of coronary bifurcation lesions. However, restenosis occurs mostly at the bifurcation area even in present era of drug-eluting stents. To achieve adequate deployment, physicians may unintentionally apply force to the strut of the stents through balloon, guiding catheters, or other devices. This force may deform the struts and impose excessive mechanical stresses on the arterial vessels, resulting in detrimental outcomes. This study investigated the relationship between the distribution of stress in a stent and bifurcation angle using finite element analysis. The unintentionally applied force following stent implantation was measured using a force sensor that was made in the laboratory. Geometrical information on the coronary arteries of 11 subjects was extracted from contrast-enhanced computed tomography scan data. The numerical results reveal that the application of force by physicians generated significantly higher mechanical stresses in the arterial bifurcation than in the proximal and distal parts of the stent (post hoc P?0.01). The maximal stress on the vessels was significantly higher at bifurcation angle <70� than at angle ?70� (P?0.05). The maximal stress on the vessels was negatively correlated with bifurcation angle (P?0.01). Stresses at the bifurcation ostium may cause arterial wall injury and restenosis, especially at small bifurcation angles. These finding highlight the effect of force-induced mechanical stress at coronary artery bifurcation stenting, and potential mechanisms of in-stent restenosis, along with their relationship with bifurcation angle.
Hemifacial Spasm Caused by Fusiform Aneurysm at Vertebral Artery-Posterior Inferior Cerebellar Artery Junction
Choi, Seok-Keun; Park, Bong-Jin; Lim, Young-Jin
Hemifacial spasm induced by intracranial aneurysm is a rare clinical condition. A 45-year-old male patient presented with a 3-year history of progressive involuntary twitching movement on right face. On radiological study, a dilated vascular lesion compressing the brain stem was found at the junction of vertebral artery and posterior inferior cerebellar artery. On operative field, we found the posterior inferior cerebellar artery and the fusiform aneurysm compressing root exit zone of facial nerve. Microvascular decompression was performed and the facial symptom was relieved without complications. PMID:19137088
... and animations for grades K-6. The Coronary Arteries | Share Coronary Circulation The heart muscle, like every ... into two main coronary blood vessels (also called arteries). These coronary arteries branch off into smaller arteries, ...
A transferable, beta-naphthoflavone-inducible, hyperpolarizing factor is synthesized by native and cultured porcine coronary endothelial cells.
Popp, R; Bauersachs, J; Hecker, M; Fleming, I; Busse, R
1. The vascular endothelium releases a hyperpolarizing factor (endothelium-derived hyperpolarizing factor, EDHF) tentatively identified as a cytochrome P450-derived arachidonic acid metabolite. However, there is still controversy concerning its transferability and identity. We designed a bioassay system for assessing EDHF release in which the membrane potential was recorded in cultured vascular smooth muscle cells located downstream from donor endothelial cells. 2. Under combined nitric oxide (NO) synthase and cyclo-oxygenase blockade with NG-nitro-L-arginine (100 mumol l-1) and diclofenac (10 mumol l-1), the superfusate from bradykinin (30 mumol l-1)-stimulated, cultured porcine coronary endothelial cells induced a distinct hyperpolarization followed by a depolarization. Direct application of bradykinin to the smooth muscle cells resulted solely in membrane depolarization. Similar results were obtained using bradykinin-stimulated porcine coronary arteries as donor. 3. Single-channel current measurements suggest that this EDHF-induced hyperpolarization was elicited by the activation of Ca(2+)-dependent K+ channels. 4. Increasing the transmural pressure within the donor segment significantly enhanced the duration, but not the amplitude of the hyperpolarization induced by the effluate from bradykinin-stimulated donor segments. 5. Inhibition of P450 oxygenase activity with clotrimazole (3 mumol l-1) or 17-octadecynoic acid (3 mumol l-1) abolished EDHF release from the coronary endothelium, while the P450-derived arachidonic acid metabolite, 5,6-epoxyeicosatrienoic acid, induced a hyperpolarization of detector smooth muscle cells almost identical to that induced by EDHF. Moreover, induction of P450 activity by beta-naphthoflavone (3 mumol l-1, 48 h), significantly increased the bradykinin-induced release of EDHF. 6. These findings suggest that the vascular endothelium releases a transferable hyperpolarizing factor, chemically distinct from NO and prostacyclin, in response to agonists and mechanical stimulation. This beta-naphthoflavone-inducible EDHF appears to be a cytochrome P450-derived metabolite of arachidonic acid, which elicits hyperpolarization by activation of Ca(2+)-dependent K+ channels. PMID:9003555
Simultaneous onset of infantile spasms in monozygotic twins.
Coppola, Giangennaro; Grosso, Salvatore; Verrotti, Alberto; D'Aniello, Alfredo; Pascotto, Antonio
The clinical, electroencephalographic, and genetic findings are reported for three pairs of monozygotic twins who developed infantile spasms in their first year. In all three pairs, the spasms started on the same day in each member of the pair. Neither sequencing of the ARX and CDKL5 (alias STK9) genes nor array comparative genomic hybridization assessment revealed any abnormalities. The long-term outcome was poor in all twins, although with different severity in individual pairs. These findings suggest that genes other than those currently known likely play a role in predisposition to infantile spasms, and that genetic susceptibility is linked to a variable phenotypic expression, ranging from quite benign to very severe, in monozygotic twins with no other apparent risk factors. PMID:20610124
Autosomal recessive polymicrogyria with infantile spasms and limb deformities.
Ciardo, F; Zamponi, N; Specchio, N; Parmeggiani, L; Guerrini, R
We describe two siblings, a girl and a boy, aged 4 and 2 years and 10 months respectively, born from non-consanguineous parents,with diffuse polymicrogyria, lower limb deformities, infantile spasms and developmental delay. Spasms had a good outcome under antiepileptic drug treatment. Clinical and imaging features were of identical severity in both siblings. Muscle biopsy,creatine kinase, metabolic investigations and chromosomal analysis were normal. This combination of anatomo-clinical features and their occurrence in siblings of both sexes suggests an autosomal recessive malformation syndrome. PMID:11870589
The Other Babinski Sign in Hemifacial Spasm William Stamey, MD, Joseph Jankovic, MD
Lichtarge, Olivier
by contraction of the frontalis muscle ipsilateral to the facial spasm. METHODSMETHODS REFERENCESREFERENCES 1 Salp�tri�re. 1905;18:418-423. 3. Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment. MuscleThe Other Babinski Sign in Hemifacial Spasm William Stamey, MD, Joseph Jankovic, MD Parkinson
The application of air bag technology: An objective clinical measure of involuntary muscle spasm
MH Granat; P Edmond
Objectives: To develop a technique which could objectively monitor and quantify spasms in spinal cord injured persons. Methods: This technique used accelerometers to detect movements in the limb caused by spasms. Accelerometer signals from movements caused by spasms and a variety of movements caused by other subject activities (movement in a wheelchair, transfers etc) were recorded and linear discriminant analysis
Clinical profile and treatment of infantile spasms using vigabatrin and ACTH - a developing country perspective
Shahnaz Ibrahim; Shamshad Gulab; Sidra Ishaque; Taimur Saleem
BACKGROUND: Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of patients with infantile spasms from Pakistan. METHODS: All patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from
LY215840, a high-affinity 5-HT7 receptor ligand, blocks serotonin-induced relaxation in canine coronary artery.
Cushing, D J; Zgombick, J M; Nelson, D L; Cohen, M L
The canine coronary artery possesses a smooth muscle relaxant serotonin (5-HT) receptor distinct from previously characterized 5-HT receptors. On the basis of the ability of LY53857 to block weakly coronary smooth muscle relaxation to 5-HT, we examined several structurally related ergolines in endothelium denuded rings of canine coronary artery precontracted with PGF2 alpha (10 microM). 5-HT (10 nM-100 microM)-induced relaxation was antagonized competitively by the ergoline esters LY53857 (-log KB = 6.5) and sergolexole (-log KB = 6.4) and by the ergoline amide amersergide, (-log KB = 6.7). In contrast to the relatively low affinity of these ergolines, LY215840, another ergoline amide, antagonized 5-HT-induced relaxation in a competitive manner with the highest affinity (-log KB = 8.3). This effect was independent of the 5-HT2 receptor affinity of these ergolines, because LY215840, LY53857, sergolexole and amesergide all possessed similar 5-HT2 receptor affinity. Further, all four ergolines possessed affinity for the human 5-HT7 receptor, and LY215840 had the highest 5-HT7 receptor affinity (Ki = 14.7 nM). Finally, in vascular smooth muscle under basal tone, LY215840 (1 microM) blocked the relaxant response to high concentrations of 5-HT and 5-MeOT without altering their contractile potency. LY215840 (1 microM) did not alter contraction to sumatriptan, an agent that lacks relaxant activity. In contrast, LY215840 (1 microM) markedly potentiated contraction to 5-carboxamidotryptamine, the most potent coronary relaxant agonist and the agonist with the highest 5-HT7 receptor affinity. The ability of LY215840 to block the relaxant 5-HT receptor in canine coronary artery may reflect its 5-HT7 receptor antagonist activity and make it a useful tool to probe the relationship between the 5-HT7 receptor and the coronary vasoactive properties of 5-HT. PMID:8667223
Efficacy of short-term cordyceps sinensis for prevention of contrast-induced nephropathy in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention.
Zhao, Kai; Lin, Yu; Li, Yong-Jian; Gao, Sheng
Contrast-induced nephropathy (CIN) is one of the major causes of hospital-acquired acute renal failure. The pathophysiological mechanism of CIN remains unknown. There has been little evidence regarding the effects of Traditional Chinese Medicine (TCM) on CIN. Cordyceps sinensis (CS), a traditional Chinese herb, has been widely used clinically for the prevention of the progression of renal failure. We performed a prospective, randomized controlled trial to investigate the role of CS in the prevention of CIN in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI). The 150 ACS patients were randomly assigned to three groups, basic treatment group (n=51), standard CS therapy group (n=49, corbrin capsule 2 g, 3 times/d were used 3 days before and after angiography), and intensive CS therapy group (n=50, corbrin capsule 3 g, 3 times/d were used 3 days before and after angiography). Renal function was assessed at the time of hospital admission and on days 1, 2, and 3 after PCI. CIN occurred in 13 of 150 patients (8.67%). The incidence of CIN was lower in the CS treatment groups than in the basic treatment group (P<0.05), and a significant decrease in the incidence of CIN in the intensive CS therapy group was shown (P<0.01). In conclusion, prophylactic treatment with CS during the peri-procedural stage in ACS patients undergoing elective PCI has a preventive role against CIN, and intensive CS therapy could be more effective. PMID:25664103
The loss of cervical lordosis in radiographs of patients presenting with neck pain is sometimes ascribed to muscle spasm. We performed a cross-sectional study of the prevalence of 'straight' cervical spines in three populations: 83 patients presenting to an accident department with acute neck pain, 83 referred to a radiology department with chronic neck problems, and 80 radiographs from a
Part One: Infantile Spasms--The New Consensus
ERIC Educational Resources Information Center
Pellock, John
Infantile spasms (IS, West syndrome) represent a difficult to treat and sometimes not immediately recognized form of epilepsy which is relatively rare. West Syndrome or IS is one of the most recognized types of epileptic encephalopathy, a form of epilepsy usually associated with developmental regression and delay, frequently difficult to treat and�
Polygraphic Study during Whole Night Sleep in Infantile Spasms
Yukio Fukuyama; Atsuko Shionaga; Yoko Iida
The whole night EEG were polygraphically recorded and analyzed in 9 patients with infantile spasms prior to ACTH therapy. The subjects were divided into two groups, favorable and unfavorable, depending upon the response to the ACTH therapy. (1) Among the unfavorable group, the deep sleep stage was not observed; while the light sleep stage tended to dominate. (2) REM sleep
Heparin-Induced Thrombocytopenia After Coronary Artery Bypass Grafting with Cardiopulmonary Bypass: Report of a Case
Keiichi Ishida; Mizuho Imamaki; Atsushi Ishida; Hitoshi Shimura; Masaru Miyazaki
A 79-year-old man was transferred to our hospital with severe chest pain and a suspected diagnosis of acute myocardial infarction. Emergency cardiac catheterization showed triple-vessel coronary artery disease, and we performed coronary artery bypass grafting under cardiopulmonary bypass (CPB). Continuous hemodiafiltration was started for acute renal failure postoperatively, and heparin was given as an anticoagulanting agent. By 9 days after
Mechanisms of coronary vasoconstriction induced by Na arachidonate in experimentally diabetic dogs
L. Sterin-Borda; E. Borda; E. J. del Castillo; M. F. Gimeno; A. L. Gimeno
Summary Na arachidonate (NaA) enhanced the resting basal tone of isolated coronary arteries from diabetic dogs and depressed it in coronary arteries from normal controls. Inhibitors of thromboxane A2 biosynthesis and of lipoxygenases abolished the vasoconstrictor effect of NaA on diabetic arteries, whereas inhibitors of cyclooxygenase activity and PGI2 biosynthesis blocked the vasodilating action of NaA on normal arteries.
Altered coronary flow properties in diffuse coronary artery ectasia
�mer Aky�rek; Berkten Berkalp; Tamer Say?n; Deniz Kumbasar; Celal Kervanc?o?lu; Dervi? Oral
Objectives The purpose of this study was to investigate coronary blood flow properties in patients with diffuse coronary artery ectasia (CAE) associated with exercise-induced myocardial ischemia.Methods Seventeen patients with diffuse CAE and without coexisting coronary artery stenosis were enrolled in the study (CAE group). CAE was defined as luminal dilatation 1.5 to 2 times that of the adjacent normal coronary
TNF-?-induced cardiomyocyte apoptosis contributes to cardiac dysfunction after coronary microembolization in mini-pigs.
Chen, Zhang-Wei; Qian, Ju-Ying; Ma, Jian-Ying; Chang, Shu-Fu; Yun, Hong; Jin, Hang; Sun, Ai-Jun; Zou, Yun-Zeng; Ge, Jun-Bo
This experimental study was designed to clarify the relationship between cardiomyocyte apoptosis and tumour necrosis factor-alpha (TNF-?) expression, and confirm the effect of TNF-? on cardiac dysfunction after coronary microembolization (CME) in mini-pigs. Nineteen mini-pigs were divided into three groups: sham-operation group (n = 5), CME group (n = 7) and adalimumab pre-treatment group (n = 7; TNF-? antibody, 2 mg/kg intracoronary injection before CME). Magnetic resonance imaging (3.0-T) was performed at baseline, 6th hour and 1 week after procedure. Cardiomyocyte apoptosis was detected by cardiac-TUNEL staining, and caspase-3 and caspase-8 were detected by RT-PCR and immunohistochemistry. Furthermore, serum TNF-?, IL-6 and troponin T were analysed, while myocardial expressions of TNF-? and IL-6 were detected. Both TNF-? expression (serum level and myocardial expression) and average number of apoptotic cardiomyocyte nuclei were significantly increased in CME group compared with the sham-operation group. Six hours after CME, left ventricular end-systolic volume (LVESV) was increased and the left ventricular ejection fraction (LVEF) was decreased in CME group. Pre-treatment with adalimumab not only significantly improved LVEF after CME (6th hour: 54.9 � 2.3% versus 50.4 � 3.9%, P = 0.036; 1 week: 56.7 � 4.2% versus 52.7 � 2.9%, P = 0.041), but also suppressed cardiomyocyte apoptosis and the expression of caspase-3 and caspase-8. Meanwhile, the average number of apoptotic cardiomyocytes nuclei was inversely correlated with LVEF (r = -0.535, P = 0.022). TNF-?-induced cardiomyocyte apoptosis is likely involved in cardiac dysfunction after CME. TNF-? antibody therapy suppresses cardiomyocyte apoptosis and improves early cardiac function after CME. PMID:25130514
Intra-operative neurophysiology during microvascular decompression for hemifacial spasm.
Fern�ndez-Conejero, I; Ulkatan, S; Sen, C; Deletis, V
There is evidence that primary hemifacial spasm (HFS) in the majority of patients is related to a vascular compression of the facial nerve at its root exit zone (REZ). As a consequence, the hyperexcitability of facial nerve generates spasms of the facial muscles. Microvascular decompression (MVD) of the facial nerve near its REZ has been established as an effective treatment of HFS. Intra-operative disappearance of abnormal muscle responses (lateral spread) elicited by stimulating one of the facial nerve branches has been used as a method to predict MVD effectiveness. Other neurophysiologic techniques, such as facial F-wave, blink reflex and facial corticobulbar motor evoked potentials (FCoMEP), are feasible to intra-operatively study changes in excitability of the facial nerve and its nucleus during MVDs. Intra-operative neuromonitoring with the mentioned techniques allows a better understanding of HFS pathophysiology and helps to optimise the MVD. PMID:22136736
Hemifacial spasm: 20-year surgical experience, lesson learned
Soriano-Baron, Hector; Vales-Hidalgo, Olivia; Arvizu-Saldana, Emiliano; Moreno-Jimenez, Sergio; Revuelta-Gutierrez, Rogelio
Background: Hemifacial spasm is characterized by unilateral, paroxysmal, and involuntary contractions. It is more common in women on the left side. Its evolution is progressive, and it rarely improves without treatment. Methods: Microvascular decompressions (N = 226) were performed in 194 Hispanic patients (May 1992�May 2011). Outcomes were evaluated on a 4-point scale: Excellent (complete remission); good (1�2 spasms/day); bad (>2 spasms/day); and recurrence (relapse after initial excellent/good response). Results: Most patients were female (n = 123); 71 were male. Mean (�SD) age was 49.4 (�11.7) years; age at onset, 43.9 (�11.9) years; time to surgery, 5.7 (�4.7) years. The left side was affected in 114 patients. Typical syndrome occurred in 177 (91.2%); atypical in 17 (8.8%). Findings were primarily vascular compression (n = 185 patients): Anterior inferior cerebellar artery (n = 147), posterior inferior cerebellar artery (n = 12), basilar artery (n = 10), superior cerebellar artery (n = 8), and 2 vessels (n = 8); 9 had no compression. Postsurgical results were primarily excellent (79.9% [n = 155]; good, 4.6% [n = 9]; bad, 15.5% [n = 30]), with recurrence in 21 (10.8%) at mean 51-month (range, 1�133 months) follow-up. Complications included transient hearing loss and facial palsy. Conclusions: The anterior inferior cerebellar artery is involved in most cases of hemifacial spasm. Failure to improve postsurgically after 1 week warrants reoperation. Sex, side, and onset are unrelated to treatment response. Microvascular decompression is the preferred treatment. It is minimally invasive, nondestructive, and achieves the best long-term results, with minor morbidity. To our knowledge, this series is the largest to date on a Hispanic population. PMID:26015871
Effect of thimerosal on arrhythmia induced by coronary ligation: the involvement of ATP-dependent potassium channels.
Bozdogan, Omer; Gonca, Ers�z; Nebigil, Melih; Tiryaki, Eylem Suveren
Thiol-modifying agents induce the release of nitric oxide (NO) from endothelial epithelium and the release of reactive oxygen free radicals in the vascular system. Moreover, thiol groups are essential for the functioning of the ATP dependent potassium channel (K-ATP). The effects of thiol-modifying agents and their molecular mechanisms on arrhythmia have not been widely studied. In this study, we investigated the effect of the hydrophilic SH-group-oxidizing substance thimerosal on the arrhythmia induced by reperfusion/ischemia after coronary artery ligation in rats. We studied the possible involvement of the K-ATP and NOS on the effect of thimerosal. Thimerosal pretreatment (3, 30 mg/kg dose iv. 10 minutes before coronary occlusion) significantly decreased the length of total arrhythmia, ventricular tachycardia, and the arrhythmia score. This effect of thimerosal was reversed by the K-ATP opener pinacidil but not by the K-ATP blocker glibenclamide. The inhibition of iNOS by L-NAME did not alter the antiarrhythmic effect of thimerosal. These data clearly suggest that the antiarrhythmic effect of thimerosal is dependent upon the blockage of K-ATP. PMID:16157962
Infantile spasms are associated with abnormal copy number variations.
Tiwari, Vijay N; Sundaram, Senthil K; Chugani, Harry T; Huq, A H M M
The authors tested the hypothesis that de novo copy number variations (CNVs) implicated in known genomic disorders ("pathogenic CNVs") are significant predisposing factors of infantile spasms. The authors performed a genome-wide analysis of single-nucleotide polymorphism genotyping microarray data to identify the role of de novo/known pathogenic large CNVs in 13 trios of children affected by infantile spasms. A rare, large (4.8 Mb) de novo duplication was detected in the 15q11-13 region of 1 patient. In addition, 3 known pathogenic CNVs (present in the patient as well as 1 of the parents) were detected in total. In 1 patient, a known pathogenic deletion was detected in the region of 2q32.3. Similarly, in 1 other patient, 2 known pathogenic deletions in the regions of 16p11.2 and Xp22.13 (containing CDKL5) were detected. These findings suggest that some specific pathogenic CNVs predispose to infantile spasms and may be associated with different phenotypes. PMID:22914377
Does intrathecal baclofen have a place in the treatment of painful spasms in friedreich ataxia?
Berntsson, Shala Ghaderi; Holtz, Anders; Melberg, Atle
We present the case of a 50-year-old female patient with Friedreich ataxia (FA) who was treated successfully with an intrathecal baclofen (ITB)-delivering pump for painful spasms. To our knowledge, this is the second reported case of FA where ITB relieved painful and disabling spasms. We suggest that ITB should be considered in the treatment of disabling spasms in patients with FA. PMID:24348400
Automatic identification and classification of muscle spasms in long-term EMG recordings.
Winslow, Jeffrey; Martinez, Adriana; Thomas, Christine K
Spinal cord injured (SCI) individuals may be afflicted by spasticity, a condition in which involuntary muscle spasms are common. EMG recordings can be analyzed to quantify this symptom of spasticity but manual identification and classification of spasms are time consuming. Here, an algorithm was created to find and classify spasm events automatically within 24-h recordings of EMG. The algorithm used expert rules and time-frequency techniques to classify spasm events as tonic, unit, or clonus spasms. A companion graphical user interface (GUI) program was also built to verify and correct the results of the automatic algorithm or manually defined events. Eight channel EMG recordings were made from seven different SCI subjects. The algorithm was able to correctly identify an average (�SD) of 94.5 � 3.6% spasm events and correctly classify 91.6 � 1.9% of spasm events, with an accuracy of 61.7 � 16.2%. The accuracy improved to 85.5 � 5.9% and the false positive rate decreased to 7.1 � 7.3%, respectively, if noise events between spasms were removed. On average, the algorithm was more than 11 times faster than manual analysis. Use of both the algorithm and the GUI program provide a powerful tool for characterizing muscle spasms in 24-h EMG recordings, information which is important for clinical management of spasticity. PMID:24801733
Stent-induced coronary artery stenosis characterized by multimodal nonlinear optical microscopy
NASA Astrophysics Data System (ADS)
Wang, Han-Wei; Simianu, Vlad; Locker, Mattew J.; Cheng, Ji-Xin; Sturek, Michael
We demonstrate for the first time the applicability of multimodal nonlinear optical (NLO) microscopy to the interrogation of stented coronary arteries under different diet and stent deployment conditions. Bare metal stents and Taxus drug-eluting stents (DES) were placed in coronary arteries of Ossabaw pigs of control and atherogenic diet groups. Multimodal NLO imaging was performed to inspect changes in arterial structures and compositions after stenting. Sum frequency generation, one of the multimodalities, was used for the quantitative analysis of collagen content in the peristent and in-stent artery segments of both pig groups. Atherogenic diet increased lipid and collagen in peristent segments. In-stent segments showed decreased collagen expression in neointima compared to media. Deployment of DES in atheromatous arteries inhibited collagen expression in the arterial media.
Angiotensin II Induces Endothelial Xanthine Oxidase Activation Role for Endothelial Dysfunction in Patients With Coronary Disease
Ulf Landmesser; Stephan Spiekermann; Christoph Preuss; Sajoscha Sorrentino; Dieter Fischer; Costantina Manes; Maja Mueller; Helmut Drexler
Objective�Xanthine oxidase (XO), a major source of superoxide, has been implicated in endothelial dysfunction in atherosclerosis. Mechanisms, however, leading to endothelial XO activation remain poorly defined. We tested the effect of angiotensin II (Ang II) on endothelial XO and its relevance for endothelial dysfunction in patients with coronary disease. Methods and Results�XO protein levels and XO-dependent superoxide production were determined
The effects of ablations in the central nervous system on arrhythmias induced by coronary occlusion in the rat.
Curtis, M. J.; Macleod, B. A.; Walker, M. J.
The role of the central nervous system (CNS) in arrhythmogenesis in the 4 h period following occlusion of a coronary artery was investigated in rats by use of CNS ablations and other procedures. Ablations in the CNS included pithing, spinalization and decerebration combined with acute and chronic surgical preparation and noradrenaline/adrenaline infusions. All procedures involving acute surgery reduced the incidence and severity of the arrhythmias induced by occlusion. Such reductions were most marked in the second (0.5-4 h post-occlusion) arrhythmic period. The observed reductions in arrhythmias could not be explained in terms of involvement of the CNS or adrenoceptor activation. When circulating leucocytes, platelets and serum potassium were measured in a group of pithed rats before and after occlusion, reduced levels (20-50%) of both leucocytes and platelets occurred while serum potassium levels rose by 50-100%. Arrhythmias following coronary occlusion may depend in part on factors in the blood such as leucocytes, platelets and serum potassium and these factors may be altered by acute surgery. PMID:4063585
Neutrophil-to-lymphocyte ratio predicts contrast-induced nephropathy in patients undergoing primary percutaneous coronary intervention.
Kaya, Ahmet; Kaya, Yasemin; Top�u, Selim; G�naydin, Zeki Y�ksel; Kurt, Mustafa; Tanbo?a, Ibrahim Halil; Kalkan, Kamuran; Aksakal, Enbiya
We investigated the relationship between baseline neutrophil-to-lymphocyte ratio (NLR) and contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction (STEMI). Consecutive patients diagnosed with STEMI (n = 691) who underwent primary percutaneous coronary intervention (p-PCI) were included in the study. The CIN was defined as an increase in serum creatinine concentration ?25% over baseline at 48 hours. Both NLR and C-reactive protein levels were significantly higher in the CIN group. There was a stronger correlation in patients with a known history of chronic kidney disease and in patients with a history of diabetes mellitus (DM). Advanced age, DM, low baseline glomerular filtration rate, reduced postprocedural ST resolution, high amount of contrast media, high NLR, and low left ventricular ejection fraction were independent predictors of CIN. The NLR may be used as a simple and reliable indicator of CIN in patients with STEMI who underwent p-PCI. PMID:23620308
Reversible arterial spasm in an adolescent with primary oxalosis.
van Damme-Lombaerts, R; Proesmans, W; Alexandre, G; van Dyck, M; Serrus, M; Wilms, G
A 16-year-old girl with primary oxalosis type I presented with progressive claudication soon after being treated with chronic intermittent hemodialysis. Arterial insufficiency of the lower limbs was confirmed clinically (purple discoloration of the skin and absence of arterial pulses) and with Doppler sonography. The arteriogram showed diffuse and symmetric narrowing with smooth vessel walls. Treatment with sodium nitroprusside had a spectacular effect; nifedipine was less effective. Renal transplantation with the father's kidney resulted in a rapid, complete and sustained reversal of the ischemic features. Magnesium withdrawal is assumed to be a pathogenic factor of the vascular spasm in this patient. PMID:3063419
Wolfgang Koenig
The notion that fibrinogen is strongly, consistently, and independently related to coronary risk has been widely accepted.\\u000a The evidence is based on numerous prospective epidemiological studies and clinical observations. However, the reasons why\\u000a fibrinogen is elevated in coronary disease and in atherosclerosis are only incompletely understood. All cells involved in\\u000a the atherogenetic process are able to produce cytokines which induce
Association analysis of polymorphisms of the CRHR1 gene with infantile spasms
While >200 types of etiologies have been shown to be involved in the pathogenesis of infantile spasms, the pathophysiology of infantile spasms remains largely elusive. Pre-natal stress and hypothalamic-pituitary-adrenal axis dysfunction were shown to be involved in the development of infantile spasms. To test the genetic association between the CRHR1 gene, which encodes the corticotrophin-releasing hormone (CRH) receptor, and infantile spasms, five single nucleotide polymorphisms (SNPs) in the CRHR1 gene were genotyped in a sample set of 128 cases with infantile spasms and 131 healthy controls. Correlation analysis was performed on the genotyped data. Under the assumption of the dominant model, the selected five SNPs, rs4458044, rs171440, rs17689966, rs28364026 and rs242948, showed no association with the risk of infantile spasms and the effectiveness of adrenocorticotropic hormone treatment. In addition, subsequent haplotype analysis suggested none of them was associated with infantile spasms. In conclusion, the experimental results of the present study suggested no association between the CRHR1 gene and infantile spasms in a Chinese population. PMID:25954915
Differences in improvement between patients with idiopathic versus neurovascular hemifacial spasm after botulinum toxin treatment
Tu?ba Tun�; Leyla �avdar; Ye?im S�c�ll� Karada?; Esra Okuyucu; �zlem Co?kun; Levent E. Inan
This study was performed to investigate the differences in response to botulinum toxin treatment between patients with idiopathic versus neurovascular hemifacial spasm. A total of 69 patients with hemifacial spasm were investigated prospectively with cranial magnetic resonance imaging and magnetic resonance angiography. Neurovascular contact was found in 23 patients. All patients were assessed with a severity scale and a disease
Association analysis of polymorphisms of the CRHR1 gene with infantile spasms.
Yang, Guang; Zou, Li-Ping; Wang, Jing; Shi, Xiu-Yu; Yang, Xiao-Fan; Wang, Bin; Liu, Yu-Jie; Sun, Yan-Hong; Jia, Fei-Yong
While >200 types of etiologies have been shown to be involved in the pathogenesis of infantile spasms, the pathophysiology of infantile spasms remains largely elusive. Pre-natal stress and hypothalamic-pituitary-adrenal axis dysfunction were shown to be involved in the development of infantile spasms. To test the genetic association between the CRHR1 gene, which encodes the corticotrophin-releasing hormone (CRH) receptor, and infantile spasms, five single nucleotide polymorphisms (SNPs) in the CRHR1 gene were genotyped in a sample set of 128�cases with infantile spasms and 131�healthy controls. Correlation analysis was performed on the genotyped data. Under the assumption of the dominant model, the selected five SNPs, rs4458044, rs171440, rs17689966, rs28364026 and rs242948, showed no association with the risk of infantile spasms and the effectiveness of adrenocorticotropic hormone treatment. In addition, subsequent haplotype analysis suggested none of them was associated with infantile spasms. In conclusion, the experimental results of the present study suggested no association between the CRHR1 gene and infantile spasms in a Chinese population. PMID:25954915
Practice Parameter: Medical Treatment of Infantile Spasms Report of the American Academy of Neurology and the Child Neurology Society
M. T. Mackay; S. K. Weiss; T. Adams-Webber; S. Ashwal; D. Stephens; K. Ballaban-Gill; T. Z. Baram; M. Duchowny; D. Hirtz; J. M. Pellock; W. D. Shields; S. Shinnar; E. Wyllie; O. C. Snead III
Objective: To determine the current best practice for treatment of infantile spasms in children. Methods: Database searches of MEDLINE from 1966 and EMBASE from 1980 and searches of reference lists of retrieved articles were performed. Inclusion criteria were the documented presence of infantile spasms and hypsarrhythmia. Outcome measures included complete cessation of spasms, resolution of hypsarrhythmia, relapse rate, developmental outcome,
Effects of Ro 40-5967, a novel calcium antagonist, on myocardial function during ischemia induced by lowering coronary perfusion pressure in dogs: comparison with verapamil.
Clozel, J P; Banken, L; Osterrieder, W
Ro 40-5967 is a structurally novel calcium antagonist that binds to the verapamil binding site but has very weak negative inotropic effects compared to verapamil. The goals of the present study were to assess the effects of Ro 40-5967 on myocardial function during ischemia, and to compare them to those of verapamil. For this purpose, in anesthetized dogs where the circumflex coronary artery was cannulated and perfused at controlled pressure, myocardial function was measured using piezo electric crystals implanted into the endocardium. Myocardial distribution of coronary blood flow was assessed using radioactive microspheres. Ischemia was produced by lowering perfusion pressure from 100 to 15 mm Hg in steps. During ischemia, Ro 40-5967 partially prevented the decrease of segmental shortening (p less than 0.01) and increased coronary flow, especially in the endocardium (p less than 0.01). In contrast, verapamil did not improve myocardial function during ischemia. The protective effect of Ro 40-5967 could be partially explained by the decrease of arterial pressure and heart rate induced by Ro 40-5967. However, Ro 40-5967 injected directly inside the coronary artery did not induce systemic effects, but still had protective effects (p less than 0.05). Verapamil injected intracoronary produced severe cardiac depression. We conclude that in the present model during ischemia Ro 40-5967 has no negative inotropic effects, and in contrast to verapamil can improve the myocardial function. PMID:2481185
Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables.
Dangas, George; Iakovou, Ioannis; Nikolsky, Eugenia; Aymong, Eve D; Mintz, Gary S; Kipshidze, Nicholas N; Lansky, Alexandra J; Moussa, Issam; Stone, Gregg W; Moses, Jeffrey W; Leon, Martin B; Mehran, Roxana
We previously found that contrast-induced nephropathy (CIN) complicating percutaneous coronary intervention adversely affects patients with chronic kidney disease (CKD). Therefore, we further investigated whether the predictors and outcome of CIN after percutaneous coronary intervention differ among patients with versus without CKD. Among 7,230 consecutive patients, CIN (>or=25% or >or=0.5 mg/dl increase in preprocedure serum creatinine 48 hours after the procedure) developed in 381 of 1,980 patients (19.2%) with baseline CKD (estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m(2)) and in 688 of 5,250 patients (13.1%) without CKD. Decreased eGFRs, periprocedural hypotension, higher contrast media volumes, lower baseline hematocrit, diabetes, pulmonary edema at presentation, intra-aortic balloon pump use, and ejection fraction <40% were the most significant predictors of CIN in patients with CKD. Apart from intra-aortic balloon pump use, predictors of CIN in patients without CKD were the same as mentioned, plus older age and type of contrast media. Regardless of baseline renal function, CIN correlated with longer in-hospital stay and higher rates of in-hospital complications and 1-year mortality compared with patients without CIN. By multivariate analysis, CIN was 1 of the most powerful predictors of 1-year mortality in patients with preexisting CKD (odds ratio 2.37, 95% confidence interval 1.63 to 3.44) or preserved eGFR (odds ratio 1.78; 95% confidence interval 1.22 to 2.60). Thus, regardless of the presence of CKD, baseline characteristics and periprocedural hemodynamic parameters predict CIN, and this complication is associated with worse in-hospital and 1-year outcomes. PMID:15619387
Heart ischaemia�reperfusion induces local up-regulation of vasoconstrictor endothelin ETB receptors in rat coronary arteries downstream of occlusion
Skovsted, G F; Kruse, L S; Larsen, R; Pedersen, A F; Trautner, S; Sheykhzade, M; Edvinsson, L
Background and Purpose Endothelins act via two receptor subtypes, ETA and ETB. Under physiological conditions in coronary arteries, ETA receptors expressed in smooth muscle cells mediate vasoconstriction whereas ETB receptors mainly found in endothelial cells mediate vasorelaxation. However, under pathophysiological conditions, ETB receptors may also be expressed in vascular smooth muscle cells mediating vasoconstriction. Here, we have investigated whether vasoconstrictor ETB receptors are up-regulated in coronary arteries after experimental myocardial ischaemia in rats. Experimental Approach Male Sprague-Dawley rats were subjected to either heart ischaemia�reperfusion (15?min ischaemia and 22?h reperfusion), permanent ischaemia (22?h) by ligation of the left anterior descending coronary artery, or sham operation. Using wire myography, the endothelin receptor subtypes mediating vasoconstriction were examined in isolated segments of the left anterior descending and the non-ligated septal coronary arteries. Endothelin receptor-mediated vasoconstriction was examined with cumulative administration of sarafotoxin 6c (ETB receptor agonist) and endothelin-1 (with or without ETA or ETB receptor blockade). The distribution of ETB receptors was localized with immunohistochemistry and quantified by Western blot. Key Results Endothelin ETB receptor-mediated vasoconstriction and receptor protein levels were significantly augmented in coronary arteries situated downstream of the occlusion after ischaemia�reperfusion compared with non-ischaemic arteries. In contrast, the ETA receptor-mediated vasoconstriction was unaltered in all groups. Conclusions and Implications Ischaemia�reperfusion induced local up-regulation of ETB receptors in the smooth muscle cells of coronary arteries in the post-ischaemic area. In contrast, in non-ischaemic areas, ETB receptor function was unaltered. PMID:24467585
Marked Acceleration of Atherosclerosis following Lactobacillus casei induced Coronary Arteritis in a Mouse Model of Kawasaki Disease
Chen, Shuang; Lee, Young Ho; Crother, Timothy R.; Fishbein, Michael; Zhang, Wenxuan; Yilmaz, Atilla; Shimada, Kenichi; Schulte, Danica J; Lehman, Thomas J.A.; Shah, Prediman K.; Arditi, Moshe
Objective To investigate if Lactobacillus casei cell wall extract (LCWE)-induced Kawasaki Disease (KD) accelerates atherosclerosis in hypercholesterolemic mice. Method and Resuslts Apoe?/? or Ldlr?/? mice were injected with LCWE (KD mice) or PBS, fed high fat diet for 8 weeks, and atherosclerotic lesions in aortic sinuses (AS), arch (AC) and whole aorta were assessed. KD mice had larger, more complex aortic lesions with abundant collagen, and both extracellular and intracellular lipid and foam cells, compared to lesions in control mice despite similar cholesterol levels. Both Apoe?/? KD and Ldlr?/? KD mice showed dramatic acceleration in atherosclerosis vs. controls, with increases in en face aortic atherosclerosis and plaque size in both the AS and AC plaques. Accelerated atherosclerosis was associated with increased circulating IL-12p40, IFN-?, TNF-?, and increased macrophage, DC, and T cell recruitment in lesions. Furthermore, daily injections of the IL-1Ra, which inhibits LCWE induced KD vasculitis, prevented the acceleration of atherosclerosis. Conclusions Our results suggest an important pathophysiologic link between coronary arteritis/vasculitis in the KD mouse model and subsequent atherosclerotic acceleration, supporting the concept that a similar relation may also be present in KD patients. These results also suggest that KD in childhood may predispose to accelerated and early atherosclerosis as adults. PMID:22628430
Activation of group IVC phospholipase A(2) by polycyclic aromatic hydrocarbons induces apoptosis of human coronary artery endothelial cells.
Tithof, Patricia K; Richards, Sean M; Elgayyar, Mona A; Menn, Fu-Minn; Vulava, Vijay M; McKay, Larry; Sanseverino, John; Sayler, Gary; Tucker, Dawn E; Leslie, Christina C; Lu, Kim P; Ramos, Kenneth S
Exposure to environmental pollutants, such as polycyclic aromatic hydrocarbons (PAHs) found in coal tar mixtures and tobacco sources, is considered a significant risk factor for the development of heart disease in humans. The goal of this study was to determine the influence of PAHs present at a Superfund site on human coronary artery endothelial cell (HCAEC) phospholipase A(2) (PLA(2)) activity and apoptosis. Extremely high levels of 12 out of 15 EPA high-priority PAHs were present in both the streambed and floodplain sediments at a site where an urban creek and its adjacent floodplain were extensively contaminated by PAHs and other coal tar compounds. Nine of the 12 compounds and a coal tar mixture (SRM 1597A) activated group IVC PLA(2) in HCAECs, and activation of this enzyme was associated with histone fragmentation and poly (ADP) ribose polymerase (PARP) cleavage. Genetic silencing of group IVC PLA(2) inhibited both (3)H-fatty acid release and histone fragmentation by PAHs and SRM 1597A, indicating that individual PAHs and a coal tar mixture induce apoptosis of HCAECs via a mechanism that involves group IVC PLA(2). Western blot analysis of aortas isolated from feral mice (Peromyscus leucopus) inhabiting the Superfund site showed increased PARP and caspase-3 cleavage when compared to reference mice. These data suggest that PAHs induce apoptosis of HCAECs via activation of group IVC PLA(2). PMID:21132278
2014 Williams Harvey Lecture: importance of coronary vasomotion abnormalities-from bench to bedside.
Shimokawa, Hiroaki
Coronary vasomotion abnormalities play important roles in the pathogenesis of ischaemic heart disease, in which endothelial dysfunction and coronary artery spasm are substantially involved. Endothelial vasodilator functions are heterogeneous depending on the vessel size, with relatively greater role of nitric oxide (NO) in conduit arteries and predominant role of endothelium-derived hyperpolarizing factor (EDHF) in resistance arteries, where endothelium-derived hydrogen peroxide serves as an important EDHF. The functions of NO synthases in the endothelium are also heterogeneous with multiple mechanisms involved, accounting for the diverse functions of the endothelium in vasomotor as well as metabolic modulations. Cardiovascular abnormalities and metabolic phenotypes become evident when all three NO synthases are deleted, suggesting the importance of both NO and EDHF. Coronary artery spasm plays important roles in the pathogenesis of a wide range of ischaemic heart disease. The central mechanism of the spasm is hypercontraction of vascular smooth muscle cells (VSMCs), but not endothelial dysfunction, where activation of Rho-kinase, a molecular switch of VSMC contraction, plays a major role through inhibition of myosin light-chain phosphatase. The Rho-kinase pathway is also involved in the pathogenesis of a wide range of cardiovascular diseases and new Rho-kinase inhibitors are under development for various indications. The registry study by the Japanese Coronary Spasm Association has demonstrated many important aspects of vasospastic angina. The ongoing international registry study of vasospastic angina in six nations should elucidate the unknown aspects of the disorder. Coronary vasomotion abnormalities appear to be an important therapeutic target in cardiovascular medicine. PMID:25354517
Differential role of endothelial versus neuronal nitric oxide synthase in the regulation of coronary blood flow during pacing-induced increases in cardiac workload
Shabeeh, Husain; Melikian, Narbeh; Dworakowski, Rafal; Casadei, Barbara; Chowienczyk, Phil
Endothelial nitric oxide synthase (eNOS) was assumed to be the only source of nitric oxide (NO) involved in the regulation of human coronary blood flow (CBF). However, our recent first-in-human study using the neuronal NOS (nNOS)-selective inhibitor S-methyl-L-thiocitrulline (SMTC) showed that nNOS-derived NO also plays a role. In this study, we investigated the relative contribution of nNOS and eNOS to the CBF response to a pacing-induced increase in cardiac workload. Incremental right atrial pacing was undertaken in patients with angiographically normal coronary arteries during intracoronary infusion of saline vehicle and then either SMTC or NG-monomethyl-l-arginine (l-NMMA; which inhibits both eNOS and nNOS). Intracoronary SMTC (0.625 ?mol/min) and l-NMMA (25 ?mol/min) reduced basal CBF to a similar extent (?19.2 � 3.2% and 25.0 � 2.7%, respectively; n = 10 per group). Pacing-induced increases in CBF were significantly blunted by l-NMMA (maximum CBF: 83.5 � 14.2 ml/min during saline vs. 61.6 � 9.5 ml/min during l-NMMA; P < 0.01). By contrast, intracoronary SMTC had no effect on the maximum CBF during pacing (98.5 � 12.9 ml/min during saline vs. 102.1 � 16.6 ml/min during SMTC; P = not significant). l-NMMA also blunted the pacing-induced increase in coronary artery diameter (P < 0.001 vs. saline), whereas SMTC had no effect. Our results confirm a role of nNOS in the regulation of basal CBF in humans but show that coronary vasodilation in response to a pacing-induced increase in cardiac workload is exclusively mediated by eNOS-derived NO. PMID:23479261
Modulatory effect of diclofenac on antispasmodic effect of pitofenone in cholinergic spasm.
Kulkarni, Shrinivas K; Patil, Chandrashekhar S; Jain, Naveen K; Singh, Amarjit
Biliary, ureteric and intestinal colic are extremely common clinical conditions associated with smooth muscle spasm. In the present study, antispasmodic activity was carried out against acetylcholine (10-640 ng/ml)-induced contractions on guinea pig ileum. Acetylcholine (10-640 ng/ml) induced concentration-dependent contraction of smooth muscle. Diclofenac, in varying concentration (9.4 x 10(-5) mol/l and 14.1 x 10(-5) mol/l) shifted the concentration response curve of acetylcholine to the right without suppressing the maximal response. However, in higher concentration diclofenac (18.9 x 10(-5) mol/l) blocked the response in an unsurmountable fashion. Further, analgin (11.09 x 10(-5), 16.63 x 10(-5) and 22.18 x 10(-5) mol/l) in equimolar concentrations did not alter the concentration response curve of acetylcholine, but in higher concentration analgin (44.36 x 10(-5) mol/l) also blocked the response in an unsurmountable fashion. Pitofenone (2.5 x 10(-6) mol/l) also, shifted the concentration response curve of acetylcholine to right in a parallel fashion with no change in maximal response. The present study confirms the potent antispasmodic activity of diclofenac-pitofenone combination in comparison to analgin-pitofenone in molar equivalent concentration (in comparison to diclofenac) against acetylcholine-induced contractions of guinea pig ileum. PMID:15260106
[A case of hemifacial spasm in a juglar foramen tumor patient treated by microvascular decompression].
Kamoshima, Yuuta; Terasaka, Shunsuke; Shimoda, Yusuke; Fukuda, Satoshi; Houkin, Kiyohiro
Hemifacial spasm is a movement disorder characterized by involuntary paroxysmal chronic contractions of the facial musculature. The usual cause is simple vascular compression of the facial nerve, at its root exit zone of the brain stem. Previously only a case of hemifacial spasm associated with a juglar foramen tumor has been reported in the literature. In this article, we report a case in which hemifacial spasm accompanied an ipsilateral juglar foramen tumor in a 62-year-old woman. The sole use of arterial decompression of the facial nerve at the root exit zone resulted in complete resolution of the patient's symptoms. PMID:22036823
Beta-blocker induced changes in the cholesterol: High-density lipoprotein cholesterol ratio and risk of coronary heart disease
B. G. Woodcock; N. Rietbrock
Summary The lowering of blood pressure with beta-blocking drugs has had a low impact on coronary heart disease (CHD) mortality and the question has been raised whether adverse changes in plasma lipoproteins offset the benefits of blood pressure reduction. Comparison of plasma lipoprotein concentrations in hypertensive patients treated with commonly used beta-blockers with lipoprotein concentrations in patients with coronary heart
eNOS Activation Induced by a Polyphenol-Rich Grape Skin Extract in Porcine Coronary Arteries
Socorro Vanesca Frota Madeira; Cyril Auger; Eric Anselm; Marta Chataigneau; Thierry Chataigneau; Roberto Soares de Moura; Val�rie B. Schini-Kerth
Background\\/Aims: Drinking red wine is associated with a decreased mortality from coronary heart diseases. This study examined whether polyphenols contained in a grape skin extract (GSE) triggered the endothelial formation of nitric oxide (NO) and investigated the underlying mechanism. Methods: Vascular reactivity was assessed in organ chambers using porcine coronary artery rings in the presence of indomethacin (a cyclooxygenase inhibitor)
Restenosis and clinical outcome in patients treated with amlodipine after angioplasty: results from the coronary AngioPlasty Amlodipine REStenosis Study (CAPARES)
Bj�rn J�rgensen; Svein Simonsen; Knut Endresen; Kolbj�rn Forfang; Karleif Vatne; James Hansen; John Webb; Christopher Buller; Gilles Goulet; Jan Erikssen; Erik Thaulow
OBJECTIVESOur intent was to investigate the effect of the dihydropyridine calcium channel blocker amlodipine on restenosis and clinical outcome in patients undergoing percutaneous transluminal coronary angioplasty (PTCA).BACKGROUNDAmlodipine has sustained vasodilatory effects and relieves coronary spasm, which may reduce luminal loss and clinical complications after PTCA.METHODSIn a prospective, double-blind design, 635 patients were randomized to 10 mg of amlodipine or placebo.
L-citrulline for protection of endothelial function from ADMA�induced injury in porcine coronary artery
Xuan, Chao; Lun, Li-Min; Zhao, Jin-Xia; Wang, Hong-Wei; Wang, Jue; Ning, Chun-Ping; Liu, Zhen; Zhang, Bei-Bei; He, Guo-Wei
Endogenous nitric oxide synthase (eNOS) inhibitor asymmetric dimethylarginine (ADMA) is a cardiovascular risk factor. We tested the hypothesis that L-citrulline may ameliorate the endothelial function altered by ADMA in porcine coronary artery (PCA). Myograph study for vasorelaxation, electrochemical measurement for NO, RT-PCR, and Western blot analysis for expression of eNOS, argininosuccinate synthetase (ASS), and p-eNOSser1177 were performed. cGMP was determined by enzyme immunoassay. Superoxide anion (O2.?) production was detected by the lucigenin-enhanced chemiluminescence method. Compare with controls (96.03%?�?6.2%), the maximal relaxation induced by bradykinin was significantly attenuated (61.55%?�?4.8%, p?0.01), and significantly restored by L-citrulline (82.67?�?6.4%, p?0.05) after 24?hours of ADMA exposure. Expression of eNOS, p-eNOSser1177, and ASS in PCA significantly increased after L-citrulline incubation. L-citrulline also markedly restored the NO production, and cGMP level which was reduced by ADMA. The increased O2.? production by ADMA was also inhibited by L-citrulline. L-citrulline restores the endothelial function in preparations treated with ADMA by preservation of NO production and suppression of O2.? generation. Preservation of NO is attributed to the upregulation of eNOS expression along with activation of p-eNOSser1177. L-citrulline improves endothelium-dependent vasodilation through NO/ cGMP pathway. PMID:26046576
P. A. Wielopolski; R. J. M. van Geuns; P. J. de Feyter; M. Oudkerk
.�� Conventional coronary angiography (CA) is the standard of excellence for the evaluation of coronary artery disease. However,\\u000a non-invasive imaging modalities have developed that can play an important clinical role in the diagnosis. Magnetic resonance\\u000a imaging (MRI) can offer a comprehensive evaluation of the heart and the coronary arteries by virtue of its high soft tissue\\u000a contrast capabilities, double-oblique tomographic
Atypical hemifacial spasm due to vertebral artery dolichoectasia: rare cause of a rarer clinical entity
Mathur, Tarun; Srivastava, Trilochan; Sardana, Vijay; Jain, Rahul
A 32-year-old man presented with atypical left hemifacial spasm (HFS) with MRI showing compression of left facial nerve at the root exit zone. HFS rarely presents atypically with onset in orbicularis oris and later spreading upward to involve the orbicularis oculi as was seen in our case. Atypical presentation of hemifacial spasm is rare and vertebral artery dolichoectasia as the underlying aetiology, like in our case is even rarer and has not been described in literature so far. PMID:23845680
Red wine polyphenols induce EDHF-mediated relaxations in porcine coronary arteries through the redox-sensitive activation of the PI3-kinase/Akt pathway
Ndiaye, Mamadou; Chataigneau, Thierry; Chataigneau, Marta; Schini-Kerth, Val�rie B
Red wine polyphenolic compounds (RWPCs) are potent inducers of endothelium-dependent relaxations of coronary arteries, which involve both nitric oxide and endothelium-derived hyperpolarizing factor (EDHF). The EDHF-mediated relaxation to RWPCs is critically dependent on the formation of reactive oxygen species by a flavin-dependent enzyme. The aim of the present study was to determine the role of redox-sensitive protein kinases including p38 MAPK, ERK1/2 and PI3-kinase/Akt in RWPCs-induced EDHF-mediated relaxation. Porcine coronary artery rings were suspended in organ chambers for measurement of changes in isometric tension. Confluent cultures of porcine coronary artery endothelial cells were used to determine the phosphorylation level of p38 MAPK, ERK1/2 and Akt by Western blot analysis. All experiments were performed in the presence of indomethacin and N?-nitro-L-arginine. RWPCs caused pronounced endothelium-dependent relaxations, which were significantly reduced by wortmannin and LY294002, two inhibitors of PI3-kinase, and not affected by PD98059 (an inhibitor of ERK1/2 kinase kinase) and SB203580 (an inhibitor of p38 MAPK). In contrast, wortmannin did not affect relaxations to bradykinin or levcromakalim. RWPCs elicited within minutes a sustained and concentration-dependent phosphorylation of p38 MAPK, ERK1/2 and Akt in endothelial cells. The phosphorylation of Akt in response to RWPCs was abolished by wortmannin and LY294002, and by the membrane-permeant analogue of superoxide dismutase Mn(III)tetrakis(1-methyl-4-pyridyl)porphyrin. The present findings demonstrate that RWPCs cause EDHF-mediated relaxations of coronary arteries; these responses are critically dependent on the redox-sensitive activation of the PI3-kinase/Akt pathway in endothelial cells. PMID:15249422
Dependence of cathepsin L-induced coronary endothelial dysfunction upon activation of NAD(P)H oxidase
Fan Zhang; Yang Zhang; Pin-Lan Li
Cathepsin L is a cysteine protease that can generate endogenous endostatin in vascular and epithelial basement membranes and importantly participates in a variety of pathophysiological processes. The present study was designed to determine whether this cathepsin L-derived endogenous endostatin alters endothelium-dependent vasodilator responses in coronary arteries via NAD(P)H oxidase activation. In isolated and perfused small bovine coronary arteries, administration of
Myeloperoxidase Is Not Useful for Detecting Stress Inducible Myocardial Ischemia but May Be Indicative of the Severity of Coronary Artery Disease
Schuhmann, Christoph G.; Hacker, Marcus; Jung, Philip; Kr�tz, Florian
Background and Objectives Elevated levels of myeloperoxidase (MPO) have been found in patients in different stages of coronary artery disease (CAD). The aim of this study was to assess whether the MPO liberation is increased by stress inducible myocardial ischemia and could be used to improve the diagnostic accuracy of non-invasive evaluation for myocardial ischemia. Subjects and Methods Seventy-six patients with suspected myocardial ischemia who underwent stress myocardial perfusion scintigraphy (MPS) were enrolled. 59 patients with an acute coronary syndrome (ACS) who received a percutaneous coronary intervention along with 12 healthy volunteers were also included in the study. In every subject the MPO plasma levels were assessed by enzyme linked immunosorbent assay. In patients undergoing MPS, the MPO levels were measured serially before and after the stress testing. Results Of the 76 patients undergoing MPS, 38 were diagnosed with a stress inducible myocardial ischemia. The patients with a stress induced ischemia had significantly higher basal MPO levels than those without it (32�3 ng/mL vs. 24�4 ng/mL, p=0.03). However, there was no relevant change in the MPO levels after the stress test compared to the baseline. The patients with ACS showed significantly higher MPO levels than the patients undergoing MPS (131�14 ng/mL vs. 28�2 ng/mL, p<0.01) and the healthy subjects (131�14 ng/mL vs. 26�2 ng/mL, p<0.01). Conclusion Since the MPO plasma levels did not increase after the stress MPS, MPO appears not to be a useful biomarker for detecting a stress inducible myocardial ischemia. Yet, the MPO levels correlate with the different stages of CAD and may hold significance as an indicator for its clinical severity. PMID:24497884
[Abdominal spasms, meteorism, diarrhea: fructose intolerance, lactose intolerance or IBS?].
Litschauer-Poursadrollah, Margaritha; El-Sayad, Sabine; Wantke, Felix; Fellinger, Christina; Jarisch, Reinhart
Meteorism, abdominal spasms, diarrhea, casually obstipation, flatulence and nausea are symptoms of fructose malabsorption (FIT) and/or lactose intolerance (LIT), but are also symptoms of irritable bowel syndrome (IBS). Therefore these diseases should be considered primarily in patients with digestive complaints. For diagnosis an H(2)-breath test is used.In 1,935 patients (526 m, 1,409 f) a fructose intolerance test and in 1,739 patients (518 m,1,221 f) a lactose intolerance test was done.FIT is found more frequently than LIT (57 versus 52 % in adults (p?0,02) and in children 90 versus 62 % (p?0,001)) and is in polyintolerances most frequently correlated to histamine intolerance (HIT). Headache (ca. 10 %), fatigue (ca. 5 %) and dizziness (ca. 3 %) may occur after the test, irrespective whether the test was positive or negative.In more than 2/3 of patients a diet reduced in fructose or lactose may lead to improvement or remission of these metabolic disorders. IBS, which is often correlated with FIT (183/221 patients?=?83 %), can be improved by relevant but also not relevant diets indicating that irritable bowel disease seems to be caused primarily by psychological disorders. PMID:23224632
L-citrulline for protection of endothelial function from ADMA-induced injury in porcine coronary artery.
Xuan, Chao; Lun, Li-Min; Zhao, Jin-Xia; Wang, Hong-Wei; Wang, Jue; Ning, Chun-Ping; Liu, Zhen; Zhang, Bei-Bei; He, Guo-Wei
Endogenous nitric oxide synthase (eNOS) inhibitor asymmetric dimethylarginine (ADMA) is a cardiovascular risk factor. We tested the hypothesis that L-citrulline may ameliorate the endothelial function altered by ADMA in porcine coronary artery (PCA). Myograph study for vasorelaxation, electrochemical measurement for NO, RT-PCR, and Western blot analysis for expression of eNOS, argininosuccinate synthetase (ASS), and p-eNOS(ser1177) were performed. cGMP was determined by enzyme immunoassay. Superoxide anion (O2.(-)) production was detected by the lucigenin-enhanced chemiluminescence method. Compare with controls (96.03%?�?6.2%), the maximal relaxation induced by bradykinin was significantly attenuated (61.55%?�?4.8%, p?0.01), and significantly restored by L-citrulline (82.67?�?6.4%, p?0.05) after 24?hours of ADMA exposure. Expression of eNOS, p-eNOS(ser1177), and ASS in PCA significantly increased after L-citrulline incubation. L-citrulline also markedly restored the NO production, and cGMP level which was reduced by ADMA. The increased O2.(-) production by ADMA was also inhibited by L-citrulline. L-citrulline restores the endothelial function in preparations treated with ADMA by preservation of NO production and suppression of O2.(-) generation. Preservation of NO is attributed to the upregulation of eNOS expression along with activation of p-eNOS(ser1177). L-citrulline improves endothelium-dependent vasodilation through NO/ cGMP pathway. PMID:26046576
Androgens inhibit tumor necrosis factor-?-induced cell adhesion and promote tube formation of human coronary artery endothelial cells.
Liao, Chun-Hou; Lin, Feng-Yen; Wu, Yi-No; Chiang, Han-Sun
Endothelial cells contribute to the function and integrity of the vascular wall, and a functional aberration may lead to atherogenesis. There is increasing evidence on the atheroprotective role of androgens. Therefore, we studied the effect of the androgens-testosterone and dihydrotestosterone-and estradiol on human coronary artery endothelial cell (HCAEC) function. We found by MTT assay that testosterone is not cytotoxic and enhances HCAEC proliferation. The effect of testosterone (10-50 nM), dihydrotestosterone (5-50 nM), and estradiol (0.1-0.4 nM) on the adhesion of tumor necrosis factor-? (TNF-?)-stimulated HCAECs was determined at different time points (12-96 h) by assessing their binding with human monocytic THP-1 cells. In addition, the expression of adhesion molecules, vascular cell adhesion molecule-1 (VCAM-1) and intracellular adhesion molecule-1 (ICAM-1), was determined by ELISA and Western blot analysis. Both testosterone and dihydrotestosterone attenuated cell adhesion and the expression of VCAM-1 and ICAM-1 in a dose- and time-dependent manner. Furthermore, androgen treatment for a longer duration inhibited cell migration, as demonstrated by wound-healing assay, and promoted tube formation on a Matrigel. Western blot analysis demonstrated that the expression of phosphorylated endothelial nitric oxide synthase (eNOS) increased, whereas that of inducible nitric oxide synthase (iNOS) decreased following the 96-h steroid treatment of TNF-?-stimulated HCAECs. Our findings suggest that androgens modulate endothelial cell functions by suppressing the inflammatory process and enhancing wound-healing and regenerative angiogenesis, possibly through an androgen receptor (AR)-dependent mechanism. PMID:22504554
Aronia melanocarpa juice, a rich source of polyphenols, induces endothelium-dependent relaxations in porcine coronary arteries via the redox-sensitive activation of endothelial nitric oxide synthase.
Kim, Jong Hun; Auger, Cyril; Kurita, Ikuko; Anselm, Eric; Rivoarilala, Lalainasoa Odile; Lee, Hyong Joo; Lee, Ki Won; Schini-Kerth, Val�rie B
This study examined the ability of Aronia melanocarpa (chokeberry) juice, a rich source of polyphenols, to cause NO-mediated endothelium-dependent relaxations of isolated coronary arteries and, if so, to determine the underlying mechanism and the active polyphenols. A. melanocarpa juice caused potent endothelium-dependent relaxations in porcine coronary artery rings. Relaxations to A. melanocarpa juice were minimally affected by inhibition of the formation of vasoactive prostanoids and endothelium-derived hyperpolarizing factor-mediated responses, and markedly reduced by N(?)-nitro-l-arginine (endothelial NO synthase (eNOS) inhibitor), membrane permeant analogs of superoxide dismutase and catalase, PP2 (Src kinase inhibitor), and wortmannin (PI3-kinase inhibitor). In cultured endothelial cells, A. melanocarpa juice increased the formation of NO as assessed by electron paramagnetic resonance spectroscopy using the spin trap iron(II)diethyldithiocarbamate, and reactive oxygen species using dihydroethidium. These responses were associated with the redox-sensitive phosphorylation of Src, Akt and eNOS. A. melanocarpa juice-derived fractions containing conjugated cyanidins and chlorogenic acids induced the phosphorylation of Akt and eNOS. The present findings indicate that A. melanocarpa juice is a potent stimulator of the endothelial formation of NO in coronary arteries; this effect involves the phosphorylation of eNOS via the redox-sensitive activation of the Src/PI3-kinase/Akt pathway mostly by conjugated cyanidins and chlorogenic acids. PMID:23973200
... the NHLBI on Twitter. What Is a Coronary Calcium Scan? A coronary calcium scan is a test ... you have calcifications in your coronary arteries. Coronary Calcium Scan Figure A shows the position of the ...
Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... Coronary heart disease (CHD) is the leading cause of death in the United States for men and women. Coronary ...
Coronary Artery Bypass Grafting
... from the NHLBI on Twitter. What Is Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is ... bypass multiple coronary arteries during one surgery. Coronary Artery Bypass Grafting Figure A shows the location of ...
Plasma-induced nanopillars on bare metal coronary stent surface for enhanced endothelialization.
Loya, Mariana C; Brammer, Karla S; Choi, Chulmin; Chen, Li-Han; Jin, Sungho
An increased risk of late stent thrombosis associated with polymer carriers on the surface of drug-eluting stents remains one of the challenges in cardiovascular stent technology, which has instigated a renewed interest in the polymer-less, bare metal stent approach. As thrombus formation is most likely augmented by the lack of endothelial cell coverage at the exposed stented site, an improved stent surface that enhances cell coverage is essential for viable polymer-less all metal stents. We demonstrate superior endothelial cell growth, more continuous monolayer formation and overall improved endothelialization with nanopillar arrays created via radio frequency plasma surface texturing on our all metallic stent surface of MP35N stent alloy. It is shown that the nanotextured surface significantly up-regulates primary bovine aortic endothelial cell (BAEC) functionality when compared with unprocessed, smooth MP35N surfaces without a nanopillar topography. The desirable presence of transmembrane tight junctions and highly organized monolayer formation was induced by the presence of the nanopillar surface texture. The nanopillar structure also produced a reduced level of oxidative stress in the BAECs. These findings may contribute to new nanotechnology-based surface design concepts for bare metal stents producing advanced cardiovascular implants which mitigate late stent thrombosis. PMID:20624494
Hemifacial spasm and postural abnormalities; clinical and posturographical analyses.
Degirmenci, Eylem; Oguzhanoglu, Attila; Atalay, Nilgun; Sahin, Fusun
Hemifacial spasm (HFS) is defined as an involuntary, irregular clonic, or tonic movement of muscles innervated by the ipsilateral seventh cranial nerve. It is reported that the coexistence of non-motor- and motor-related symptoms can be seen in patients with HFS. Postural disturbances were investigated in some movement disorders; however, postural abnormalities due to HFS had not been reported before. In this study, we aimed to investigate the postural abnormalities in patients with HFS. In this cross-sectional, controlled study, Tinetti Balance and Gait Test (TBGT) scores and static posturography were performed on fifteen patients with HFS and fifteen healthy age- and sex-matched controls. The total TBGT score and TBGT-balance score were found to be significantly lower in the patient group than in the control group (p values were, respectively, 0.046 and 0.011). The ratio of the patients with high risk of falling was 40�%, and the difference was found to be significantly higher in the patient group (p value�=�0.008). In Fourier analyses, a significant difference was found in the medium to high frequencies (F5-6) when the posturographic evaluation was performed on a solid ground with closed eyes, head rotated to right, and head rotated to the left positions (p values were, respectively, 0.045 and 0.007). The stability index of the HFS group was significantly higher than the control group when tested on the neutral, head right, and head left positions (p values were, respectively, 0.004, 0.049, and 0.003). In conclusion, our study showed that the patients with HFS have more balance and falling problems than the controls, which can be both clinically and posturographically determined. PMID:25228403
Intravascular Ultrasound to Guide Percutaneous Coronary Interventions
Executive Summary Objective The objective of this health technology policy assessment was to determine the effectiveness and cost-effectiveness of using intravascular ultrasound (IVUS) as an adjunctive imaging tool to coronary angiography for guiding percutaneous coronary interventions. Background Intravascular Ultrasound Intravascular ultrasound is a procedure that uses high frequency sound waves to acquire 3-dimensional images from the lumen of a blood vessel. The equipment for performing IVUS consists of a percutaneous transducer catheter and a console for reconstructing images. IVUS has been used to study the structure of the arterial wall and nature of atherosclerotic plaques, and obtain measurements of the vessel lumen. Its role in guiding stent placement is also being investigated. IVUS is presently not an insured health service in Ontario. Clinical Need Coronary artery disease accounts for approximately 55% of cardiovascular deaths, the leading cause of death in Canada. In Ontario, the annual mortality rate due to ischemic heart disease was 141.8 per 100,000 population between 1995 and 1997. Percutaneous coronary intervention (PCI), a less invasive approach to treating coronary artery disease, is used more frequently than coronary bypass surgery in Ontario. The number of percutaneous coronary intervention procedures funded by the Ontario Ministry of Health and Long-term Care is expected to increase from approximately 17, 780 in 2004/2005 to 22,355 in 2006/2007 (an increase of 26%), with about 95% requiring the placement of one or more stents. Restenosis following percutaneous coronary interventions involving bare metal stents occurs in 15% to 30% of the cases, mainly because of smooth muscle proliferation and migration, and production of extracellular matrix. In-stent restenosis has been linked to suboptimal stent expansion and inadequate lesion coverage, while stent thrombosis has been attributed to incomplete stent-to-vessel wall apposition. Since coronary angiography (the imaging tool used to guide stent placement) has been shown to be inaccurate in assessing optimal stent placement, and IVUS can provide better views of the vessel lumen, the clinical utility of IVUS as an imaging tool adjunctive to coronary angiography in coronary intervention procedures has been explored in clinical studies. Method A systematic review was conducted to answer the following questions: What are the procedure-related complications associated with IVUS? Does IVUS used in conjunction with angiography to guide percutaneous interventions improve patient outcomes compared to angiographic guidance without IVUS? Who would benefit most in terms of clinical outcomes from the use of IVUS adjunctive to coronary angiography in guiding PCIs? What is the effectiveness of IVUS guidance in the context of drug-eluting stents? What is the cost-effectiveness ratio and budget impact of adjunctive IVUS in PCIs in Ontario? A systematic search of databases OVID MEDLINE, EMBASE, MEDLINE In-Process & Other Non-Indexed Citations, The Cochrane Library, and the International Agency for Health Technology Assessment (INAHTA) database for the period beginning in May 2001 until the day of the search, November 4, 2005 yielded 2 systematic reviews, 1 meta-analysis, 6 randomized controlled trials, and 2 non-randomized studies on left main coronary arteries. The quality of the studies ranged from moderate to high. These reports were combined with reports from a previous systematic review for analysis. In addition to qualitative synthesis, pooled analyses of data from randomized controlled studies using a random effect model in the Cochrane Review Manager 4.2 software were conducted when possible. Findings of Literature Review & Analysis Safety Intravascular ultrasound appears to be a safe tool when used in coronary interventions. Periprocedural complications associated with the use of IVUS in coronary interventions ranged from 0.5% in the largest study to 4%. Coronary rupture was reported in 1 study (1/54). Other complications included prolonged spasms of the arter
P. A. Wielopolski; R. J. M. van Geuns; P. J. de Feyter; M. Oudkerk
.�� Coronary angiography (CA) is presently considered the gold standard for the assessment of the coronary arteries. However,\\u000a the presence of ionizing radiation, its invasiveness and the small associated risk of morbidity prompted long ago the development\\u000a of more patient-friendly imaging modalities. A promising technique, magnetic resonance imaging (MRI), has been regarded as\\u000a the major modality in the coming decade.
Co-administration of Grape Seed Extract and Exercise Training Improves Endothelial Dysfunction of Coronary Vascular Bed of STZ-Induced Diabetic Rats
Badavi, Mohammad; Abedi, Hassan Ali; Sarkaki, Ali Reza; Dianat, Mahin
Background One of the known complications of diabetes mellitus is vascular dysfunction. Inability of the coronary vascular response to cardiac hyperactivity might cause a higher incidence of ischemic heart disease in diabetic subjects. It has been indicated that regular exercise training and antioxidants could prevent diabetic cardiovascular problems enhanced by vascular damage. Objectives The aim of this study was to determine the effects of grape seed extract (as antioxidant), with and without exercise training on coronary vascular function in streptozotocin induced diabetic rats. Materials and Methods Fifty male Wistar rats weighing 200 � 232 grams were randomly divided into five groups of 10 rats each: sedentary control, sedentary diabetic, trained diabetic, grape seed extract (200 mg/kg) treated sedentary diabetic and, grape seed extract treated trained diabetic. Diabetes was induced by one intraperitoneal injection of streptozotocin. After eight weeks, coronary vascular responses to vasoactive agents were determined. Results The endothelium dependent vasorelaxation to acetylcholine was reduced significantly in diabetic animals; exercise training or grape seed extract administration partially improves this response. However, exercise training in combination with grape seed extract restores endothelial function completely. The endothelium independent vasorelaxation to sodium nitroprusside was improved by combination of exercise training and grape seed extract. On the other hand, the basal perfusion pressure and vasoconstrictive response to phenylephrine did not change significantly. Conclusions The data indicated that co-administration of grape seed extract and exercise training had more significant effects than exercise training or grape seed extract alone; this may constitute a convenient and inexpensive therapeutic approach to diabetic vascular complications. PMID:24693368
Arachidonic Acid�Induced Dilation in Human Coronary Arterioles: Convergence of Signaling Mechanisms on Endothelial TRPV4?Mediated Ca2+ Entry
Zheng, Xiaodong; Zinkevich, Natalya S.; Gebremedhin, Debebe; Gauthier, Kathryn M.; Nishijima, Yoshinori; Fang, Juan; Wilcox, David A.; Campbell, William B.; Gutterman, David D.; Zhang, David X.
Background Arachidonic acid (AA) and/or its enzymatic metabolites are important lipid mediators contributing to endothelium?derived hyperpolarizing factor (EDHF)�mediated dilation in multiple vascular beds, including human coronary arterioles (HCAs). However, the mechanisms of action of these lipid mediators in endothelial cells (ECs) remain incompletely defined. In this study, we investigated the role of the transient receptor potential vanilloid 4 (TRPV4) channel in AA?induced endothelial Ca2+ response and dilation of HCAs. Methods and Results AA induced concentration?dependent dilation in isolated HCAs. The dilation was largely abolished by the TRPV4 antagonist RN?1734 and by inhibition of endothelial Ca2+?activated K+ channels. In native and TRPV4?overexpressing human coronary artery ECs (HCAECs), AA increased intracellular Ca2+ concentration ([Ca2+]i), which was mediated by TRPV4?dependent Ca2+ entry. The AA?induced [Ca2+]i increase was inhibited by cytochrome P450 (CYP) inhibitors. Surprisingly, the CYP metabolites of AA, epoxyeicosatrienoic acids (EETs), were much less potent activators of TRPV4, and CYP inhibitors did not affect EET production in HCAECs. Apart from its effect on [Ca2+]i, AA induced endothelial hyperpolarization, and this effect was required for Ca2+ entry through TRPV4. AA?induced and TRPV4?mediated Ca2+ entry was also inhibited by the protein kinase A inhibitor PKI. TRPV4 exhibited a basal level of phosphorylation, which was inhibited by PKI. Patch?clamp studies indicated that AA activated TRPV4 single?channel currents in cell?attached and inside?out patches of HCAECs. Conclusions AA dilates HCAs through a novel mechanism involving endothelial TRPV4 channel?dependent Ca2+ entry that requires endothelial hyperpolarization, PKA?mediated basal phosphorylation of TRPV4, and direct activation of TRPV4 channels by AA. PMID:23619744
Fruit juice-induced endothelium-dependent relaxations in isolated porcine coronary arteries: evaluation of different fruit juices and purees and optimization of a red fruit juice blend.
Auger, Cyril; Kim, Jong-Hun; Trinh, Sandrine; Chataigneau, Thierry; Popken, Anne M; Schini-Kerth, Val�rie B
Numerous studies have indicated that several polyphenol-rich sources such as red wine and green tea are potent inducers of endothelium-dependent relaxations in isolated arteries. As various fruits and berries are known to contain high levels of polyphenols, the aim of the present study was to assess the ability of selected pure fruit juices and purees as well as blends to cause endothelium-dependent relaxations in isolated arteries. Vascular reactivity was assessed using porcine coronary artery rings, and fruit juices, purees and blends were characterized for their content in vitamin C, total phenolic, sugar and antioxidant activity. Fruit juices and purees caused variable concentration-dependent relaxations, with blackcurrant, aronia, cranberry, blueberry, lingonberry, and grape being the most effective fruits. Several blends of red fruits caused endothelium-dependent relaxations. Relaxations to blend D involved both a NO- and an EDHF-mediated components. The present findings indicate that some berries and blends of red fruit juices are potent inducers of endothelium-dependent relaxations in the porcine coronary artery. This effect involves both endothelium-derived NO and EDHF, and appears to be dependent on their polyphenolic composition rather than on the polyphenolic content. PMID:21779562
Arterial Hypertension in Patients with Left Primary Hemifacial Spasm Is Associated with Neurovascular Compression of the Left Rostral Ventrolateral Medulla
Tomomi Nakamura; Mikio Osawa; Shinichiro Uchiyama; Makoto Iwata
The aim of the study was to clarify the relationship between neurovascular compression of the rostral ventrolateral medulla and arterial hypertension in patients with primary hemifacial spasm. We enrolled 82 patients with primary hemifacial spasm and 82 age- and sex-matched magnetic resonance imaging (MRI) controls of the posterior cranial fossa. Neurovascular compression of the rostral ventrolateral medulla was assessed by
Bishop, Harry A.; O'Loughlin, Bernard J.
The rapid injection of opaque media through a large bore, closed-end, side-hole catheter positioned adjacent to the sinuses of Valsalva reliably opacifies the coronary arteries. The potential toxicity of a rapidly introduced large volume of contrast agent and the necessity of peripheral arteriotomy are drawbacks of this procedure. Such innovations as loop-ended catheters, balloon occlusion of the aorta, percutaneous arterial catheterization and acetylcholine cardiac arrest have been introduced as attempts are made to increase the reliability and safety of coronary arteriography. ImagesFigure 1.Figure 2. PMID:18732385
Stress and disease: the missing link. A vasospastic theory. I. Acute myocardial infarction - a potentially reversible event?
Boyd, G W
A review of the evidence in acute myocardial infarction indicates that it might well be initiated by coronary artery spasm, and that coronary thrombosis, although important in tipping the balance between severe damage and death of heart muscle, may merely be secondary to the spasm-induced reduction in coronary blood flow. PMID:381854
Comparison of Standard and Derived 12Lead Electrocardiograms for Diagnosis of Coronary Angioplasty-Induced Myocardial Ischemia
To determine whether a derived 12-lead electrocardiogram (ECG) would demonstrate typical ST-segment changes of ischemia during percutaneous transluminal coronary angioplasty (PTCA), 207 patients were monitored with continuous 12-lead ST-segment monitoring during angioplasty. Additionally, to compare the derived and standard ECGs during known periods of ischemia with PTCA balloon inflation, 151 patients were recorded with both electrocardiographic methods during the procedure.
Role of motoneurons in the generation of muscle spasms after spinal cord injury
Monica A. Gorassini; Michael E. Knash; Philip J. Harvey; Dave J. Bennett; Jaynie F. Yang
Summary Motoneurons in the spinal cord have intrinsic voltage- dependent persistent inward currents (PICs; e.g. persist- ent calcium currents) that amplify synaptic inputs by three- to five-fold in addition to providing a sustained excitatory drive that allows motoneurons to fire repeti- tively following a brief synaptic excitation. In this study, we examined whether prolonged involuntary muscle spasms in subjects with
Oral Therapy of Skeletal Muscle Spasm with Combined Orphenadrine-Fluphenazine
J. Pennington Warter; Ward M. Schultz; James L Brady
The oral use of combined orphenadrine fluphenazine (Orpitil�) for relief of skeletal muscle spasm or stiffness was evaluated in 111 patients with acute and chronic musculoskeletal and neuromuscular disorders. Given usually in a dosage of one tablet twice daily, the combination was a therapeutically effective and generally well tolerated skeletal muscle spasmolytic.The results of exploratory trials in 47 patients admitted
Rigidity and painful muscle spasms in a patient with probable myelitis
A. Cannas; P. Tacconi; L. Pinna; S. Congia; B. Costa; A. Fiaschi
We describe a case of continuous motor unit potential (MUP) activity of central origin (unlike stiff man syndrome and progressive encephalomyelitis) characterized clinically by rigidity, painful muscle spasms, abnormal postures and spinal myoclonus. The topography of the manifestations, the subacute and benign course, the presence of stable sequels 2 years after onset and a searching process of differential diagnosis lead
Spectral Analysis Of Involuntary Muscle Spasms In Spinal Cord Trauma Patients
M. Biirger; J. Myklebust; T. Prieto; B. Myklebust; D. Maiman; J. Kerk; D. Kreis
Surface EMGs from patients with spinal cord trauma (SCT) were recorded during spasms of the lower limbs. EMGs were also recorded from a control group of healthy young adults at maximum voluntary contraction of the legs. The data was analyzed through calculation of the power spectrum and the median frequency. A significant decrease in the median power frequency was found
Transcutaneous electrical nerve stimulation in the management of painful muscle spasm in patients with multiple sclerosis
PG Mattison
Transcutaneous electrical nerve stimulation (TENS) was used to treat eight patients with multiple sclerosis who presented with painful lower limb muscle spasms. All eight had experienced a deterioration in functional ability following initial treatment with spasmolytic agents which had produced an undesirable fall in resting muscle tone. Six of the eight patients experienced a significant improvement in symptoms with TENS
Diazepam as an adjuvant analgesic to morphine for pain due to skeletal muscle spasm
Manish Srivastava; Declan Walsh
Side effects of morphine are common when it is given in titrated doses to control severe pain in advanced cancer. We describe a case of severe back pain resistant to parenteral morphine accompanied by muscle spasm, in which the addition of diazepam both had an opioid-sparing effect and provided superior symptomatic relief. Diazepam appears to have a specific role as
Three-dimensional-MRI of neurovascular compression in patients with hemifacial spasm
T. Hosoya; N. Watanabe; K. Yamaguchi; S. Saito; O. Nakai
We prospectively studied 30 patients to assess the usefulness of three-dimensional (3D) contrastenhanced MRI in patients with hemifacial spasm. In all patients neurovascular compression of the facial nerve could be detected. Microvascular decompression was performed in 14, and vascular compression of the root exit zone of the facial nerve and the offending artery were exactyl as predicted by MRI in
Role of arterioles in management of microvascular decompression in patients with hemifacial spasm
Jin Zhu; Shi-Ting Li; Jun Zhong; Hong-Xin Guan; Ting-Ting Ying; Min Yang; Xiaosheng Yang; Qiumeng Zhou; Wei Jiao
Although microvascular decompression (MVD) is accepted as an effective therapy for hemifacial spasm (HFS), some operations still fail. While performing MVD, many surgeons focus on the large arteries but ignore the arterioles. Failure to identify involved arterioles may account for unsuccessful MVD. We aimed to refine the MVD surgery and improve post-operative outcomes by proper management of involved arterioles. Clinical
Coronary arteriography and angioplasty
King, S.B.; Douglas, J.S.
This book explores biomedical radiography of the heart. Topics considered include six bench marks in the history of cardiac catheterization; normal coronary anatomy; anomalies of the coronary arteries; pathoanotomy of the coronary arteries and complications; indications, limitations, and risks of coronary arteriography and left ventriculography; catheterization techniques in coronary arteriography and left ventriculography: the Sones technique; catheterization techniques in coronary arteriography and left ventriculography: the Judkins technique; modification of Judkins catheters; catheterization techniques in coronary arteriography and left ventriculography multipurpose technique; new views in coronary arteriography; quantitative evaluation of left ventricular function; complications of coronary arteriography: management during and following the procedure; interpretation of coronary arteriograms and left ventriculograms; prevalence and distribution of disease in patients catheterized for suspected coronary disease at Emory University Hospital; the Cardiac Catheterization Laboratory; selection for surgery or percutaneous transluminal coronary angioplasty; intracoronary thrombolysis; and percutaneous transluminal coronary angioplasty.
Coronary endothelial dysfunction increases the severity of ischaemia-induced ventricular arrhythmias in rat isolated perfused hearts.
Hassanabad, Z F; Furman, B L; Parratt, J R; Aughey, E
In order to determine the role of coronary vascular endothelial cells in generating cardioprotective substances during myocardial ischaemia, rat isolated hearts, perfused at constant flow by the Langendorff technique, were subjected to treatment with the detergent Triton X100 and the responses of these hearts to a 30 or 60 min period of coronary artery occlusion was determined. Endothelial damage or denudation was shown both by histological examination and by the altered vasodilator response to the endothelium-dependent vasodilator bradykinin (100 nM), which was reversed to vasoconstriction in hearts treated with Triton X-100. In contrast, the responses to sodium nitroprusside (100 microM) were unimpaired in these hearts and were not different from control responses. Ventricular ectopic activity was much more pronounced in hearts with endothelial dysfunction (e.g., 3329 +/- 361 ventricular premature beats over a 30 min occlusion period compared to 243 +/- 34 in controls; P < 0.01), and the duration of ventricular tachycardia was greatly increased (1162 +/- 391 s v 9 +/- 12 s in the controls; P < 0.01). Ventricular ectopic activity was still marked when the occlusion was prolonged to 1 h and was still apparent at the end of this 1 h occlusion period. Reperfusion arrhythmias (ventricular tachycardia and ventricular fibrillation) were marked in endothelium-damaged hearts (50%); whereas there were no such arrhythmias after a 30 or 60 min occlusion period in control hearts. Hearts were also preconditioned by a 3 min coronary artery occlusion period 10 min prior to a 30 min coronary artery occlusion. This reduced ventricular ectopic activity in both control and endothelium-damaged hearts to about the same extent (between 80 and 90% suppression). The results suggest that under normal conditions substances generated from endothelial cells protect the myocardium against ventricular arrhythmias both during ischaemia and reperfusion. However, in this species, preconditioning is still possible in hearts from which the coronary vascular endothelium has been removed. If these results can be extrapolated to the clinical situation, it suggests that in patients with endothelial dysfunction ventricular arrhythmias may be more pronounced following a period of ischaemia and especially of reperfusion. PMID:9782365
... ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack . Over time, ruptured plaque also hardens and narrows ...
Great heterogeneity of commercial fruit juices to induce endothelium-dependent relaxations in isolated porcine coronary arteries: role of the phenolic content and composition.
Auger, Cyril; Pollet, Brigitte; Arnold, C�cile; Marx, C�line; Schini-Kerth, Val�rie B
Since polyphenol-rich products such as red wine, grape juice, and grape extracts have been shown to induce potent endothelium-dependent relaxations, we have evaluated whether commercial fruit juices such as those from berries are also able to induce endothelium-dependent relaxations of isolated coronary arteries and, if so, to determine whether this effect is related to their phenolic content. Among the 51 fruit juices tested, 2/12 grape juices, 3/7 blackcurrant juices, 4/5 cranberry juices, 1/6 apple juices, 0/5 orange juices, 2/6 red fruit and berry juices, 3/6 blends of red fruit juices, and 0/4 non-red fruit juices were able to induce relaxations achieving more than 50% at a volume of 1%. The active fruit juices had phenolic contents ranging from 0.31 to 1.86?g GAE/L, which were similar to those of most of the less active juices with the exception of one active grape juice (2.14?g GAE/L) and one active blend of red fruit juices (3.48?g GAE/L). Altogether, these findings indicate that very few commercial fruit juices have the ability to induce potent endothelium-dependent relaxations, and that this effect is not related to their quantitative phenolic content, but rather to their qualitative phenolic composition. PMID:25009961
Structure-activity relationship of quaternary ion antagonism of levcromakalim-induced relaxation in pig coronary artery.
Piekarska, A E; McPherson, G A
The aim of this study was to investigate the interaction between the K+ channel opener levcromakalim and several quaternary ions. Cumulative vasorelaxant-response curves to levcromakalim were constructed in the absence and in the presence of the quaternary ions, in the pig coronary artery. The most potent compounds (based on 'apparent pKB' values) were: propyltriphenylphosphonium (7.33), butyltriphenylphosphonium (7.04), tetraphenylarsonium (6.86), tetraphenylphosphonium (6.81), ethyltriphenylphosphonium (6.70), and hexyltriphenylphosphonium (6.63). Tetrabutylphosphonium (6.06), tetrabutylammonium (5.12), methyltriphenylphosphonium (5.25), clofilium (5.66) and guanethidine (5.61) were significantly less potent. Tetrapropylammonium, tetrapentyltin and tetraphenylboron were inactive at the maximum concentrations used (30 microM). Tetraphenylboron (10-100 microM) fully reversed tetraphenylphosphonium, tetraphenylarsonium (both at 3 microM), tetrabutylammonium (30 microM) and clofilium (10 microM) and partially reversed guanethidine (10 microM) antagonism of levcromakalim responses indicating a similarity in the mechanism of action of these chemically distinct compounds. The results show that quaternary ions similar in structure to tetraphenylphosphonium, i.e., containing phosphonium ion centre and phenyl side chains, are the most potent antagonists of levcromakalim, in pig coronary artery. It is also apparent that marked changes can be made in the substitution on the phosphonium ion (ethyl to hexyl) with little or no effect on their potency. PMID:9088868
[Angina pectoris and coronary insufficiency with a normal coronary angiogram: pathophysiological principles, diagnosis and therapeutic consequences].
Strauer, B E
The clinical syndrome "coronary insufficience at normal coronary arteriogram" is found in approximately 10-20% of patients with exercise-induced coronary insufficience. In most of these cases disturbances of coronary microcirculation are present. They can appear in vascular diseases (arterial hypertension, systemic immunopathies, immune complex vasculitis, etc.), in rheological diseases (paraproteinemia, hyperlipoproteinemia, polyglobulia, etc.), and in disturbances of transport and diffusion of oxygen (carbon monoxide intoxication, methemoglobinemia, hyperlipoproteinemia). The clinical diagnosis is based on usual diagnostic programs (electrocardiogram, exercise electrocardiogram, responsiveness to nitroglycerin, etc.), as well as on newer, functionally orientated diagnostic procedures (determinations of coronary blood flow and of coronary vascular reserve, production of lactate, serological findings, histology and immune histology of peripheral arteries, measurements of viscosities in both plasma and blood, etc.). Many clinically relevant disturbances in coronary microcirculation can thus be detected and treated on a rational basis by the management of the internal main disease, that is, by the treatment of the vascular, rheological, and metabolic disorders. Persistent angina pectoris in the presence of normal coronary arteriogram represents no termination of coronary diagnostics, but moreover implies the clinical task for using diagnostic possibilities to enable functional and therapeutical assessment of coronary microcirculation. PMID:3066040
Serial quantitative coronary angiography and coronary events
Wendy J. Mack; Min Xiang; Robert H. Selzer; Howard N. Hodis
Background Although assessment of progression of atherosclerosis by quantitative coronary angiography (QCA) is used as a surrogate for coronary events, no validation study has compared the several QCA measures used.Methods and Results The Cholesterol Lowering Atherosclerosis Study was a clinical trial testing the efficacy of colestipol-niacin on the progression of coronary atherosclerosis. Baseline\\/2-year coronary angiograms were obtained on 156 men
Development and validation of a pre-percutaneous coronary intervention risk model of contrast-induced acute kidney injury with an integer scoring system.
Inohara, Taku; Kohsaka, Shun; Abe, Takayuki; Miyata, Hiroaki; Numasawa, Yohei; Ueda, Ikuko; Nishi, Yutaro; Naito, Kotaro; Shibata, Masaru; Hayashida, Kentaro; Maekawa, Yuichiro; Kawamura, Akio; Sato, Yuji; Fukuda, Keiichi
Previous models for contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) include procedure-related variables in addition to pre-procedural variables. We sought to develop a risk model for CI-AKI based on pre-procedural variables and compare its predictability with a conventional risk model and also to develop an integer score system based on selected variables. A total of 5,936 consecutive PCIs registered in the Japanese Cardiovascular Database were analyzed (derivation cohort, n�= 3,957; validation cohort, n�= 1,979). CI-AKI was defined as an increase in serum creatinine of 50% or 0.3�mg/dl compared with baseline. From the derivation cohort, 2 different CI-AKI risk models were generated using logistic regression analyses: a pre-procedural model and a conventional model including both pre-procedural and procedure-related variables. The predictabilities of the models were compared by c-statistics. An integer score was assigned to each variable in proportion to each estimated regression coefficient for the final model. In our derivation cohort, the proportion of CI-AKI was 9.0% (n�= 358). Predictors for CI-AKI included older age, heart failure, diabetes, previous PCI, hypertension, higher baseline creatinine level, and acute coronary syndrome. Presence of procedure-related complications and insertion of intra-aortic balloon pumping were included as procedure-related variables in the conventional model. Both the conventional model (c-statistics 0.789) and the pre-procedural model (c-statistics 0.799) demonstrated reasonable discrimination. The integer risk-scoring method demonstrated good agreement between the expected and observed risks of CI-AKI in the validation cohort. In conclusion, the pre-procedural risk model for CI-AKI had acceptable discrimination compared with the conventional model and may aid in risk stratification of CI-AKI before PCI. PMID:25891989
Microvascular decompression of trigeminal nerve root for treatment of a patient with hemimasticatory spasm.
Dou, Ning-Ning; Zhong, Jun; Zhou, Qiu-Meng; Zhu, Jin; Wang, Yong-Nan; Li, Shi-Ting
Hemimasticatory spasm is a rare disease; with little knowledge of the pathogenesis, it has still been intractable today. We presented a 56-year-old woman with involuntary painful spasm in her left masseter muscle for 11 years. The patient was successfully treated with microvascular decompression surgery. An offending superior cerebellar artery was found to contact with the motor branch of the trigeminal nerve root, which was then removed away and pieces of soft wadding were interposed between the nerve and the vessel to assure the separation. Postoperatively, the symptom totally disappeared and no recurrence was observed during the 7 months' follow-up. The treatment as well as the pathogenesis of the disease was reviewed, and we put forward a new hypothesis. PMID:24657975
CDKL5/STK9 is mutated in Rett syndrome variant with infantile spasms
Scala, E; Ariani, F; Mari, F; Caselli, R; Pescucci, C; Longo, I; Meloni, I; Giachino, D; Bruttini, M; Hayek, G; Zappella, M; Renieri, A
Background: Rett syndrome is a severe neurodevelopmental disorder, almost exclusively affecting females and characterised by a wide spectrum of clinical manifestations. Both the classic form and preserved speech variant of Rett syndrome are due to mutations in the MECP2 gene. Several other variants of Rett syndrome have been described. In 1985, Hanefeld described a variant with the early appearance of convulsions. In this variant, the normal perinatal period is soon followed by the appearance of seizures, usually infantile spasms. We have observed two patients with signs of Rett syndrome showing acquired microcephaly and stereotypic midline hand movements. The disease started with generalised convulsions and myoclonic fits at 1.5 months in the first patient and with spasms at 10 days in the other, suggesting a diagnosis of the Hanefeld variant. In these patients, MECP2 point mutations and gross rearrangements were excluded by denaturing high performance liquid chromatography and real time quantitative PCR. The ARX and CDKL5 genes have been associated with West syndrome (infantile spasms, hypsarrhythmia, and mental retardation). Methods: Based on the clinical overlap between the Hanefeld variant and West syndrome, we analysed ARX and CDKL5 in the two girls. Results: We found frameshift deletions in CDKL5 in both patients; one in exon 5 (c.163_166delGAAA) and the other in exon 18 (c.2635_2636delCT). CDKL5 was then analysed in 19 classic Rett and 15 preserved speech variant patients, all MECP2 negative, but no mutations were found. Conclusion: Our results show that CDKL5 is responsible for a rare variant of Rett syndrome characterised by early development of convulsions, usually of the spasm type. PMID:15689447
Altered spontaneous brain activity in patients with hemifacial spasm: a resting-state functional MRI study.
Tu, Ye; Wei, Yongxu; Sun, Kun; Zhao, Weiguo; Yu, Buwei
Resting-state functional magnetic resonance imaging (fMRI) has been used to detect the alterations of spontaneous neuronal activity in various neurological and neuropsychiatric diseases, but rarely in hemifacial spasm (HFS), a nervous system disorder. We used resting-state fMRI with regional homogeneity (ReHo) analysis to investigate changes in spontaneous brain activity of patients with HFS and to determine the relationship of these functional changes with clinical features. Thirty patients with HFS and 33 age-, sex-, and education-matched healthy controls were included in this study. Compared with controls, HFS patients had significantly decreased ReHo values in left middle frontal gyrus (MFG), left medial cingulate cortex (MCC), left lingual gyrus, right superior temporal gyrus (STG) and right precuneus; and increased ReHo values in left precentral gyrus, anterior cingulate cortex (ACC), right brainstem, and right cerebellum. Furthermore, the mean ReHo value in brainstem showed a positive correlation with the spasm severity (r = 0.404, p = 0.027), and the mean ReHo value in MFG was inversely related with spasm severity in HFS group (r = -0.398, p = 0.028). This study reveals that HFS is associated with abnormal spontaneous brain activity in brain regions most involved in motor control and blinking movement. The disturbances of spontaneous brain activity reflected by ReHo measurements may provide insights into the neurological pathophysiology of HFS. PMID:25603126
Etiology and Long-Term Outcomes of Late-Onset Infantile Spasms.
Mets�honkala, Liisa; Gaily, Eija; Valanne, Leena; Blomstedt, G�ran
Objectives?The purpose of the study was to evaluate the etiology and long-term outcomes of late-onset epileptic spasms (LOS). Methods?This is a retrospective analysis of all consecutive patients seen at our center with onset of clusters of epileptic spasms between 1 and 3 years of age in 1995 through 2005. Results?Overall, 17 children with LOS were identified. Overall, 14 children (82%) had structural etiology. Six patients received resective surgical treatment. Five had focal cortical dysplasia type 1 (FCD1) histology (29% of all the patients). Overall, 16 children were followed for 2 to 18 years. At the latest follow-up, seizure freedom was observed in 67% of the operated and in 50% of the nonoperated patients. Normal cognition or only mild mental deficiency was observed in nine patients (56%), of whom eight were seizure-free. All patients with intractable spasms had a severe mental deficiency. Conclusion?The overall cognitive outcome of LOS was more favorable than in the previous reports and was associated with seizure freedom. FCD1 is a frequent etiology for LOS and the cognitive outcome of patients with FCD1 seemed to be favorable. PMID:26058737
A Case of Hemifacial Spasm Caused by an Artery Passing Through the Facial Nerve
Oh, Chang Hyun; Shim, Yu Shik; Park, Hyeonseon
Hemifacial spasm (HFS) is a clinical syndrome characterized by unilateral facial nerve dysfunction. The usual cause involves vascular compression of the seventh cranial nerve, but compression by an artery passing through the facial nerve is very unusual. A 20-year-old man presented with left facial spasm that had persisted for 4 years. Compression of the left facial nerve root exit zone by the anterior inferior cerebellar artery (AICA) was revealed on magnetic resonance angiography. During microvascular decompression surgery, penetration of the distal portion of the facial nerve root exit zone by the AICA was observed. At the penetrating site, the artery was found to have compressed the facial nerve and to be immobilized. The penetrated seventh cranial nerve was longitudinally split about 2 mm. The compressing artery was moved away from the penetrating site and the decompression was secured by inserting Teflon at the operative site. Although the facial spasm disappeared in the immediate postoperative period, the patient continued to show moderate facial weakness. At postoperative 12 months, the facial weakness had improved to a mild degree. Prior to performing microvascular decompression of HFS, surgeons should be aware of a possibility for rare complex anatomy, such as compression by an artery passing through the facial nerve, which cannot be observed by modern imaging techniques. PMID:25810866
Extent and severity of myocardial hypoperfusion as predictors of prognosis in patients with suspected coronary artery disease
Marc L. Ladenheim; Brad H. Pollock; Alan Rozanski; Daniel S. Berman; Howard M. Staniloff; James S. Forrester; George A. Diamond
The ability of exercise-induced myocardial hypoperfusion on thallium scintigraphy to predict coronary events was assessed in 1,689 patients with symptoms suggestive of coronary artery disease but without prior myocardial infarction or coronary artery bypass surgery. A total of 74 patients had a coronary event in the year after testing (12 cardiac deaths, 20 nonfatal infarctions and 42 referrals for bypass
Alterations in Aortic Pressure and Coronary Blood Flow: Their Time Sequences with Induced Paroxysms of Ventricular Tachycardia in Normal and Impaired Myocardium
Jochen Thormann; Martin Schlepper
In an attempt to define more clearly the hemodynamic effects of paroxysmal tachycardia in their time sequence not only for the normal heart, we monitored coronary sinus flow (CSF), aortic mean pressure (AOMP), and coronary vascular resistance in 42 patients. They underwent stress testing of left ventricular function by paced ventricular tachycardia (VT 170\\/min); 13 patients had no heart disease
Association Between Contrast Media Volume-Glomerular Filtration Rate Ratio and Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Intervention.
Celik, Omer; Ozturk, Derya; Akin, Fatih; Ayca, Burak; Yalc?n, Ahmet Arif; Erturk, Mehmet; B?y?k, Ismail; Ayaz, Ahmet; Akturk, Ibrahim Faruk; Enhos, As?m; Aslan, Serkan
We hypothesized that contrast media volume-estimated glomerular filtration rate (CV-e-GFR) ratio may be a predictor of contrast media-induced acute kidney injury (CI-AKI). We investigated the associations between CV-e-GFR ratio and CI-AKI in 597 patients undergoing primary percutaneous coronary intervention (pPCI). An absolute ?0.3 mg/dL increase in serum creatinine compared with baseline levels within 48 hours after the procedure was considered as CI-AKI; 78 (13.1%) of the 597 patients experienced CI-AKI. The amount of contrast during procedure was higher in the CI-AKI group than in those without CI-AKI (153 vs 135 mL, P = .003). The CV-e-GFR ratio was significantly higher in patients with CI-AKI than without (2.3 vs 1.5, P < .001). In multivariate analysis, independent predictors of CI-AKI were low left ventricular ejection fraction (P = .018, odds ratio [OR] = 0.966), e-GFR <60 mL/min (P = .012, OR = 2.558), and CV-e-GFR >2 (P < .001, OR = 5.917). In conclusion, CV-e-GFR ratio is significantly associated with CI-AKI after pPCI. PMID:25005762
A solute carrier family 22 member 3 variant rs3088442 G?A associated with coronary heart disease inhibits lipopolysaccharide-induced inflammatory response.
Li, Lu; He, Meian; Zhou, Li; Miao, Xiaoping; Wu, Fangqing; Huang, Suli; Dai, Xiayun; Wang, Tian; Wu, Tangchun
Recent genome-wide association studies have identified single-nucleotide polymorphism (SNPs) within the SLC22A3 (solute carrier family 22 member 3) gene associated with coronary heart disease (CHD) in the Caucasian population. We performed molecular analysis to investigate the potential role of SLC22A3 variants in CHD. Our study showed that the common polymorphism rs3088442 G?A, which is localized in the 3' UTR of the SLC22A3 gene, was associated with a decreased risk of CHD in the Chinese population by a case control study. In silico analysis indicated that G?A substitution of SNP rs3088442 created a putative binding site for miR-147 in the SLC22A3 mRNA. By overexpressing miR-147 or inhibiting endogenous miR-147, we demonstrated that SNP rs3088442 G?A recruited miR-147 to inhibit SLC22A3 expression. Moreover, SLC22A3 deficiency significantly decreased LPS-induced monocytic inflammatory response by interrupting NF-?B and MAPK signaling cascades in a histamine-dependent manner. Notably, the expression of SLC22A3(A) was also suppressed by LPS stimulus. Our findings might indicate a negative feedback mechanism against inflammatory response by which SLC22A3 polymorphisms decreased the risk of CHD. PMID:25561729
The role of nitric oxide in testosterone-induced vasodilation in pig coronary arteries and rat thoracic aorta�
Piefer, Jason William
Several studies have provided evidence that the administration of testosterone to vascular tissue causes vasodilation (Costarella, Yue). This study examines the role of nitric oxide (NO) as a potential mechanism of testosterone-induced vasodilation...
The Effect of Renin-Angiotensin-Aldosterone System Blockade Medications on Contrast-Induced Nephropathy in Patients Undergoing Coronary Angiography: A Meta-Analysis
Wu, Zhijun; Zhang, Huan; Jin, Wei; Liu, Yan; Lu, Lin; Chen, Qiujing; Zhang, Ruiyan
Background Contrast-induced nephropathy (CIN) is the main complication of contrast media administration (CM) in patients undergoing coronary angiography (CAG) and percutaneous coronary intervention (PCI). There are inconsistent results in the literature regarding the effect of renin-angiotensin-aldosterone system (RAAS) blockers (angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin receptor blockers [ARBs]) on CIN. We evaluated the association between the administration of ACEI/ARBs and CIN, as well as the effect of ACEI/ARBs on post-procedural changes in renal function index, in patients undergoing CAG. Methods We searched Pubmed, EMBASE, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for relevant studies. The primary search generated 893 potentially relevant articles. A total of 879 studies were excluded because they did not meet the selection criteria. Finally, 14 studies were eligible for inclusion. There were 7,288 patients that received ACEI/ARBs and 8,159 patients that received placebo or naive to ACEI/ARBs in the study. A random or a fixed effect model was used to calculate the pooled odd ratios (ORs). Results The risk of CIN was significantly increased in the ACEI/ARBs group compared to the control group (OR= 1.50, 95%CI: 1.03-2.18, P =0.03). The magnitude of association was significantly reinforced in the observational studies (OR=1.84, 95%CI 1.19-2.85, P=0.006) but not in the randomized controlled trials (OR=0.88, 95%CI 0.41-1.90 P=0.74). The summary adjusted OR of 4 observational studies was 1.56 (95%CI 1.25-1.94, P<0.0001) and was weaker than the unadjusted OR. Conclusions Although there is some evidence to suggest that the administration of RAAS blockers was associated with the increased risk of CIN in patients undergoing CAG, the robustness of our study remains weak. The results are based on small observational studies and need further validation. PMID:26083525
CGRP receptors mediating CGRP-, adrenomedullin- and amylin-induced relaxation in porcine coronary arteries. Characterization with �Compound 1' (WO98/11128), a non-peptide antagonist
Hasbak, Philip; Sams, Anette; Schifter, S�ren; Longmore, Jenny; Edvinsson, Lars
Calcitonin gene-related peptide (CGRP), amylin and adrenomedullin (AM) belong to the same family of peptides. Accumulating evidence indicate that the calcitonin (CT) receptor, the CT receptor-like receptor (CRLR) and receptor-activity-modifying proteins (RAMPs) form the basis of all the receptors in this family of peptides. Using reverse transcriptase�polymerase chain reaction the presence of mRNA sequences encoding the CRLR, RAMP1 and RAMP2 were demonstrated in porcine left anterior descending (LAD) coronary arteries, whereas porcine calcitonin (CT) receptor mRNA was not present. The partial porcine mRNA sequences shared 82�92% nucleotide identity with human sequences. The human peptides ?CGRP, ?CGRP, AM and amylin induced relaxation with pEC50 values of 8.1, 8.1, 6.7 and 6.1?M respectively. The antagonistic properties of a novel non-peptide CGRP antagonist �Compound 1' (WO98/11128), ?CGRP8�37 and the proposed AM receptor antagonist AM22�52 were compared to the well-known CGRP1 receptor antagonist ?CGRP8�37. The ?CGRP8�37 and ?CGRP8�37 induced concentration-dependent (10?7�10?5?M) rightward shift of both the ?CGRP and ?CGRP concentration-response curves. ?CGRP8�37 (10?6?M) had the same effect as ?CGRP8�37 (10?6?M), but with less potent rightward shift of the concentration-response curves for ?CGRP, AM and amylin. Preincubation with �Compound 1' (10?7�10?5?M) and AM22�52 (10?6?M) had no significant antagonistic effect. In conclusion, the building blocks forming CGRP and AM receptors were present in the porcine LAD, whereas those of the amylin receptor were not. ?CGRP, ?CGRP, AM and amylin mediated vasorelaxation via the CGRP receptors. No functional response was detected to adrenomedullin via the adrenomedullin receptor. PMID:11498528
[Cannabis and acute coronary syndrome with ST segment elevation].
Ghannem, M; Belhadj, I; Tritar, A; Moukala, T; Amri, N; Noury, A; Zaghdoudi, M
Cannabis is the most common substance of drug abuse in the world and has euphoric and hallucinogenic effects. Its cardiovascular effects are well-known. However, there is limited information concerning cannabis-induced acute coronary syndrome and the exact contribution of cannabis smoking to coronary artery disease. We report and discuss a case of ST-Elevation acute coronary syndrome occurring in a young patient aged 24 years, who was a heavy cannabis smoker. PMID:24182845
Clinical coronary laser balloon angioplasty: effect on ergonovine responsiveness
NASA Astrophysics Data System (ADS)
Bowker, Timothy J.; Buller, Nigel P.; Pearson, Morag W.; Rickards, Anthony F.
Laser balloon angioplasty involves delivery of continuous wave Nd-YAG laser energy radially from the surface of a specially designed a.ngioplast.y balloon directly to the luniirial surface of an arterial segment immediately after it.s succeasfu] dilatation by conventional balloon angioplasty, the purpose being to fuse loose flaps and disrupted atheroinatous plaque thermally hack against the arterial wall and to reduce elastic recoil and smooth muscle proliferation, in an attempt to prevent re stenosis . Ergonovirie stimulates arterial wall smooth muscle, normally causes arteries to constrict and is used in the diagnosis of coronary artery spasm. Three patients were treated with laser balloon angioplasty, each receiving 380 3 over 20 seconds (30 W for 5 a, 18 W for 5 s & 14 W for 10 5) . The minimum lumirial diameter of the treated arterial segment was measured angiographically before and after conventional balloon angioplasty, immediately after laser balloon angioplasty and again 1 month later both before and after ergonovine was given. The measurements were (respectively, in mm): 1.03, 1.71, 1.85, 2.37 and 2.37 in patient 1; 0.30, 1.54, 1.85, 2.07 and 2.11 in patient 2; and 0.98, 1.76, 2.27, 2.40 and 2.40 in patient 3. The before and after ergonovire measurements were almost identical, suggesting that laser balloon angioplasty abolishes ergonovine responsiveness for at least up to one month following the procedure, and thus might be of use in treating coronary artery spasm which is resistant to medical therapy.
Hypofibrinogenemia caused by adrenocorticotropic hormone for infantile spasms: a case report.
Kamei, Atsushi; Araya, Nami; Akasaka, Manami; Mizuma, Kanako; Asami, Maya; Tanifuji, Sachiko; Chida, Shoichi
We report the case of a 7-month-old boy who developed hypofibrinogenemia (66.6 mg/dL; reference value, 170-405 mg/dL) during adrenocorticotropic hormone (ACTH) therapy for infantile spasms. Although the patient showed no clinical signs of a bleeding diathesis, we recommend that plasma fibrinogen levels should be monitored during ACTH therapy, which should be discontinued when fibrinogen levels fall below hemostatic levels (60.0mg/dL) or when bleeding tendencies are recognized. PMID:24735983
The patterns and risk factors of hearing loss following microvascular decompression for hemifacial spasm
Kwang-Wook Jo; Jong-Won Kim; Doo-Sik Kong; Sung-Hwa Hong; Kwan Park
Objective��The aim of this study was to reveal the risk factors including intraoperative brain stem auditory evoked potential (BAEP)\\u000a changes and to define parameter and warning values of BAEP beyond which the probability of hearing impairment rises significantly.\\u000a \\u000a \\u000a \\u000a \\u000a Methods��From April 1997 to February 2009, 1,156 patients underwent microvascular decompression (MVD) for hemifacial spasm (HFS) and\\u000a their medical records and audiologic
Counseling the Coronary Patient
ERIC Educational Resources Information Center
Semmler, Caryl; Semmler, Maynard
The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)
... from the NHLBI on Twitter. What Is Coronary Heart Disease? Espa�ol Coronary heart disease (CHD) is a ... Red: Eileen's Story 04/10/2014 Celebrating American Heart Month: NIH Advancing Heart Research 02/06/2014 ...
Directional coronary atherectomy (DCA)
MedlinePLUS Videos and Cool Tools
... the coronary arteries and allow more blood to flow to the heart muscle and ease the pain ... within the coronary artery to keep the vessel open. After the intervention is completed the doctor injects ...
Hemifacial Spasm Associated with Intraparenchymal Brain Stem Tumor Athanassios Leonardos, MD, Paul E. Greene, MD, Louis H. Weimer, MD, Alexander G. Khandji, MD,
Hemifacial Spasm Associated with Intraparenchymal Brain Stem Tumor Athanassios Leonardos, MD, PaulD* The Neurological Institute, Columbia University, New York, New York, USA Hemifacial spasm (HFS) is characterized by paroxys- mal bursts of involuntary clonic and tonic activity in muscles innervated by the facial nerve.1
Do cerebral potentials to magnetic stimulation of paraspinal muscles reflect changes in palpable muscle spasm, low back pain, and activity scores?
Yu Zhu; Scott Haldeman; Chang-Yu J. Hsieh; Pingjia Wu; Arnold Starr
Objective: Previous studies have shown that cortical-evoked potentials on magnetic stimulation of muscles are influenced by muscle contraction, vibration, and muscle spasm. This study was carried out to determine whether these potentials correlate with palpatory muscle spasm, patient symptoms, and disability in patients with low back pain. Methods: A prospective observational study was performed on 13 subjects with a history
Coronary magnetic resonance angiography
Matthias Stuber; Robert G. Weiss
Coronary magnetic resonance angiography (MRA) is a pow- erful noninvasive technique with high soft-tissue contrast for the visualization of the coronary anatomy without X-ray exposure. Due to the small dimensions and tortuous na- ture of the coronary arteries, a high spatial resolution and sufficient volumetric coverage have to be obtained. How- ever, this necessitates scanning times that are typically much
Idiopathic carotid and coronary vasospasm: A case treated by carotid artery stenting
Yoshimoto, Haruko; Asakuno, Keizo; Matsuo, Seigo; Ishida, Atsushi; Shiramizu, Hideki; Niimura, Kaku; Yuzawa, Miki; Yamagishi, Yasumichi; Munakata, Takehiko; Moriyama, Takashi; Hori, Tomokatsu
Background: We previously reported a case of cerebral infarction complicated by myocardial infarction. The pathogenesis of both infarctions was thought to be vasospasm; thus, we named this condition �idiopathic carotid and coronary vasospasm�. Various medical treatments for the prevention of carotid vasospasm have been unsuccessfully tried. Thus, other effective treatments should be established for patients who frequently suffer cerebral ischemic attacks. Case Description: We treated the present case of �idiopathic carotid and coronary vasospasm� by carotid artery stenting (CAS). The first stenting, of the carotid bifurcation, failed to prevent internal carotid artery (ICA) vasospasm. However, after an additional stent placement to the prepetrous portion, ischemic attacks were dramatically reduced. Conclusion: The effect of CAS for extracranial ICA vasospasm was dramatic and control of the spasm at the prepetrous portion seems to be essential. Further validation of the effectiveness and safety of CAS for ICA vasospasm will be necessary. PMID:25422789
Matrix Metalloproteinases Modulated by PKC? Mediate Resistin-Induced Migration of Human Coronary Artery Smooth Muscle Cells
Ding, Qinxue; Chai, Hong; Mahmood, Nausheen; Tsao, Jerry; Mochly-Rosen, Daria; Zhou, Wei
Background Emerging evidence showed that resistin induces vascular smooth muscle cell (VSMC) migration, a critical step to initiating vascular restenosis. Mechanistically, adhesion molecule expression and cytoskeletal rearrangement have been observed in this progress. Given that matrix metalloproteinases (MMPs) also regulates cell migration, we hypothesized that MMPs may mediate resistin-induced VSMC migration. Materials and Methods Human VSMCs were treated with recombinant human resistin at physiological (10 ng/mL) and pathological (40 ng/mL) concentrations for 24 hours. Cell migration was determinate by Boyden chamber assay. MMP and TIMP mRNA and protein levels were measured with real-time PCR and ELISA. MMP enzymatic activity was measured by zymography on precast gels. In another experiment, neutralizing antibodies against MMP-2 and MMP-9 were co-incubated with resistin in cultured VSMCs. The regulation of MMP by protein kinase C (PKC) was determined by ?V1�2, a selective PKC? inhibitor. Results Resistin-induced SMC migration was confirmed by Boyden chamber assay. 40ng/mL Resistin increased SMC migration by 3.7 fold. Molecularly, resistin stimulated MMP-2 and - MMP9 mRNA and protein expressions. In contrast, the TIMP-1 and TIMP-2 mRNA levels were inhibited by resistin. Neutralizing antibodies against MMP-2 and MMP-9 effectively reversed VSMC migration. Furthermore, resistin activated PKC? and selective PKC? inhibitor suppressed resistin-induced MMP expression, activity and cell migration. Conclusions Our study confirmed that resistin increases vascular smooth muscle cell migration in vitro. Mechanistically, resistin-stimulated cell migration was associated with increased MMP expression and activity, which was dependent on PKC? activation. PMID:21277149
AntiC5a monoclonal antibody reduces cardiopulmonary bypass and cardioplegia-induced coronary endothelial dysfunction
Motohisa Tofukuji; Gregory L. Stahl; Azin Agah; Caroline Metais; Michael Simons; Frank W. Sellke
Objective: Because C5a induces tissue injury by activating polymorphonuclear leukocytes, the hypothesis was that inhibition of C5a activity would reduce cardioplegia-related injury. Methods: Pigs were placed on cardiopulmonary bypass. The hearts were arrested for 1 hour with hyperkalemic cardioplegia. Pigs were then separated from bypass, and the hearts were reperfused for 2 hours. Anti-porcine C5a monoclonal antibody (1.6 mg\\/kg, intravenously;
Alpha-Adrenoceptor Modulation in Central Nervous System Trauma: Pain, Spasms, and Paralysis - An Unlucky Triad.
Lemmens, Stefanie; Br�ne, Bert; Dooley, Dearbhaile; Hendrix, Sven; Geurts, Nathalie
Many researchers have attempted to pharmacologically modulate the adrenergic system to control locomotion, pain, and spasms after central nervous system (CNS) trauma, although such efforts have led to conflicting results. Despite this, multiple studies highlight that ?-adrenoceptors (?-ARs) are promising therapeutic targets because in the CNS, they are involved in reactivity to stressors and regulation of locomotion, pain, and spasms. These functions can be activated by direct modulation of these receptors on neuronal networks in the brain and the spinal cord. In addition, these multifunctional receptors are also broadly expressed on immune cells. This suggests that they might play a key role in modulating immunological responses, which may be crucial in treating spinal cord injury and traumatic brain injury as both diseases are characterized by a strong inflammatory component. Reducing the proinflammatory response will create a more permissive environment for axon regeneration and may support neuromodulation in combination therapies. However, pharmacological interventions are hindered by adrenergic system complexity and the even more complicated anatomical and physiological changes in the CNS after trauma. This review is the first concise overview of the pros and cons of ?-AR modulation in the context of CNS trauma. PMID:25546087
Contrast Volume/Raw eGFR Ratio for Predicting Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention for Myocardial Infarction
Park, Hoon Suk; Kim, Chan Joon; Yi, Jeong-Eun; Hwang, Byung-Hee; Kim, Tae-Hoon; Koh, Yoon Seok; Park, Hun-Jun; Her, Sung-Ho; Jang, Sung Won; Park, Chul-Soo; Lee, Jong Min; Kim, Hee Yeol; Jeon, Doo Soo; Kim, Pum-Joon; Yoo, Ki-Dong; Chang, Kiyuk; Jin, Dong Chan; Seung, Ki-Bae
Background Considering that contrast medium is excreted through the whole kidney in a similar manner to drug excretion, the use of raw estimated glomerular filtration rate (eGFR) rather than body surface area (BSA)-normalized eGFR is thought to be more appropriate for evaluating the risk of contrast-induced acute kidney injury (CI-AKI). Methods This study included 2,189 myocardial infarction patients treated with percutaneous coronary intervention. Logistic regression analysis was performed to identify the independent risk factors. We used receiver-operating characteristic (ROC) curves to compare the ratios of contrast volume (CV) to eGFR with and without BSA normalization in predicting CI-AKI. Results The area under the curve (AUC) of the ROC curve for the model including all the significant variables such as diabetes mellitus, left ventricular ejection fraction, preprocedural glucose, and the CV/raw modification of diet in renal disease (MDRD) eGFR ratio was 0.768 [95% confidence interval (CI), 0.720-0.816; p < 0.001]. When the CV/raw MDRD eGFR ratio was used as a single risk value, the AUC of the ROC curve was 0.650 (95% CI, 0.590-0.711; p < 0.001). When the CV/MDRD eGFR ratio with BSA normalization ratio was used, the AUC of the ROC curve further decreased to 0.635 (95% CI, 0.574-0.696; p < 0.001). The difference between the two AUCs was significant (p = 0.002). Conclusions Raw eGFR is a better predictor for CI-AKI than BSA-normalized eGFR. PMID:25759701
Safe contrast volumes for preventing contrast-induced nephropathy in elderly patients with relatively normal renal function during percutaneous coronary intervention.
Liu, Yong; Liu, Yuan-hui; Chen, Ji-yan; Tan, Ning; Zhou, Ying-ling; Duan, Chong-Yang; Yu, Dan-qing; Xie, Nian-jin; Li, Hua-long; Chen, Ping-yan
The aim of this study was to evaluate contrast media volume to creatinine clearance (V/CrCl) ratio for predicting contrast-induced nephropathy (CIN) and to determine a safe V/CrCl cut off value to avoid CIN in elderly patients with relatively normal renal function during percutaneous coronary intervention (PCI). We prospectively enrolled 1020 consecutive elderly patients (age ?65 years) with relative normal renal function (baseline serum creatinine <1.5?mg/dL) undergoing PCI. Receiver operating characteristic (ROC) curves were used to identify the optimal cut off value of V/CrCl for detecting CIN. The predictive value of V/CrCl for CIN was assessed with a multivariate logistic regression. Thirty-nine patients (3.8%) developed CIN. There was a significant association between a higher V/CrCl ratio and CIN risk (P?0.001). ROC curve analysis indicated that a V/CrCl ratio of 2.74 was a fair discriminator for CIN (C statistic?=?0.68). After adjusting for other known CIN risk factors, V/CrCl ratios >2.74 remained significantly associated with CIN (odds ratio?=?3.21, 95% confidence interval [CI] 1.45-7.09, P?=?0.004) and worse long-term mortality (hazard ratio?=?1.96, 95% CI 1.14-3.38, P?=?0.016). A V/CrCl ratio >2.74 was a significant independent predictor of CIN and was independently associated with long-term mortality in elderly patients with relatively normal renal function. PMID:25816028
Comparison of the Efficacy of Rosuvastatin versus Atorvastatin in Preventing Contrast Induced Nephropathy in Patient with Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention
Tan, Ning; Chen, Ji-yan; Zhou, Ying-ling; Li, Li-wen; Duan, Chong-yang; Chen, Ping-Yan; Luo, Jian-fang; Li, Hua-long; Wei-Guo
Objectives We prospectively compared the preventive effects of rosuvastatin and atorvastatin on contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI). Methods We enrolled 1078 consecutive patients with CKD undergoing elective PCI. Patients in Group 1 (n?=?273) received rosuvastatin (10 mg), and those in group 2 (n?=?805) received atorvastatin (20 mg). The primary end-point was the development of CIN, defined as an absolute increase in serum creatinine ?0.5 mg/dL, or an increase ?25% from baseline within 48�72 h after contrast medium exposure. Results CIN was observed in 58 (5.4%) patients. The incidence of CIN was similar in patients pretreated with either rosuvastatin or atorvastatin (5.9% vs. 5.2%, p?=?0.684). The same results were also observed when using other definitions of CIN. Clinical and procedural characteristics did not show significant differences between the two groups (p>0.05). Additionally, there were no significant inter-group differences with respect to in-hospital mortality rates (0.4% vs. 1.5%, p?=?0.141), or other in-hospital complications. Multivariate logistic regression analysis revealed that rosuvastatin and atorvastatin demonstrated similar efficacies for preventing CIN, after adjusting for potential confounding risk factors (odds ratio?=?1.17, 95% confidence interval, 0.62�2.20, p?=?0.623). A Kaplan�Meier survival analysis showed that patients taking either rosuvastatin or atorvastatin had similar incidences of all-cause mortality (9.4% vs. 7.1%, respectively; p?=?0.290) and major adverse cardiovascular events (29.32% vs. 23.14%, respectively; p?=?0.135) during follow-up. Conclusions Rosuvastatin and atorvastatin have similar efficacies for preventing CIN in patients with CKD undergoing PCI. PMID:25357250
A systematic review of the pathophysiology of 5-fluorouracil-induced cardiotoxicity
Background Cardiotoxicity is a serious side effect to treatment with 5-fluorouracil (5-FU), but the underlying mechanisms are not fully understood. The objective of this systematic review was to evaluate the pathophysiology of 5-FU- induced cardiotoxicity. Methods We systematically searched PubMed for articles in English using the search terms: 5-FU OR 5-fluorouracil OR capecitabine AND cardiotoxicity. Papers evaluating the pathophysiology of this cardiotoxicity were included. Results We identified 27 articles of 26 studies concerning the pathophysiology of 5-FU-induced cardiotoxicity. The studies demonstrated 5-FU-induced: hemorrhagic infarction, interstitial fibrosis and inflammatory reaction in the myocardium; damage of the arterial endothelium followed by platelet aggregation; increased myocardial energy metabolism and depletion of high energy phosphate compounds; increased superoxide anion levels and a reduced antioxidant capacity; vasoconstriction of arteries; changes in red blood cell (RBC) structure, function and metabolism; alterations in plasma levels of substances involved in coagulation and fibrinolysis and increased endothelin-1 levels and N-terminal-pro brain natriuretic peptide levels. Based on these findings the proposed mechanisms are: endothelial injury followed by thrombosis, increased metabolism leading to energy depletion and ischemia, oxidative stress causing cellular damage, coronary artery spasm leading to myocardial ischemia and diminished ability of RBCs to transfer oxygen resulting in myocardial ischemia. Conclusions There is no evidence for a single mechanism responsible for 5-FU-induced cardiotoxicity, and the underlying mechanisms might be multifactorial. Further research is needed to elucidate the pathogenesis of this side effect. PMID:25186061
Effects of Cardiac Motion on Right Coronary Artery Hemodynamics
Dehong Zeng; Zhaohua Ding; Morton H. Friedman; C. Ross Ethier
The purpose of this work was to investigate the effects of physiologically realistic cardiac-induced motion on hemodynamics in human right coronary arteries. The blood flow patterns were numerically simulated in a modeled right coronary artery (RCA) having a uniform circular cross section of 2.48 mm diam. Arterial motion was specified based on biplane cineangiograms, and incorporated physiologically realistic bending and
Impaired coronary microvascular endothelial function in men with metabolic syndrome
Teragawa, Hiroki; Mitsuba, Naoya; Nishioka, Kenji; Ueda, Kentaro; Kono, Shingo; Higashi, Yukihito; Chayama, Kazuaki; Kihara, Yasuki
AIM: To assess coronary endothelial function of conduit and resistance vessels in patients with metabolic syndrome (MS). METHODS: Seventy-eight men (mean age, 57 years) with chest pain and angiographically normal coronary arteries were included in the study. Patients with coronary spastic angina were excluded. Changes in coronary artery diameter and coronary blood flow (CBF) in response to acetylcholine (ACh) were determined using quantitative coronary angiography and Doppler velocity measurements. Coronary flow reserve was calculated as the ratio of coronary blood velocity after adenosine triphosphate infusion relative to baseline values. Patients were divided into two groups based on the presence or absence of MS. RESULTS: There were 24 patients in the MS group (31%). The increase in CBF in response to ACh infusion was impaired in the MS group (P < 0.0001) compared to the non-MS group, whereas changes in coronary artery diameter in response to ACh infusion did not differ between the two groups. Multivariate regression analysis revealed that MS was a significant factor associated with the lesser change in CBF induced by ACh infusion at 30 ?g/min (P < 0.0001, r2 = 0.46). CONCLUSION: Coronary endothelial dysfunction was present at the level of resistance vessels but not conduit vessels in the MS patients included in our study. PMID:21160752
... a specific type of seizure seen in an epilepsy syndrome of infancy and childhood known as West ... supports broad and varied programs of research on epilepsy and other seizure disorders. This research is aimed ...
Botulinum-A toxin in the treatment of craniocervical muscle spasms: Short and long-term, local and systemic effects
Jonathan J. Dutton
Botulinum toxin has become the initial treatment of choice for the management of essential blepharospasm, hemifacial spasm and other craniocervical dystonias. Numerous studies have confirmed a 90% to 95% response rate. Although a number of common side effects have been reported, the occurrence and incidence of rare local complications remains poorly understood. More importantly, the acute and chronic distant effects
The influence of etiology upon ictal semiology, treatment decisions and long-term outcomes in infantile spasms and West syndrome
Andrew L. Lux; John P. Osborne
Studying infantile spasms is challenging because there are so many aspects of variation that introduce potential bias. These might relate to the many underlying etiologies, and variations in clinical semiology and electroencephalographic features that relate more to age or timing of investigation than to the underlying epilepsy or seizures type. New gene defects associated with the CDKL5\\/STK9 and ARX genes
Copy number variants and infantile spasms: evidence for abnormalities in ventral forebrain development and pathways of synaptic function
Alex R Paciorkowski; Liu Lin Thio; Jill A Rosenfeld; Marzena Gajecka; Christina A Gurnett; Shashikant Kulkarni; Wendy K Chung; Eric D Marsh; Mattia Gentile; James D Reggin; James W Wheless; Sandhya Balasubramanian; Ravinesh Kumar; Susan L Christian; Carla Marini; Renzo Guerrini; Natalia Maltsev; Lisa G Shaffer; William B Dobyns
Infantile spasms (ISS) are an epilepsy disorder frequently associated with severe developmental outcome and have diverse genetic etiologies. We ascertained 11 subjects with ISS and novel copy number variants (CNVs) and combined these with a new cohort with deletion 1p36 and ISS, and additional published patients with ISS and other chromosomal abnormalities. Using bioinformatics tools, we analyzed the gene content
An ectopic cranial nerve identified during surgery in the posterior fossa for hemifacial spasm: a word of caution.
Tubbs, R Shane; Lau, Ryan R; Cohen-Gadol, Aaron A
Variations of cranial nerve morphology may effect surgical technique and, if not appreciated, lead to complications and iatrogenic injury. The authors report an unusual course of the hypoglossal nerve within the posterior cranial fossa observed during microvascular decompression surgery for hemifacial spasm. PMID:20726758
Midkine: A Novel and Early Biomarker of Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions
Bachorzewska-Gajewska, Hanna; Koc-Zorawska, Ewa; Malyszko, Jacek S.; Kobus, Grazyna; Dobrzycki, Slawomir
We tested the hypothesis whether midkine could represent an early biomarker of contrast-induced acute kidney injury (CIAKI) in 89 patients with normal serum creatinine undergoing PCI. Midkine, serum and urinary NGAL, and cystatin C were evaluated before and 2, 4, 8, 24, and 48 hours after PCI using commercially available kits. Serum creatinine was assessed before and 24 and 48 hours after PCI. We found a significant rise in serum midkine as early as after 2 hours (P < 0.001) when compared to the baseline values. It was also significantly higher 4 hours after PCI and then returned to the baseline values after 24 hours and started to decrease after 48 hours. When contrast nephropathy was defined as an increase in serum creatinine by >25% of the baseline level 48 hours after PCI, the prevalence of CIN was 10%. Patients with CIN received significantly more contrast agent (P < 0.05), but durations of PCI were similar. Midkine was significantly higher 2, 4, and 8 hours after PCI in patients with CIN. Since the �window of opportunity� is narrow in CIAKI and time is limited to introduce proper treatment after initiating insult, particularly when patients are discharged within 24 hours after the procedure, midkine needs to be investigated as a potential early marker for renal ischemia and/or nephrotoxicity. PMID:25629054
Arbab-Zadeh, Armin; Nakano, Masataka; Virmani, Renu; Fuster, Valentin
In the United States alone, more than 400,000 Americans die annually from coronary artery disease and more than 1,000,000 suffer acute coronary events, i.e., myocardial infarction and sudden cardiac death.1 Considering the aging of our population and increasing incidence of diabetes and obesity, the morbidity from coronary artery disease, and its associated costs, will place an increasing, substantial burden on our society.2 Between 2010 and 2030, total direct medical costs spent in the US for cardiovascular diseases are projected to triple from 273 to 818 billion dollars.2 Although effective treatments are available and considerable efforts are ongoing to identify new strategies for the prevention of coronary events, predicting such events in an individual has been challenging.3 In hopes of improving our ability to determine the risk of coronary events, it is prudent to review our knowledge of factors that lead to acute coronary events. PMID:22392862
Neurectomy for breast reconstruction-related spasms of the pectoralis major muscle.
Adkinson, Joshua M; Miller, Nathan F; Murphy, Robert X
Tissue expander-based breast reconstruction is the most commonly utilized technique in the U.S. This modality, however, may be associated with significant pain related to pectoralis myospasms. Spasms of the pectoralis major likely result from trauma to the pectoral nerves during muscle elevation. In a subset of patients, Botox(�) therapy may be inadequate for long-term relief. We describe a patient with intractable pectoralis myospasms after breast reconstruction. Upon failing Botox(�) therapy, medial and lateral pectoral neurectomies were performed. Nine months after the procedure, the patient noted dramatic improvement in both symptoms and cosmesis with no musculoskeletal sequelae. We recommend medial and lateral pectoral neurectomy as an alternative in patients with intractable pectoral myospasms after tissue expander reconstruction. PMID:23790561
Assessment of coronary thrombolysis
Geltman, E.M.; Abendschein, D.R.; Devries, S.R.
The efficacy of coronary thrombolysis may be assessed by several invasive and noninvasive means, including coronary angiography, contrast and radionuclide angiography, thallium 201 or /sup 99m/Tc-pyrophosphate scintigraphy, positron emission tomography, cardiac ultrasonography, electrocardiography, and analysis of plasma creatine kinase activity. Each technique has its own strengths and limitations, but when used in concert these methods may provide insight into the physiology of coronary reperfusion and the efficacy of reperfusion in individual patients and populations. 104 references.
Coronary Artery Bypass Grafting
Liubov Ben-Noun
Long-term psychosocial outcomes were examined in 132 patients 7 to 22 years M = 9.4 years after coronary artery bypass grafting. The control group comprised 145 medically treated patients with coronary heart disease of 7 to 22 year duration M = 9.2. Significantly more medically than surgically treated patients were scored in the clinically significant range for anxiety, and for
HMG-CoA Reductase Inhibitors Reduce Nicotine-Induced Expression of Cellular Adhesion Molecules in Cultured Human Coronary Endothelial Cells
Plinio Cirillo; Mario Pacileo; Salvatore De Rosa; Paolo Calabr�; Annarita Gargiulo; Valeria Angri; Nella Prevete; Isabella Fiorentino; Grazia Ucci; Laura Sasso; Gianluca Petrillo; Sergio Musto D�Amore; Massimo Chiariello
Background: Smoking predisposes to the development of atherosclerosis and of its complications. The mechanisms responsible for these effects are not completely understood. We have investigated whether nicotine might promote a proatherosclerotic state in human coronary endothelial cells (HCAECs), studying the role of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors in preventing these phenomena. Methods and Results: Real-time PCR showed that nicotine
Outcome predictors, efficacy and safety of Botox and Dysport in the long-term treatment of hemifacial spasm
A. R. Bentivoglio; A. Fasano; T. Ialongo; F. Soleti; S. Lo Fermo; A. Albanese
Background and purpose: To review the clinical characteristics and the long-term outcome of patients with hemifacial spasm (HFS) who received botulinum neurotoxin (BoNT) over the past 10 years. Results: A total of 108 patients received 665 treat- ments. Mean latency of clinical effect was 5.4 � 5.3 days for Botox and 4.9 � 4.6 days for Dysport (P > 0.05).
The influence of etiology upon ictal semiology, treatment decisions and long-term outcomes in infantile spasms and West syndrome.
Lux, Andrew L; Osborne, John P
Studying infantile spasms is challenging because there are so many aspects of variation that introduce potential bias. These might relate to the many underlying etiologies, and variations in clinical semiology and electroencephalographic features that relate more to age or timing of investigation than to the underlying epilepsy or seizures type. New gene defects associated with the CDKL5/STK9 and ARX genes are associated with infantile spasms, but these illustrate that, when studying neurodevelopmental outcomes, it is necessary to deal also with heterogeneity at the level of genotype-phenotype correlation. We discuss these design issues with consideration of data from the United Kingdom infantile spasms study (UKISS)--in which neurodevelopmental outcomes show evidence of an interaction between underlying etiologic classification and randomised treatment--and with consideration to proposals on study design from the recent consensus statement of the West Delphi group. In the continual debate about whether we should "lump" or "split" when studying epilepsy syndromes, we propose the adoption of study designs using valid and consistent methods that permit both lumping and splitting. PMID:16828260
Disruption of the serine/threonine kinase 9 gene causes severe X-linked infantile spasms and mental retardation.
Kalscheuer, Vera M; Tao, Jiong; Donnelly, Andrew; Hollway, Georgina; Schwinger, Eberhard; K�bart, Sabine; Menzel, Corinna; Hoeltzenbein, Maria; Tommerup, Niels; Eyre, Helen; Harbord, Michael; Haan, Eric; Sutherland, Grant R; Ropers, Hans-Hilger; G�cz, Jozef
X-linked West syndrome, also called "X-linked infantile spasms" (ISSX), is characterized by early-onset generalized seizures, hypsarrhythmia, and mental retardation. Recently, we have shown that the majority of the X-linked families with infantile spasms carry mutations in the aristaless-related homeobox gene (ARX), which maps to the Xp21.3-p22.1 interval, and that the clinical picture in these patients can vary from mild mental retardation to severe ISSX with additional neurological abnormalities. Here, we report a study of two severely affected female patients with apparently de novo balanced X;autosome translocations, both disrupting the serine-threonine kinase 9 (STK9) gene, which maps distal to ARX in the Xp22.3 region. We show that STK9 is subject to X-inactivation in normal female somatic cells and is functionally absent in the two patients, because of preferential inactivation of the normal X. Disruption of the same gene in two unrelated patients who have identical phenotypes (consisting of early-onset severe infantile spasms, profound global developmental arrest, hypsarrhythmia, and severe mental retardation) strongly suggests that lack of functional STK9 protein causes severe ISSX and that STK9 is a second X-chromosomal locus for this disorder. PMID:12736870
(1) Coronary Events Caused by Myocardial Bridge
Yoko, Kawawa; Ehiichi, Kohda; Toshiharu, Ishii
Myocardial bridge (MB), which covers a part of the left anterior descending coronary artery (LAD), is a normal anatomical variant structure (45% in frequency by autopsy) in LAD. MB contraction plays the role of a �double-edged sword� on the coronary events, suppressing coronary atherosclerosis under the MB, yet generating abnormal blood flow associated with coronary heart diseases (CHDs). High shear stress driven by MB compression causes the suppression of vascular permeability and vasoactive protein expression such as e-NOS and endothelin-1, which leads to the suppression of atherosclerosis in the LAD segment under the MB. However, despite the prevalent view of MB as benignancy by conventional coronary angiography (5-6% in frequency), with advance of imaging technique such as multislice spiral computed tomography [(MSCT); 16% in frequency], cardiologists are now frequently aware of symptomatic MB occurring not only in hospitalized patients, but also in young athletes free from atherosclerosis. Moreover, the large mass volume of MB muscle induces atherosclerosis evolution at the settled site in LAD proximal to MB and contributes to the occurrence of myocardial infarction. These events upon the coronary events result from the different pathophysiological mechanisms induced by contractile force of MB, which is solely determined just by the integration of anatomical properties of MB, such as the location, length and thickness of MB in an individual LAD. A recent MSCT provides the objective quantification of the anatomical variables that correlate with the histopathological results in relation to the occurrence of CHD. In this review, we therefore discuss the necessity to explore MB as a inherent chance anatomical risk factor for CHD. PMID:23555365
Coronary artery ectasia in Egyptian patients with coronary artery disease.
Waly, H M; Elayda, M A; Lee, V V; el-Said, G; Reul, G J; Hall, R J
We conducted a retrospective study of 45 Egyptian patients with coronary artery ectasia who underwent coronary bypass grafting at our institution between 1980 and 1995. We examined the anatomic distribution and type of coronary ectasia and its association with coronary risk factors in these patients, and evaluated the severity of their coronary artery disease. We compared these findings with those from a group of 230 Egyptian patients who did not have coronary ectasia. These patients also underwent coronary artery bypass grafting between 1980 and 1995 at our institution. Obesity was present in 60% of the patients who had coronary artery ectasia, compared with 42% of patients who did not have ectasia (P < 0.01). Coronary artery ectasia was not related to any coronary risk factors other than obesity. However, patients who had ectasia did have a higher rate of triple-vessel coronary artery disease than did patients without ectasia (82% vs 67%, P < 0.05). Of the coronary vessels affected by ectasia, 43% were left anterior descending arteries. Diffuse disease was noted in 84% of all ectatic segments. We conclude that in this patient population, 2 conditions had a positive correlation with coronary ectasia: obesity and the severity of coronary artery disease. Images PMID:9456489
Botulinum Toxin as an Alternative to Treat the Spasm of the Near Reflex.
Laria, Carlos; Merino-Su�rez, Mar�a L; Pi�ero, David P; G�mez-Hurtado, Arantxa; P�rez-Cambrod�, Rafael J
Abstract We describe the case of an eight-year-old girl with complaints of headaches and blurred vision (uncorrected visual acuity: 0.1 decimal) that showed on examination miotic pupils, pseudomyopia, no ocular motility restrictions, and no associated neurological disease. After initial treatment with cyclopentolate for two months, pseudomyopia persisted with an intermittent and variable esotropia. Spectacles of +1 both eyes and atropine 1% one drop daily were then prescribed. The situation improved and remained stable for several weeks, with pseudomyopia and esotropia reappearing later. Finally, botulinum toxin (2.5 iu Botox�) was injected in the medial rectus muscle on two occasions and a visual therapy program based on the stimulation of fusional divergence, diplopia, and stereopsis consciousness was recommended. This prescription was combined with the use of atropine during the first few weeks. Orthotropia and corrected distance visual acuity of 1.0 were found three months after treatment. The evolution and clinical results of this case report suggest that botulinum toxin in combination with other therapeutic alternatives may be useful in the treatment of spasm of the near reflex. PMID:24809739
Microvascular decompression for primary hemifacial spasm. Importance of intraoperative neurophysiological monitoring.
Sindou, M P
There is considerable evidence that primary Hemi-Facial Spasm (HFS) is in almost all cases related to a vascular compression of the facial nerve at its Root Exit Zone (REZ) from brainstem, and that Micro-Vascular Decompression (MVD) constitutes its curative treatment. Clinical as well as electrophysiological features plead for mechanisms of the disease in structural lesions at the neural fibers (putatively: focal demyelination at origin of ephapses) and functional changes in the nuclear cells (hyperactivity of the facial nucleus). Lateral Spread Responses (LSRs) elicited by stimulation of the facial nerve branches testify of these electrophysiological perturbations. Monitoring LSRs during surgery is feasible; however the practical value of their intraoperative disappearance as control-test of an effective decompression remains controversial.MVD allows cure of the disease in most cases. Because the VIIIth nerve is at risk during surgery, intraoperative monitoring of Brainstem Auditory Evoked Potentials (BEAPs) is of value to reduce occurrence of hearing loss. Increase in latency of Peak V and decrease in amplitude of Peak I are warning-signals of an excessive stretching of the the cochlear nerve and impairment of the cochlear vascular supply, respectively. PMID:16094508
Positron emission tomography with oxygen-15 of stunned myocardium caused by coronary artery vasospasm after recovery.
Agostini, D.; Iida, H.; Takahashi, A.
Stunned myocardium is often observed after unstable angina, myocardial infarction, thrombolysis, angioplasty, and bypass surgery but rarely after coronary vasospasm. A case of stunned myocardium caused by diffuse coronary artery vasospasm and mimicking myocardial infarction is reported. The patient had an emergency coronary angiography, which showed no pathological coronary disease, but the left ventricular ejection fraction showed severe left ventricular dysfunction. Repeat coronary angiography 24 days later after medical treatment (diltiazem and nitrates) showed complete recovery of wall function, and a diffuse vasospasm was induced in both coronary arteries (left anterior and right coronary arteries). Two days later the patient underwent a positron emission tomography study with water labelled with oxygen-15 to evaluate the viable myocardium and oxygen-15 to evaluate oxidative metabolism. The results showed normal myocardial blood flow and perfusable tissue density, confirming that the myocardium was viable, and normal myocardial oxidative metabolism, reflecting the recovery of the left ventricular function. Images PMID:7888266
Coronary Fistulas: A Case Series
Fennich, Nada; Elouali, Fedoua; Saghi, Ghita; Bouzammour, Nadia; Haddour, Leila; Zarzur, Jamila; Cherti, Mohamed
Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms. PMID:24501660
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Coronary artery bypass grafting
Kenji Takazawa; Yasuyuki Hosoda; Taira Yamamoto; Shiori Kawasaki; Shiro Sasaguri
Objectives: The aim of this study was to analyze the long-term results of coronary artery bypass grafting in Japanese patients who were\\u000a followed more than 10 years after surgery, and, without resorting to actuarial methods, to determine the factors that influence\\u000a long-term survival.Subjects and Methods: From January 1984 through December 1986, 376 patients received coronary artery bypass grafting at the
Coronary Artery Imaging in Children
Coronary artery problems in children usually have a significant impact on both short-term and long-term outcomes. Early and accurate diagnosis, therefore, is crucial but technically challenging due to the small size of the coronary artery, high heart rates, and limited cooperation of children. Coronary artery visibility on CT and MRI in children is considerably improved with recent technical advancements. Consequently, CT and MRI are increasingly used for evaluating various congenital and acquired coronary artery abnormalities in children, such as coronary artery anomalies, aberrant coronary artery anatomy specific to congenital heart disease, Kawasaki disease, Williams syndrome, and cardiac allograft vasculopathy. PMID:25741188
Coronary artery ectasia--a variant of occlusive coronary arteriosclerosis.
Swanton, R H; Thomas, M L; Coltart, D J; Jenkins, B S; Webb-Peploe, M M; Williams, B T
In a study of 1000 consecutive coronary arteriograms, 12 patients (all men) had coronary artery ectasia. Ectasia was found most frequently in the circumflex or right coronary artery. Only 1 patient had ectasia in the left anterior descending coronary artery. In 11 patients, ectasia of one artery was associated with severe stenosis or occlusion of other vessels, typical of arteriosclerosis. Histology from an ectatic segment in one of this group showed changes of severe arteriosclerosis with extensive intimal fibrosis and destruction of the media. One patient had a mixed collagen vascular disease. Measurement of coronary sinus flow in 2 patients with coronary artery ectasia showed flows in the range of patients with non-ectatic coronary artery disease. At cardiac surgery flows down the graft to ectatic arteries were in the same range as in grafts to non-ectatic vessels. Patients with coronary artery ectasia should be anticoagulated. Images PMID:646906
Ultrasound based assessment of coronary artery flow and coronary flow reserve using the pressure overload model in mice.
Chang, Wei-Ting; Fisch, Sudeshna; Chen, Michael; Qiu, Yiling; Cheng, Susan; Liao, Ronglih
Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow reserve (CFR) in humans. Reduced CFR is accompanied by marked intramyocardial and pericoronary fibrosis and is used as an indication of the severity of dysfunction. This study explores, step-by-step, the real-time changes measured in the coronary flow velocity, CFR and systolic to diastolic peak velocity (S/D) ratio in the setting of an aortic banding model in mice. By using a Doppler transthoracic imaging technique that yields reproducible and reliable data, the method assesses changes in flow in the septal coronary artery (SCA), for a period of over two weeks in mice, that previously either underwent aortic banding or thoracotomy. During imaging, hyperemia in all mice was induced by isoflurane, an anesthetic that increased coronary flow velocity when compared with resting flow. All images were acquired by a single imager. Two ratios, (1) CFR, the ratio between hyperemic and baseline flow velocities, and (2) systolic (S) to diastolic (D) flow were determined, using a proprietary software and by two independent observers. Importantly, the observed changes in coronary flow preceded LV dysfunction as evidenced by normal LV mass and fractional shortening (FS). The method was benchmarked against the current gold standard of coronary assessment, histopathology. The latter technique showed clear pathologic changes in the coronary artery in the form of peri-coronary fibrosis that correlated to the flow changes as assessed by echocardiography. The study underscores the value of using a non-invasive technique to monitor coronary circulation in mouse hearts. The method minimizes redundant use of research animals and demonstrates that advanced ultrasound-based indices, such as CFR and S/D ratios, can serve as viable diagnostic tools in a variety of investigational protocols including drug studies and the study of genetically modified strains. PMID:25938185
Exercise Does Not Attenuate Early Coronary Artery Disease Progression in a Pig Model
Arce-Esquivel, Arturo A.; Kreutzer, Kurt V.; Rush, James W. E.; Turk, James R.; Laughlin, M. Harold
Purpose This study was designed to examine the effects of high fat (HF) diet and subsequent exercise training (Ex) on coronary arteries of an animal model of early stage coronary artery disease (CAD). We hypothesized that HF diet would induce early stage disease and promote a pro-atherogenic coronary phenotype, while Ex would blunt disease progression and induce a healthier anti-inflammatory environment reflected by increased expression of antioxidant capacity and decreased expression of inflammatory markers in both the macro and microvasculature of the coronary circulation. Methods Immunohistochemistry in left anterior descending (LAD) and right coronary arteries (RCA), and immunoblots in LAD and left ventricular (LV) arterioles were used to characterize effects of HF diet and Ex on the progression of coronary atherosclerosis. Results Our results revealed that HF diet promoted a pro-atherogenic coronary endothelial cell phenotype as evidenced by the endothelial expression of inflammatory and oxidative stress markers. Ex did not significantly alter any of these immunohistochemical markers in conduit arteries; however, Ex did increase antioxidant protein content in LV arterioles. Conclusions We conclude that, at this early stage of CAD, Ex did not seem to modify vascular cell phenotypes of conduit coronary arteries from pro- to a more favorable anti-atherogenic status; however, Ex increased antioxidant protein content in coronary arterioles. These findings also support the idea that endothelial phenotype expression follows different patterns in the macro and microvasculature of the coronary circulation. PMID:21685817
Coronary anomalies: left main coronary artery aneurysm.
Varda, Rajsekhar; Chitimilla, Santosh Kumar; Lalani, Aslam
Coronary artery aneurysm is one of the rarest anomalies that we see in our medical practice and they are mostly associated with obstructive lesions due to atherosclerotic changes. Management of these aneurysm patients (conservative or surgical repair) usually depends on obstructive lesions and associated symptoms. We are presenting a case of left main aneurysm measuring around 14 � 28?mm with other obstructive leisons. It was treated with surgical repair in view of obstructive lesions and symptoms. PMID:24860680
Severe chest pain during stress dobutamine echocardiogram in patient with patent epicardial coronary arteries.
Hussein, Hesham; El-Menyar, Ayman; Ahmed, Emad; Gehani, Abdulrazzak
Dobutamine induced ST-segment elevation in the absence of obstructive coronary artery disease is a rare condition. We report a case of a 37-year-old man, a smoker, who developed severe chest pain associated with transient ST-segment elevation in anterolateral leads and significant segmental wall motion abnormalities during dobutamine stress echocardiography that was immediately relieved by sublingual nitrates without evidence of acute myocardial infarction. Coronary angiogram showed patent epicardial coronary arteries. PMID:20685062
Botulinum toxin injections for the treatment of hemifacial spasm over 16years.
Sorgun, Mine Hayriye; Yilmaz, Rezzak; Akin, Yusuf Alper; Mercan, Fatma Nazli; Akbostanci, Muhittin Cenk
The aim of this study was to investigate the efficacy and side effects of botulinum toxin (BTX) in the treatment of hemifacial spasm (HFS). We also focused on the divergence between different injection techniques and commercial forms. We retrospectively evaluated 470 sessions of BTX injections administered to 68 patients with HFS. The initial time of improvement, duration and degree of improvement, and frequency and duration of adverse effects were analysed. Pretarsal and preseptal injections and Botox (Allergan, Irvine, CA, USA) and Dysport (Ipsen Biopharmaceuticals, Paris, France) brands were compared in terms of efficacy and side effects, accompanied by a review of papers which reported BTX treatment of HFS. An average of 34.5 units was used per patient. The first improvement was felt after 8days and lasted for 14.8weeks. Patients experienced a 73.7% improvement. In 79.7% of injections, no adverse effect was reported, in 4.9% erythema, ecchymosis, and swelling in the injection area, in 3.6% facial asymmetry, in 3.4% ptosis, in 3.2% diplopia, and in 2.3% difficulty of eye closure was detected. Patients reported 75% improvement on average after 314 sessions of pretarsal injections and 72.7% improvement after 156 sessions of preseptal injections (p=0.001). The efficacy and side effects of Botox and Dysport were similar. BTX is an effective and safe treatment option for HFS. No difference was determined between Botox and Dysport, and pretarsal injection is better than preseptal injection regarding the reported degree of improvement. PMID:26100157
Functional Testing Underlying Coronary Revascularisation
Multivessel Coronary Artery Disease; Vessel Disease; Stable Angina; Unstable Angina or Stabilized Non-ST Elevated Myocardial Infarction; Patients With ST-elevated Myocardial Infarction; Revascularization of Culprit Coronary Artery
Integrative physiology of coronary microcirculation.
Kajiya, F; Goto, M
Coronary microvessels play a crucial role for mechanoenergetic interaction between blood flow and myocardial function, which is not uniform transmurally. Thus, highly organized vascular regulations are required for matching local blood flow with myocardial energy requirement. Recently, new technologies to investigate in vivo coronary microcirculation with new knowledge of the signaling molecules for vascular regulation have revolutionized our abilities to understand the integrative regulation of coronary microcirculation. In this review, the mechanical aspects of the interaction between coronary blood flow and myocardium, coronary arte-rial tree and its roles in myocardial blood flow regulation, hierarchical and dynamic control of coronary flow, capillary network and function, function of venous drainage system, and molecular and cellular aspects of integrative coronary blood flow regulation are discussed, focusing on their integrational roles in maintaining coronary microvascular function and cell signaling. PMID:10529484
Coronary CT Angiography: Native Vessels
Stephan Achenbach
\\u000a Visualization of the coronary arteries has been the major focus of cardiac CT in the past years. Noninvasive �coronary CT\\u000a angiography� has tremendous clinical potential for detecting or ruling out coronary artery stenoses in selected patients.\\u000a In addition, imaging of coronary atherosclerotic plaque may play a potential role in risk stratification. However, spatial\\u000a resolution and temporal resolution of CT imaging,
Alpha Adrenergic Vasoconstriction and Nitroglycerin Vasodilation of Large Coronary Arteries in the Conscious Dog
Vatner, Stephen F.; Pagani, Massimo; Manders, W. Thomas; Pasipoularides, Ares D.
The effects of methoxamine and nitroglycerin on measurements of large vessel (left circumflex) coronary dimensions were examined in eight conscious dogs using an ultrasonic dimension gauge, and total coronary resistance was calculated from measurements of arterial pressure and coronary blood flow. Methoxamine (50 ?g/kg per min), after transiently increasing left circumflex coronary dimensions, induced sustained reductions in left circumflex diameter (9�2%) and external (18�4%) and internal (27�5%) cross-sectional areas, at a time when mean arterial pressure rose by 65�5%, left ventricular dP/dt had decreased only slightly, and heart rate and mean coronary blood flow remained at control levels. Calculated large vessel and total coronary resistances rose similarly, i.e., by 108�29 and 92�14%, respectively. Methoxamine reduced coronary arterial wall stiffness from control at comparable stress levels, although at any common radius, wall stiffness was augmented substantially. Nitroglycerin (25 ?g/kg) induced an initial decrease in coronary dimensions along with the fall in arterial pressure. However, left circumflex coronary dimensions then rose, reaching a maximum 5 min later at a time when left circumflex coronary blood flow was reduced and heart rate and left ventricular dP/dt were at control levels. At this time, significantly different effects were observed on large vessel coronary resistance, which fell by 18�2%, and on total coronary resistance, which rose by 11�4%. Thus, in the conscious dog, large coronary vessels not only react passively to changes in aortic pressure but also undergo substantial active changes. Alpha adrenergic stimulation is sufficiently powerful to reduce cross-sectional area, despite the opposing elevation of distending pressure. PMID:6765959
Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial
H. G. Pratzel; R.-G. Alken; S. Ramm
The efficacy and safety of oral tolperisone hydrochloride (Mydocalm�) in the treatment of painful reflex muscle spasm was assessed in a prospective, randomized, double-blind, placebo-controlled trial. A total of 138 patients, aged between 20 and 75 years, with painful reflex muscle spasm associated with diseases of the spinal column or proximal joints were enrolled in eight rehabilitation centers. Patients were
Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease
Patrick W. Serruys; Marie-Claude Morice; A. Pieter Kappetein; Antonio Colombo; David R. Holmes; Michael J. Mack; E. Stahle; Ted E. Feldman; Marcel van den Brand; Eric J. Bass; Nic Van Dyck; K. Leadly; Keith D. Dawkins; Friedrich W. Mohr
BACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS We randomly assigned 1800 patients with three-vessel or left
Total arterial coronary revascularization�patient selection, stenoses, conduits, targets
Graft patency determines prognosis in coronary artery bypass grafting (CABG). Numerous reports over the past 20 years have documented superior patencies and prognosis when multiple arterial grafts are used, yet less than 10% of CABG have multiple arterial grafts. Several conduits have been proposed, with varying degrees of success. Saphenous vein grafts (SVG) begin to fail with intimal hypertrophy and then atheroma after 5 years, with patency rates of 50% to 60% at 10 years, and <30% at 15 years. In contrast, left internal thoracic artery (LITA) patency is >95% at 10 years and >90% at 20 years. The radial artery is extremely versatile and can reach all territories, but is muscular and vulnerable to spasm and competitive flow. Similarly, the right gastroepiploic artery is also muscular, and is best suited to the posterior descending coronary artery, especially in reoperations and is also affected by competitive flow. In addition, bilateral internal thoracic artery grafting (BITA) grafts and total arterial revascularization (TACR) can be performed with identical perioperative mortality (1%) and perioperative morbidity to LITA + SVG. Importantly, survival is superior�85% to 90% at 10 years versus 75% to 80% respectively. BITA/TACR patients also suffer fewer late cardiac events and reoperations, with superior results for older patients, those requiring urgent surgery, diabetics, patients with renal dysfunction and in reoperations. Contraindications to BITA include obesity, insulin dependent diabetics, and severe chronic obstructive airways disease. As such, arterial grafts have better patencies and clinical results. BITA/TACR is often underutilized, but can be achieved in the majority of patients. Opportunities exist to enhance BITA/TACR use in CABG to the potential benefit of our patients. PMID:23977629
[Coronary artery disease in women].
Niemel�, Matti; Kervinen, Kari; Romppanen, Hannu; Vikman, Saila
Although the rate of coronary artery disease mortality has decreased over the last decades, it is still the leading cause of death in Finland. Coronary artery disease appears in women with a delay of ten years as compared with men. For women, diabetes and smoking increase the risk of developing the disease more than for men. Women's coronary arteries are smaller in size, which previously impaired the results of invasive treatment. Treatment outcome with current techniques is equal independently of gender. In spite of this, women in an acute attack of coronary artery disease are less frequently directed to coronary angiography. PMID:19432079
Coronary vasodilator reserve. Comparison of the effects of papaverine and adenosine on coronary flow, ventricular function, and myocardial metabolism.
Christensen, C W; Rosen, L B; Gal, R A; Haseeb, M; Lassar, T A; Port, S C
To evaluate coronary flow reserve during cardiac catheterization, intracoronary adenosine and papaverine have been used in the clinical setting. Although papaverine maximizes coronary blood flow, it induces several toxic side effects that reduce its desirability as a coronary dilator. This investigation was designed to compare the subselective intracoronary administration of papaverine with that of adenosine in an animal model. In dogs (n = 34), we studied the effects of each agent on hemodynamics, regional myocardial blood flow, contractility (sonomicrometric and echocardiographic), metabolism (coronary arterial and venous lactate and tissue high-energy phosphates), and electrocardiographic (ST and QT intervals) parameters. Barbiturate and morphine anesthesia/analgesia was induced, and a left thoracotomy was performed. An arterial shunt was created from the left carotid artery to the left anterior descending coronary artery. Two separate groups were studied: group 1 (n = 16) for regional myocardial blood flow and mechanical function and group 2 (n = 18) for biochemical measurements. Adenosine (67 +/- 2 micrograms/min) or papaverine (6 +/- 1 mg/min) was infused into the coronary shunt at a rate of 0.5 + 0.1 ml/min for a maximum duration of 3.5 minutes. Regional myocardial blood flows were determined at control (predrug) and maximal coronary flow using radiolabeled microspheres. All hemodynamic, wall motion, biochemical, and electrocardiographic parameters were also measured at these times. Both drugs produced comparable increases in total and regional coronary blood flows (adenosine, 1.21 +/- 0.15 to 4.83 +/- 0.36 ml/min/g; papaverine, 1.21 +/- 0.05 to 4.89 +/- 0.28 ml/min/g) upon infusion into the left anterior descending coronary artery. Papaverine produced significant (p less than 0.05) changes in subendocardial ST segment electrocardiogram (-2.5 mm), QT prolongation (8 +/- 2%), myocardial creatine phosphate (47% decrease), and coronary sinus serum lactate (277% increase) compared with control. In addition, intracoronary papaverine induced an abnormal contractile pattern. No significant changes in any of these parameters (i.e., ST segment, QT prolongation, myocardial creatine phosphate level, or lactate level) were observed with intracoronary adenosine infusions. We conclude that intracoronary adenosine is comparable to papaverine for maximizing coronary blood flow without the deleterious properties observed with intracoronary papaverine. PMID:1984887
T vector and loop characteristics in coronary artery disease and during acute ischemia
Aigars Rubulis; Jens Jensen; Gunilla Lundahl; Jari Tapanainen; Liliane Wecke; Lennart Bergfeldt
ObjectiveThree-dimensional characterization of the ventricular repolarization by the T vector and T vector loop morphology in coronary artery disease (CAD), and their response to short-term (no flow) ischemia induced by coronary occlusion during a percutaneous intervention (PCI).
Body Fat Distribution as a Risk Factor for Coronary Artery Atherosclerosis in Female Cynomolgus Monkeys
Carol A. Shively; Thomas B. Clarkson; L Cheryl Miller; Kurt W. Weingand
Central fat deposition Is associated with Increased risk of coronary heart disease morbidity and mortality In women. Subcutaneous fat distribution was Investigated as a potential factor that might exacerbate diet-Induced coronary artery atherosclerosis (CAA) in female cynomolgus monkeys (Macaca fasclcularls) which share with North American Caucasian women a gender-related protection against CAA. In a retrospec- tive necropsy study (n =
Brugada syndrome: a case report of an unusual association with vasospastic angina and coronary myocardial bridging.
Imazio, Massimo; Ghisio, Aldo; Coda, Luisella; Tidu, Massimo; Belli, Riccardo; Trinchero, Rita; Brusca, Antonio
This report describes a case of an unusual association between vasospastic angina, coronary myocardial bridging, and Brugada syndrome. The patient complained of chest pain followed by rhythmic palpitation and syncope. Brugada syndrome ECG markers were documented with transient ST-segment elevation in lateral leads. A coronary angiogram showed a myocardial bridging in the left anterior descending artery and coronary vasospasm was reproduced after intracoronary ergonovine injection in the circumflex coronary artery. Ventricular fibrillation was induced by programmed electrical stimulation. The described association can be important because interaction between ischemia and Brugada syndrome electrophysiological substrate could modulate individual susceptibility to life-threatening ventricular tachyarrhythmias. PMID:11991381
Percutaneous coronary intervention in two patients with a solitary coronary artery from the right coronary sinus of Valsalva
AlFaleh, Hussam F.
Two patients with a common coronary artery arising from the right sinus of Valsalva, who underwent coronary angiography and percutaneous coronary intervention following an acute coronary syndrome, are presented. The anatomic description based on previously published classification schemes is described. The clinical implications of this rare coronary anomaly and interventional considerations are addressed. PMID:22048514
Upregulation of Nav1.8 in demyelinated facial nerves might be relevant to the generation of hemifacial spasm.
Xia, Lei; Dou, Ning-Ning; Zhong, Jun; Zhu, Jin; Wang, Yong-Nan; Liu, Ming-Xing; Visocchi, Massimiliano; Li, Shi-Ting
Our previous studies demonstrated that the abnormal muscle response could vanish when the ipsilateral superior cervical ganglion was removed and reappear when norepinephrine was dripped at the neurovascular conflict site. Evidentially, we believed that the mechanism of hemifacial spasm should involve emersion of ectopical action potential in the compressed facial nerve fibers. As the action potential is ignited by ion channel opening, we focused on Nav1.8 that has been found overexpressed in peripheral nerve while damaged. In this study, Moller model was adopted, 20 Sprague-Dawley rats underwent drip of norepinephrine, and the abnormal muscle response wave was monitored in 14 rats. Antibodies against unique epitopes of the ? subunit of sodium channel isoforms were used to detect the Nav1.8 neuronal isoforms, and the immunohistochemistry showed strong staining in 13 rats, which were all in the abnormal muscle response positive group (P < 0.05). Accordingly, we concluded that the substance of hemifacial spasm is an ectopic action potential that emerged on the damaged facial nerve, which might be coupled by Nav1.8. PMID:24892416
Protective and Therapeutic Effects of Chinese Medicine Formula Jiajian Yunvjian on Experimental Cardiac Remodeling after Myocardial Infarction Induced by Coronary Artery Ligation
Du, Jun; Gu, Wei-liang; Chen, Chang-xun; Wang, Ying; Lv, Jian
Introduction. This study was designed to explore the effect and mechanism of a classic Chinese medicine formula Jiajian Yunvjian (JJYNJ) on cardiac remodeling. Cardiac remodeling after myocardial infarction (MI) model was achieved by coronary artery ligation (CAL). Methodology. When dosed orally once daily, the effects of JJYNJ on hemodynamics, left ventricular weight index (LVWI), heart weight index (HWI), concentration, and gene expression of neuroendocrine factors as well as the histomorphological observation were determined. Results. After 4 weeks, mild cardiac remodeling in CAL group was characterized compared with sham group, but after 4 weeks of treatment of JJYNJ, hemodynamics improved, HWI reduced, and circulating angiotensin II (Ang II), endothelin-1 (ET-1), tumor necrosis factor-? (TNF-?), and hydroxyproline (Hyp) concentrations as well as Ang II receptor type 1 (AT1R) mRNA, transforming growth factor ?1 (TGF-?1) mRNA, and TNF-? mRNA levels in myocardium were lower than in CAL group. Decreased plasma aldosterone (ALD) concentration, cross-sectional area of cardiomyocyte, collagen volume fraction (CVF), collagen types I and III, perivascular collagen area (PVCA), and upregulated nitric oxide (NO) levels were observed at the same time. Conclusions. These findings suggest that JJYNJ may have a protective and therapeutic function on cardiac remodeling related to MI. PMID:26185521
Suppression of exercise-induced angina by magnesium sulfate in patients with variant angina
Kugiyama, K.; Yasue, H.; Okumura, K.; Goto, K.; Minoda, K.; Miyagi, H.; Matsuyama, K.; Kojima, A.; Koga, Y.; Takahashi, M.
The effects of intravenous magnesium on exercise-induced angina were examined in 15 patients with variant angina and in 13 patients with stable effort angina and were compared with those of placebo. Symptom-limited bicycle exercise and thallium-201 myocardial scintigraphy were performed after intravenous administration of 0.27 mmol/kg body weight of magnesium sulfate and after placebo on different days. In all patients, serum magnesium levels after administration of magnesium sulfate were about twofold higher than levels after placebo. Exercise-induced angina associated with transient ST segment elevation occurred in 11 patients with variant angina receiving placebo and in only 2 of these patients receiving magnesium (p less than 0.005). On the other hand, exercise-induced angina was not suppressed by magnesium in any patient with stable effort angina. In these patients there was no significant difference in exercise duration after administration of placebo versus after administration of magnesium. The size of the perfusion defect as measured by thallium-201 scintigraphy was significantly less in patients with variant angina receiving magnesium than that in those receiving placebo (p less than 0.001), whereas it was not significantly different in patients with stable effort angina receiving placebo versus magnesium. In conclusion, exercise-induced angina is suppressed by intravenous magnesium in patients with variant angina but not in patients with stable effort angina. This beneficial effect of magnesium in patients with variant angina is most likely due to improvement of regional myocardial blood flow by suppression of coronary artery spasm.
Motexafin lutetium in graft coronary artery disease
NASA Astrophysics Data System (ADS)
Woodburn, Kathryn W.; Rodriquez, Shari L.; Yamaguchi, Atsushi; Hayase, Motoya; Robbins, Robert C.; Kessel, David
Graft coronary artery disease (GCAD) is the chief complication following cardiac transplantation. Presently, there are limited treatment options. Insights into more expedient diagnosis and amelioration, if only partially, of GCAD are fervently sought. The selectivity of Antrin Injection (Lu-Tex) with subsequent photoactivation has been evaluated in several preclinical atherosclerosis models. The inhibitory effect of Lu-Tex induced photosensitization was demonstrated with human bypass coronary smooth muscle cells. The biodistribution of Lu-Tex was evaluated in a rat model of heterotopic cardiac allografts 60 days following transplantation. Lu-Tex was retained in the cardiac allograft, exhibiting a five-fold increase in retention between the allograft and native heart. These findings lead us to suggest that further studies are warranted to ascertain the merits of Lu-Tex for the diagnosis and possible attenuation of chronic graft vascular disease.
Coronary CT Angiography in the Quantitative Assessment of Coronary Plaques
Coronary computed tomography angiography (CCTA) has been recently evaluated for its ability to assess coronary plaque characteristics, including plaque composition. Identification of the relationship between plaque composition by CCTA and patient clinical presentations may provide insight into the pathophysiology of coronary artery plaque, thus assisting identification of vulnerable plaques which are associated with the development of acute coronary syndrome. CCTA-generated 3D visualizations allow evaluation of both coronary lesions and lumen changes, which are considered to enhance the diagnostic performance of CCTA. The purpose of this review is to discuss the recent developments that have occurred in the field of CCTA with regard to its diagnostic accuracy in the quantitative assessment of coronary plaques, with a focus on the characterization of plaque components and identification of vulnerable plaques. PMID:25162010
Is It Always Necessary to Apply Botulinum Toxin into the Lower Facial Muscles in Hemifacial Spasm? A Randomized, Single-Blind, Crossover Trial
Beril Donmez Colakoglu; Raif Cakmur; Fatma Uzunel
Background: Botulinum toxin (BTX) injections are accepted as safe and efficacious in the treatment of hemifacial spasm (HFS), but it is still debated whether BTX treatment of lower facial muscles should be performed or not. Objective: The study aims to evaluate the necessity of BTX administration into lower facial muscles in patients with HFS. Methods: A randomized, single-blind, crossover, clinical
Efficacy of a low-dose regimen of cyclobenzaprine hydrochloride in acute skeletal muscle spasm: Results of two placebo-controlled trials
David G. Borenstein; Scott Korn
Background: Cyclobenzaprine hydrochloride is a muscle relaxant that is effective in improving muscle spasm, reducing local pain and tenderness, and increasing range of motion in acute, painful musculoskeletal conditions. Sedation is the most common adverse event associated with its use at the usual dosage of 10 mg TID. Studies in healthy adults sugges that a lower dose may produce less
Merosin-negative congenital muscular dystrophy, occipital epilepsy with periodic spasms and focal cortical dysplasia. Report of three Italian cases in two families
Antonella Pini; Luciano Merlini; Fernando M. S. Tome�; Martine Chevallay; Giuseppe Gobbi
We report clinical, EEG and neuroimaging findings of three patients in two Italian families with merosin-negative congenital muscular dystrophy (CMD), drug-resistant occipital epilepsy, diffuse persistent cerebral white matter changes and focal cortical dysplasia. Clinical and epilepsy histories, EEG and neuroimaging findings were very similar in all patients. Seizures started in childhood and mainly consisted of periodic spasms, a particular type
Surgical Outcome and Improvement in Quality of Life after Microvascular Decompression for Hemifacial Spasms: A Case Series Assessment Using a Validated Disease-Specific Scale
Dibyendu K. Ray; Diaa Bahgat; Shirley McCartney; Kim J. Burchiel
Background: Hemifacial spasm (HFS) is a movement disorder characterized by intermittent, involuntary clonic or tonic-clonic contractions of muscles innervated by the ipsilateral facial nerve. Recent studies have documented change in quality of life after HFS management with botulinum toxin injection. However, we failed to locate any study that documented change in quality of life after surgical management with retrosigmoid microvascular
What Is Coronary Artery Bypass Grafting (CABG)?
... Medical Illustrations: Jill Rhead, MA What is Coronary Artery Bypass Grafting (CABG)? What Can Happen When Blockages ... Condition be Like After CABG? WHAT IS CORONARY ARTERY BYPASS GRAFTING (CABG)? Coronary artery bypass grafting or " ...
Mark W. Majesky
Lineage mapping studies have shown an extracardiac origin for the coronary vasculature. Mesothelial cells arising from septum\\u000a transversum mesenchyme contact the developing myocardium via a transient structure called the proepicardial organ (PEO). Proepicardial\\u000a cells first extend over the surface of the heart to form the epicardial layer. Then, a subset of epicardial cells transform\\u000a from epithelial to mesenchymal cells, migrate
Christopher J. O�Donnell; Udo Hoffmann
Because coronary artery disease (CAD) is the most frequent cause of death in industrialized nations (1) and the available tools for prediction of CAD onset are imperfect, there is a need for new methods to screen apparently\\u000a healthy individuals to identify those at increased risk. Current risk prediction of CAD is based on the patient�s age and\\u000a sex as well
Coronary fistula between the left anterior descending coronary artery and the pulmonary artery: Two case reports
Ibrahim, Mohamed F.; Sayed, Sameh; Elasfar, Abdelfatah; Sallam, Ayman; Fadl, Mazin; Al Baradai, Abdulaziz
Coronary artery fistulae are rare congenital or acquired connections between the coronary vessels and the cardiac chambers or other vascular structures. We present two consecutive cases of coronary fistulae between the proximal left anterior descending artery (LAD) and the main pulmonary artery. Both cases where admitted with history of acute coronary syndromes and had multivessel coronary disease along with coronary pulmonary fistulae. The two cases were managed by coronary artery bypass grafting (CABG) and repair of the fistulae. PMID:24174833
Methotrexate loaded SAE coated coronary stents reduce neointimal hyperplasia in a porcine coronary model
Huang, Y; Salu, K; Liu, X; Li, S; Wang, L; Verbeken, E; Bosmans, J; De Scheerder, I
Objective: To evaluate the effect of stent based methotrexate delivery on neointimal hyperplasia. Methods: Stainless steel coronary stents and biological polymer coated (SAE) stents were randomly implanted in coronary arteries of pigs with a stent to artery ratio of 1.1:1. The pigs were killed after five days (10 stents) or four weeks (20 stents). Second, stainless steel coronary stents were dip coated in a 10 mg/ml methotrexate�SAE polymer solution, resulting in a total load of 150 ?g methotrexate/stent. SAE coated stents and methotrexate loaded stents were randomly implanted in porcine coronary arteries with a stent to artery ratio of 1.2:1 and followed up to four weeks. Results: SAE coated stents and bare stents elicited a similar tissue response at five days. At four weeks, neointimal hyperplasia induced by the coated stents was less pronounced than with the bare stents (1.32 (0.66) v 1.73 (0.93) mm2, p > 0.05). In vitro drug release studies showed that 50% of the methotrexate was released in 24 hours, and all drug was released within four weeks. No impact on vascular smooth muscle cell proliferation or viability was observed in in vitro cell cultures. At four weeks the arteries with methotrexate loaded stents had decreased peristrut inflammation and neointimal hyperplasia (1.22 (0.34) v 2.25 (1.28) mm2, p < 0.01). Conclusions: SAE coating had an excellent biocompatibility with vascular tissue. Stent based delivery of methotrexate in the SAE coating effectively reduced neointimal hyperplasia in a porcine coronary stent model, potentially due to reduced peristrut inflammation. PMID:14729797
[Extra-coronary atherosclerosis in documented coronary patients].
Hodara, M; Bonithon-Kopp, C; Courbon, D; Gu�rin, F; Richard, J
The prevalence and severity of extracoronary atherosclerosis in 728 patients (572 men and 156 women; average age 59 years) referred for coronary angiography and who had a history of coronary disease for at least 2 years, were assessed by ultrasonography. This population was divided into 3 groups: Group I, 115 patients without lesions at coronary angiography: Group II, 76 patients with mild coronary stenosis ang Group III, 537 patients with at least one severe coronary artery stenosis, a group which included 294 cases of single vessel disease. The authors observed a strong correlation between the presence, severity and diffusion of the coronary artery disease and ultra sonographic signs of peripheral arterial disease: the frequency increased regularly from 45% in Group I to 88% in patients with triple vessel disease in Group III. About two thirds of patients in Group III had carotid or lower limb atherosclerosis and half of them had atherosclerosis or aneurysm of the abdominal aorta. Severe peripheral lesions were not common but all the aortic aneurysms were observed in Group III. Similarly, simultaneous disease in all three peripheral arterial territories ranged from 12% in Group I to 51% in Group III. The risk of finding peripheral arterial disease was increased in patients with coronary artery disease compared with normal subjects. For each peripheral localisation, the risk was two-fold in cases of mild coronary disease and three or four-fold in patients with triple vessel disease in whom the risk of finding at least one severe peripheral lesion was multiplied by ten. The authors conclude that the prevalence and severity of ultrasonographic peripheral atherosclerosis in documented coronary patients was closely related to the presence, severity and diffusion of the coronary lesions. PMID:9749246
Assessment of the Long-Term Reproducibility of Baseline and Dobutamine-Induced Myocardial Blood Flow in Patients with Stable Coronary Artery Disease
Rohan Jagathesan; Philipp A. Kaufmann; Stuart D. Rosen; Ornella E. Rimoldi; Federico Turkeimer; Rodney Foale; Paolo G. Camici
0.26 (24%) at rest and 0.49 (27%) and 0.58 (26%) during Dob stress. Conclusion: In patients with clinically stable CAD, Dob induces reproducible changes in both global and regional MBF and CFR over a time interval of 24 wk. The reproducibility of MBF and CFR with Dob was comparable with the short-term repeatability reported for adenosine and physical exercise in
Lipid-induced epigenomic changes in human macrophages identify a coronary artery disease-associated variant that regulates PPAP2B Expression through Altered C/EBP-beta binding.
Reschen, Michael E; Gaulton, Kyle J; Lin, Da; Soilleux, Elizabeth J; Morris, Andrew J; Smyth, Susan S; O'Callaghan, Christopher A
Genome-wide association studies (GWAS) have identified over 40 loci that affect risk of coronary artery disease (CAD) and the causal mechanisms at the majority of loci are unknown. Recent studies have suggested that many causal GWAS variants influence disease through altered transcriptional regulation in disease-relevant cell types. We explored changes in transcriptional regulation during a key pathophysiological event in CAD, the environmental lipid-induced transformation of macrophages to lipid-laden foam cells. We used a combination of open chromatin mapping with formaldehyde-assisted isolation of regulatory elements (FAIRE-seq) and enhancer and transcription factor mapping using chromatin immuno-precipitation (ChIP-seq) in primary human macrophages before and after exposure to atherogenic oxidized low-density lipoprotein (oxLDL), with resultant foam cell formation. OxLDL-induced foam cell formation was associated with changes in a subset of open chromatin and active enhancer sites that strongly correlated with expression changes of nearby genes. OxLDL-regulated enhancers were enriched for several transcription factors including C/EBP-beta, which has no previously documented role in foam cell formation. OxLDL exposure up-regulated C/EBP-beta expression and increased genomic binding events, most prominently around genes involved in inflammatory response pathways. Variants at CAD-associated loci were significantly and specifically enriched in the subset of chromatin sites altered by oxLDL exposure, including rs72664324 in an oxLDL-induced enhancer at the PPAP2B locus. OxLDL increased C/EBP beta binding to this site and C/EBP beta binding and enhancer activity were stronger with the protective A allele of rs72664324. In addition, expression of the PPAP2B protein product LPP3 was present in foam cells in human atherosclerotic plaques and oxLDL exposure up-regulated LPP3 in macrophages resulting in increased degradation of pro-inflammatory mediators. Our results demonstrate a genetic mechanism contributing to CAD risk at the PPAP2B locus and highlight the value of studying epigenetic changes in disease processes involving pathogenic environmental stimuli. PMID:25835000
The Coronary Patient in Industry
NASA Technical Reports Server (NTRS)
Schuster, B.
The coronary patient, as he pertains to industry particularly NASA, is discussed. Concepts of precoronary care, acute attacks which may develop while on the job, and the return of the cardiac patient to work are covered. Major emphasis was on the prevention of sudden death due to coronary disease.
Coronary Arteriovenous Fistulae: A Review
Challoumas, Dimitris; Pericleous, Agamemnon; Dimitrakaki, Inetzi A.; Danelatos, Christos; Dimitrakakis, Georgios
Coronary arteriovenous fistulae are a coronary anomaly, presenting in 0.002% of the general population. Their etiology can be congenital or acquired. We present a review of recent literature related to their epidemiology, etiology, pathophysiology, clinical presentation, diagnostic approach, and therapeutic management. PMID:24940026
Myocardial synthesis of prostaglandin-like substances and coronary reactions to cardiostimulation and to hypoxia.
Sunahara, F A; Talesnik, J
1 Continuous recording of cardiac contractions and coronary flow from isolated perfused hearts of rats permitted the study of coronary reactions to: (a) cardiostimulation induced by single doses or slow infusions of noradrenaline, CaCl2, glucagon or electrically induced tachycardia; (b) short interruptions of coronary inflow (hypoxia). 2 Except during tachycardia the heart rate was kept constant at 210 beats/min by electrical pacing. 3 Metabolic coronary vasodilatation (MCD) resulting from cardiac hyperactivity induced by noradrenaline, Ca2+, tachycardia or glucagon was inhibited by administration of prostaglandin E2. Reactive hyperaemia response to hypoxia was unaffected by prostaglandin administration. 4 Inhibition of MCD could also be obtained by prolonged infusion with arachidonic acid (1.6 X 10(-7) M), presumably by its conversion into prostaglandin-like substance since arachidonic acid failed to block MCD in hearts from rats pretreated with non-steroidal anti-inflammatory drugs (indomethacin, naproxen, phenylbutazone). 5 Reactive hyperaemia was unaffected either by arachidonic acid or by blockade of the synthesis of prostaglandin-like substances by anti-inflammatory drugs. 6 Since prostaglandin synthetase inhibition does not prevent but may enhance MCD, we do not advocate prostaglandin-like substances as agents directly responsible for the coronary vasodilatation that follows cardiac hyperactivity. 7 We postulate that cardiac overproduction of prostaglandins may lead to a failure in the adaptive coronary flow response to cardiac hyperactivity (coronary insufficiency?). PMID:760893
Myocardial ischaemia in a case of a solitary coronary ostium in the right aortic sinus with retroaortic course of the left coronary artery: documentation of the underlying pathophysiological mechanisms of ischaemia by intracoronary Doppler and pressure measurements
Schwarz, E; Hager, P; Uebis, R; Hanrath, P; Klues, H
Only a few cases of a single coronary ostium and retroaortic course of the coronary artery have been described. Almost all cases reported so far had additional coronary artery or valvar disease. However, myocardial ischaemia may be caused by the coronary malformation alone. A 40�year old woman with severe myocardial ischaemia in the absence of clinically relevant coronary atherosclerosis is described. To clarify the origin and mechanisms of ischaemia, intracoronary Doppler, pressure and ultrasound studies were performed using microtransducers. In its outer portion along the course behind the ascending aorta, coronary blood flow velocities were increased, there was an external elliptical compression, and distal coronary flow reserve was reduced. Furthermore, an overshoot in diastolic pressure above aortic pressure was detectable within this portion. Dobutamine stimulation exaggerated the observed intracoronary haemodynamics and induced myocardial ischaemia. The intracoronary diagnostic procedures performed were helpful in clarifying the pathophysiological mechanisms of functional coronary obstruction and ischaemia in this malformation. Bypass surgery was successfully performed with symptomatic improvement.?? Keywords: coronary anomaly;� Doppler;� intravascular ultrasound;� single coronary ostium;� congenital disorders PMID:9875097
Skeletonized coronary arteries: pathophysiological and clinical aspects of vascular calcification.
Serrano, Carlos V; Oranges, Marcelo; Brunaldi, Vitor; de M Soeiro, Alexandre; Torres, Tatiana Andreucci; Nicolau, Jos� Carlos; Ramires, Jos� Antonio F
The role of calcification in coronary artery disease is gaining importance, both in research studies and in clinical application. Calcified plaque has long been considered to be the most important atherosclerotic plaque within the arterial tree and frequently presents a challenge for percutaneous intervention. Current investigations have shown that plaque calcification has a dynamic course that is closely related to the magnitude of vascular inflammation. Numerous inflammatory factors synthesized during the early stages of atherosclerosis induce the expression and activation of osteoblast-like cells localized in the arterial wall that produce calcium. There is no doubt that the role of these factors in calcification associated with coronary artery disease could be a crucial strategic point in prevention and treatment. A number of diagnostic imaging methods have been developed in recent years, but their performance needs to be improved. In this context, we undertook an update on coronary calcification, focusing on physiopathology, clinical implications, and imaging techniques. PMID:21490939
Skeletonized coronary arteries: pathophysiological and clinical aspects of vascular calcification
Serrano, Carlos V; Oranges, Marcelo; Brunaldi, Vitor; de M Soeiro, Alexandre; Torres, Tatiana Andreucci; Nicolau, Jos� Carlos; Ramires, Jos� Antonio F
The role of calcification in coronary artery disease is gaining importance, both in research studies and in clinical application. Calcified plaque has long been considered to be the most important atherosclerotic plaque within the arterial tree and frequently presents a challenge for percutaneous intervention. Current investigations have shown that plaque calcification has a dynamic course that is closely related to the magnitude of vascular inflammation. Numerous inflammatory factors synthesized during the early stages of atherosclerosis induce the expression and activation of osteoblast-like cells localized in the arterial wall that produce calcium. There is no doubt that the role of these factors in calcification associated with coronary artery disease could be a crucial strategic point in prevention and treatment. A number of diagnostic imaging methods have been developed in recent years, but their performance needs to be improved. In this context, we undertook an update on coronary calcification, focusing on physiopathology, clinical implications, and imaging techniques. PMID:21490939
Real-time Monitoring of the Lateral Spread Response Resulting from Serial Decompression for Hemifacial Spasm Caused by a Fusiform Aneurysm.
Lee, Sung Ho; Choi, Seok Keun; Kim, Johnho
Fusiform aneurysm as a cause of hemifacial spasm (HFS) is an extremely rare condition. A 69-year-old man developed paroxysmal spasm of his left side facial muscles over a period of 5 years. Radiologic images demonstrated a left vertebral artery (VA) fusiform aneurysm compressing the root entry zone of the left facial nerve. The patient underwent serial surgical procedures for the treatment of HFS under intraoperative electromyography monitoring. Lateral spread response (LSR) did not disappear despite 5 minutes of extracranial left VA ligation and remained after cerebrospinal fluid drainage after dura opening. After interposition of the VA through Teflon felt insertion, the LSR finally disappeared. The patient became symptom free immediately after the surgery and continued as such throughout a follow-up period of 1 year. This is the first report involving real-time monitoring of the LSR changes resulting from serial procedures of decompression in an HFS caused by a fusiform aneurysm of the VA. PMID:26140340
Effects of morphine on coronary and left ventricular dynamics in conscious dogs.
Vatner, S F; Marsh, J D; Swain, J A
We studied the effects of i.v. 2 mg/kg morphine sulfate (MS) on coronary blood flow and resistance, left ventricular (LV) diameter and pressure (P), rate of change of pressure (dP/dt), and dP/dt/P in conscious dogs. An initial transient reduction in coronary vascular resistance, associated with increases in heart rate, dP/dt, dP/dt/P, and reductions in LV end-diastolic and end-systolic size were observed. This was followed by a prolonged increase in mean coronary vascular resistance, lasting from 5 to 30 min, while heart rate, arterial pressure, and LV end-diastolic diameter returned to control levels and dP/dt/P remained slightly but significantly above control. At 10 min, late diastolic coronary flow had fallen from 44 plus or minus 3 ml/min to a minimum level of 25 plus or minus 3 ml/min, while late diastolic coronary resistance had risen from 1.68 plus or minus 0.10 to 3.04 plus or minus 0.28 mm Hg/ml/min. Morphine also induced substantial coronary vasoconstriction when heart rate was held constant. Neither the MS-induced coronary vasoconstriction nor the positive inotropic response was abolished by bilateral adrenalectomy. The positive inotropic response of MS was reversed after beta blockade, but not the coronary vasoconstriction. Alpha receptor blockade abolished the late coronary vasoconstriction effects of morphine, and only dilatation occurred. In anesthetized dogs MS failed to produce late coronary vasoconstriction. Coronary after a respiratory-depressant dose of morphine, 10 mg/kg i.v. Smaller doses of MS, 0.25 mg/kg every 15 min, produced significant coronary vasoconstriction after a total dose of 0.75 mg/kg in the conscious dogs. The effects of morphine may differ in the normal dog and man and may vary depending upon the presence or absence of coronary artery disease. However, in the normal conscious dog, MS elicits a mild beta adrenergic increase in contractility and an important coronary vasoconstrictor effect, which is mediated through alpha adrenergic receptors. Images PMID:236324
Spontaneous coronary artery dissection in a young woman precipitated by retching.
Velusamy, Muthu; Fisherkeller, Mark; Keenan, Michael E; Kiernan, Francis J; Fram, Daniel B
Spontaneous coronary artery dissection as a cause of acute myocardial ischemia is a rare entity that has been associated with several different clinical profiles and precipitating events. The recognition of this entity as the cause of acute ischemia is important because the therapeutic considerations may be different than that for ischemia due to a ruptured atherosclerotic plaque. We report a case of spontaneous coronary artery dissection in a 31-year-old female that was induced by prolonged, forceful retching. To our knowledge, this is the first reported case of such an association. Prolonged retching should be added to the list of causes of spontaneous coronary artery dissection. PMID:11923575
Coronary Artery Disease Risk Factors, Coronary Artery Calcification and Coronary Bypass Surgery
Ulusoy, Fatih Rifat; Ipek, Emrah; Korkmaz, Ali Fuat; Gurler, Mehmet Yavuz; Gulbaran, Murat
Introduction Atherosclerosis is an intimal disease which affects large and medium size arteries including aorta and carotid, coronary, cerebral and radial arteries. Calcium accumulated in the coronary arterial plaques have substantial contribution to the plaque volume. The aim of our study is to investigate the relationship between coronary artery disease (CAD) risk factors and coronary arterial calcification, and to delineate the importance of CACS in coronary artery bypass surgery. Materials and Methods The current study is retrospective and 410 patients admitted to our clinic with atypical chest pain and without known CAD were included. These individuals were evaluated by 16 slice electron beam computed tomography with suspicion of CAD and their calcium scores were calculated. Detailed demographic and medical history were obtained from all of the patients. Results In our study, we employed five different analyses using different coronary arterial calcification score (CACS) thresold levels reported in previous studies. All of the analyses, performed according to the previously defined thresold levels, showed that risk factors had strong positive relationship with CACS as mentioned in previous studies. Conclusion Coronary arterial calcification is part of the athero-sclerotic process and although it can be detected in atherosclerotic vessel, it is absent in a normal vessel. It can be concluded that the clinical scores, even they are helpful, have some limitations in a significant part of the population for cardiovascular risk determination. It is important for an anastomosis region to be noncalcified in coronary bypass surgery. In a coronary artery, it will be helpness for showing of calcific field and anostomosis spot.
What Are the Signs and Symptoms of Coronary Heart Disease?
... What Are the Signs and Symptoms of Coronary Heart Disease? A common symptom of coronary heart disease ( ... narrow the coronary arteries. Signs and Symptoms of Heart Problems Related to Coronary Heart Disease Some people ...
Myocardial perfusion scintigraphy during maximal coronary artery vasodilation with adenosine
Verani, M.S.; Mahmarian, J.J. (Baylor College of Medicine, Houston, TX (USA))
Pharmacologic coronary vasodilation as an adjunct to thallium-201 myocardial perfusion scintigraphy provides an important alternative form of stress that has been increasingly used in patients unable to perform an exercise stress test. Although dipyridamole has traditionally been used for this purpose, there are several compelling reasons why adenosine may be a preferable agent. First, dipyridamole acts by blocking the reuptake and transport of adenosine, which is the effective substance responsible for coronary vasodilation. Second, exogenous adenosine has a very short half-life (less than 2 seconds), which explains its very short duration of action as well as the brief, self-limiting duration of its side effects. Third, the adenosine infusion is controllable and may be increased or decreased as desired. Fourth, the coronary vasodilation induced by the doses of adenosine we recommend (140 micrograms/kg/min) may be more profound than that induced by the standard dipyridamole dose. Our experience to date, with nearly 1,000 patients studied, shows the adenosine thallium-201 test to be practical and well tolerated, with high sensitivity (87%) and specificity (94%) for detecting coronary artery disease.
Coronary tortuosity: a long and winding road
Zegers, E.S.; Meursing, B.T.J.; Zegers, E.B.; Oude Ophuis, A.J.M.
Coronary tortuosity is a phenomenon often encountered by cardiologists performing coronary angiography. The aetiology and clinical importance of coronary tortuosity are still unclear. Coronary tortuosity without fixed atherosclerotic stenosis in patients with angina pectoris and an abnormal exercise stress test has never been described in the literature. This article describes three cases of patients with anginal complaints, an abnormal exercise stress test and coronary angiography without the presence of a fixed atherosclerotic lesion. It is hypothesised that coronary tortuosity leads to flow alteration resulting in a reduction in coronary pressure distal to the tortuous segment of the coronary artery, subsequently leading to ischaemia. Future studies will be necessary to elucidate the actual mechanism of coronary tortuosity and its clinical significance. (Neth Heart J 2007;15:191-5.17612682) PMID:17612682
Aneurysmal coronary cameral fistula.
Jamil, Gohar; Khan, Asad; Malik, Azhar; Qureshi, Anwer
A 26-year-old asymptomatic man, being medically managed for ventricular septal defect since childhood, presented to the outpatient clinic for a second opinion. Clinically, he was well built with normal vital signs. Cardiac auscultation was significant for a diastolic murmur over the praecordium. An ECG showed non-specific ST changes, and a subsequent transthoracic echocardiography performed revealed diastolic flow from the left ventricular (LV) anteroseptal wall into the LV cavity. A diagnosis of coronary-cameral fistula was confirmed by a multidetector CT which showed a 2.5�2 cm aneurysmal left anterior descending artery fistula to the LV. In addition to starting aspirin, transcatheter closure with occlusion device was considered knowing the potential risk of thrombus formation in the aneurysm and subsequent systemic embolisation. The patient however refused any percutaneous or surgical intervention. He remains asymptomatic 1 year after returning to his home country. PMID:23737570
Aneurysmal coronary cameral fistula
Jamil, Gohar; Khan, Asad; Malik, Azhar; Qureshi, Anwer
A 26-year-old asymptomatic man, being medically managed for ventricular septal defect since childhood, presented to the outpatient clinic for a second opinion. Clinically, he was well built with normal vital signs. Cardiac auscultation was significant for a diastolic murmur over the praecordium. An ECG showed non-specific ST changes, and a subsequent transthoracic echocardiography performed revealed diastolic flow from the left ventricular (LV) anteroseptal wall into the LV cavity. A diagnosis of coronary�cameral fistula was confirmed by a multidetector CT which showed a 2.5�2?cm aneurysmal left anterior descending artery fistula to the LV. In addition to starting aspirin, transcatheter closure with occlusion device was considered knowing the potential risk of thrombus formation in the aneurysm and subsequent systemic embolisation. The patient however refused any percutaneous or surgical intervention. He remains asymptomatic 1?year after returning to his home country. PMID:23737570
Coronary Angiography and Angioplasty
NSDL National Science Digital Library
Patient Education Institute
This patient education program explains the benefits and risks of coronary angiography and angioplasty. It also reviews the anatomy of the cardiovascular system, the causes and symptoms of blocked arteries, and what the procedure involves. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.
Coronary effects of endothelin-1 and vasopressin during acute hypotension in anesthetized goats
Nuria Fern�ndez; Ma Angeles Mart�nez; Angel Luis Garc�a-Villal�n; Luis Monge; Godofredo Di�guez
Coronary effects of endothelin-1 and vasopressin during acute hypotension, and the role of NO and prostanoids in these effects were examined in anesthetized goats. Left circumflex coronary artery flow was measured electromagnetically, and hypotension was induced by constriction of the caudal vena cava in animals non-treated (7 goats) or treated with the inhibitor of NO synthesis Nw-nitro-L-arginine methyl esther (L-NAME,
Membrane-associated signal transduction modulates contractile responses to Ca 2+ in saponin-skinned coronary smooth muscle
R. Fermum; D. Kosche; K.-U. M�ritz
Experiments on saponin-permeabilized bovine and porcine coronary arteries were performed to examine whether fluoride-induced contractile mechanisms are retained after permeabilization and whether they modulate muscle tension without a change in cytoplasmic Ca2+.
Postpartum multivessel spontaneous coronary artery dissection confirmed by coronary CT angiography
Schroder, Catherine; Stoler, Robert C.; Branning, George B.
Spontaneous coronary artery dissection is a rare but potentially life-threatening event associated with the peripartum period. We present a case of postpartum multivessel spontaneous coronary artery dissection diagnosed by conventional angiography and monitored with computed tomographic coronary angiography. The patient was initially managed medically and later received a coronary stent. PMID:17106495
Sodium bicarbonate, N-acetylcysteine, and saline for prevention of radiocontrast-induced nephropathy. A comparison of 3 regimens for protecting contrast-induced nephropathy in patients undergoing coronary procedures. A single-center prospective controlled trial
Emin E. Ozcan; Sema Guneri; Bahri Akdeniz; Z. Akylldlz; Omer Senaslan; Nezihi Baris; Ozgur Aslan; Ozer Badak
Background Several protective therapies have been developed to prevent contrast-induced nephropathy (CIN). We aimed to investigate the efficacy of sodium bicarbonate by comparing 2 other regimens, including combination of N- acetylcysteine (NAC) plus sodium chloride and sodium chloride alone, to prevent CIN in patients undergoing cardiovascular procedures. Methods We prospectively enrolled 264 patients who were scheduled for cardiovascular procedures and
Coronary endothelial dysfunction and mitochondrial reactive oxygen species in type 2 diabetic mice
Cho, Young-Eun; Basu, Aninda; Dai, Anzhi; Heldak, Michael
Endothelial cell (EC) dysfunction is implicated in cardiovascular diseases, including diabetes. The decrease in nitric oxide (NO) bioavailability is the hallmark of endothelial dysfunction, and it leads to attenuated vascular relaxation and atherosclerosis followed by a decrease in blood flow. In the heart, decreased coronary blood flow is responsible for insufficient oxygen supply to cardiomyocytes and, subsequently, increases the incidence of cardiac ischemia. In this study we investigate whether and how reactive oxygen species (ROS) in mitochondria contribute to coronary endothelial dysfunction in type 2 diabetic (T2D) mice. T2D was induced in mice by a high-fat diet combined with a single injection of low-dose streptozotocin. ACh-induced vascular relaxation was significantly attenuated in coronary arteries (CAs) from T2D mice compared with controls. The pharmacological approach reveals that NO-dependent, but not hyperpolarization- or prostacyclin-dependent, relaxation was decreased in CAs from T2D mice. Attenuated ACh-induced relaxation in CAs from T2D mice was restored toward control level by treatment with mitoTempol (a mitochondria-specific O2? scavenger). Coronary ECs isolated from T2D mice exhibited a significant increase in mitochondrial ROS concentration and decrease in SOD2 protein expression compared with coronary ECs isolated from control mice. Furthermore, protein ubiquitination of SOD2 was significantly increased in coronary ECs isolated from T2D mice. These results suggest that augmented SOD2 ubiquitination leads to the increase in mitochondrial ROS concentration in coronary ECs from T2D mice and attenuates coronary vascular relaxation in T2D mice. PMID:23986204
Relative effectiveness of moderate versus more aggressive lipid lowering, and of low dose anticoagulation versus placebo, in delaying saphenous vein coronary bypass graft atherosclerosis and preventing occlusion of saphenous grafts of patients with saphenous vein coronary bypass ...
Who Needs Coronary Artery Bypass Grafting?
... from the NHLBI on Twitter. Who Needs Coronary Artery Bypass Grafting? Coronary artery bypass grafting (CABG) is used to treat people ... or after a heart attack to treat blocked arteries. Your doctor may recommend CABG if other treatments, ...
The ASSURE ROT Registry: Bioresorbable Vascular Scaffold Following Rotablation for Complex Coronary Lesions
Cardiovascular Diseases; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Coronary Restenosis; Heart Diseases; Coronary Stenosis; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases
Coronary Ostial Stenosis after Aortic Valve Replacement
Ziakas, Antonios G.; Economou, Fotios I.; Charokopos, Nicholas A.; Pitsis, Antonios A.; Parharidou, Despina G.; Papadopoulos, Thomas I.; Parharidis, Georgios E.
Coronary ostial stenosis is a rare but potentially serious sequela after aortic valve replacement. It occurs in the left main or right coronary artery after 1% to 5% of aortic valve replacement procedures. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Although the typical treatment is coronary artery bypass grafting, patients have been successfully treated by means of percutaneous coronary intervention. Herein, we present the cases of 2 patients in whom coronary ostial stenosis developed after aortic valve replacement. In the 1st case, a 72-year-old man underwent aortic valve replacement and bypass grafting of the saphenous vein to the left anterior descending coronary artery. Six months later, he experienced a non-ST-segment-elevation myocardial infarction. Coronary angiography revealed a critical stenosis of the right coronary artery ostium. In the 2nd case, a 78-year-old woman underwent aortic valve replacement and grafting of the saphenous vein to an occluded right coronary artery. Four months later, she experienced unstable angina. Coronary angiography showed a critical left main coronary artery ostial stenosis and occlusion of the right coronary artery venous graft. In each patient, we performed percutaneous coronary intervention and deployed a drug-eluting stent. Both patients were asymptomatic on 6-to 12-month follow-up. We attribute the coronary ostial stenosis to the selective ostial administration of cardioplegic solution during surgery. We conclude that retrograde administration of cardioplegic solution through the coronary sinus may reduce the incidence of postoperative coronary ostial stenosis, and that stenting may be an efficient treatment option. PMID:20844624
[Single coronary artery and right aortic arch].
Mart�nez-Quintana, Efr�n; Rodr�guez-Gonz�lez, Fayna
Coronary anomalies are mostly asymptomatic and diagnosed incidentally during coronary angiography or echocardiography. However, they must be taken into account in the differential diagnosis of angina, dyspnea, syncope, acute myocardial infarction or sudden death in young patients. The case is presented of two rare anomalies, single coronary artery originating from right sinus of Valsalva and right aortic arch, in a 65 year-old patient with atherosclerotic coronary artery disease treated percutaneously. PMID:25304052
Functional consequences of mutations in CDKL5, an X-linked gene involved in infantile spasms and mental retardation.
Bertani, Ilaria; Rusconi, Laura; Bolognese, Fabrizio; Forlani, Greta; Conca, Barbara; De Monte, Lucia; Badaracco, Gianfranco; Landsberger, Nicoletta; Kilstrup-Nielsen, Charlotte
Mutations in the X-linked cyclin-dependent kinase-like 5 (CDKL5) gene have been identified in patients with Rett syndrome, West syndrome, and X-linked infantile spasms sharing the common features of generally intractable early seizures and mental retardation. Disease-causing mutations are distributed in both the catalytic domain and in the large COOH terminus. In this report, we examine the functional consequences of some Rett mutations of CDKL5 together with some synthetically designed derivatives useful to underline the functional domains of the protein. The mutated CDKL5 derivatives have been subjected to in vitro kinase assays and analyzed for phosphorylation of the TEY (Thr-Glu-Tyr) motif within the activation loop, their subcellular localization, and the capacity of CDKL5 to interact with itself. Whereas wild-type CDKL5 autophosphorylates and mediates the phosphorylation of the methyl-CpG-binding protein 2 (MeCP2) in vitro, Rett-mutated proteins show both impaired and increased catalytic activity suggesting that a tight regulation of CDKL5 is required for correct brain functions. Furthermore, we show that CDKL5 can self-associate and mediate the phosphorylation of its own TEY (Thr-Glu-Tyr) motif. Eventually, we show that the COOH terminus regulates CDKL5 properties; in particular, it negatively influences the catalytic activity and is required for its proper sub-nuclear localization. We propose a model in which CDKL5 phosphorylation is required for its entrance into the nucleus whereas a portion of the COOH-terminal domain is responsible for a stable residency in this cellular compartment probably through protein-protein interactions. PMID:16935860
[Anatomical and coronary angiography data on coronary anastomosis].
Lo, E A; Dia, A; Ba, S A; Faivre, R; Bernard, Y; Bassand, J P; Sow, M L
Beyond two series of heart studies (anatomical with 150 hearts treated by injection-corosion method, and angiographic with 211 coronarography 3 days after a heart attack) the authors have noticed 92 coronary anastomosis with: 28 right homolateral 22 left homolateral 42 contralateral The existence of these anastomosis has been confirmed by coronarography of 30 out of 173 patients having a significant lesion of the artery responsible for the heart attack. The authors noticed also that these anastomosis are effective when the coronary system is deficient and the supplies are ensured by the other artery. The study permits to distinguish two groups of functional collateral: the functional collateral spontaneously observed during coronarography recruitable collaterals which are ready to be functional in case of main coronary artery obstruction. PMID:1842772
Percutaneous treatment of coronary subclavian steal syndrome.
Mulvihill, Niall T; Loutfi, Mohamed; Salengro, Emmanuel; Boccalatte, Marco; Laborde, Jean-Claude; Fajadet, Jean; Marco, Jean
Coronary subclavian steal syndrome arises when a stenosis of the subclavian artery results in reduced antegrade or retrograde flow in an internal mammary artery with resultant coronary ischemia. This occurs in patients who have previously undergone surgical coronary revascularization utilizing an internal mammary artery graft. This syndrome can be successfully treated percutaneously with excellent immediate and long-term results. PMID:12840236
Changes in Coronary Perfusion after Occlusion of Coronary Arteries in Kawasaki Disease
Kwak, Ji Hee; Kang, I-Seok; Huh, June; Lee, Heung-Jae
Purpose Myocardial infarction in children with total occlusion of a coronary artery after Kawasaki disease is rare due to multiple collateral vessels. We aimed to investigate the changes in coronary perfusion associated with coronary artery occlusion after Kawasaki disease. Materials and Methods Eleven patients with coronary artery occlusion after Kawasaki disease were investigated. Serial coronary angiographies after total occlusion of a coronary artery were reviewed and the changes were described in all patients with additive information collected. Results The median age at the occlusion was 5.9 years old. The interval to occlusion was 6.2�6.9 years. Four left anterior descending coronary artery total occlusions and 10 right coronary artery total occlusions were detected. Immediate coronary artery bypass graft for left anterior descending coronary artery total occlusion made right coronary total occlusion occurred in all except one patient and the intervals thereof were 1 year, 1.8 years, and 4 years. Collaterals to the left coronary artery regressed after recanalization, while new collaterals to the right coronary artery developed. In three, collaterals to the right coronary artery decreased without recanalization without clinical signs. Conclusion The right coronary artery should be followed up carefully because of possible occlusion of new onset or changes in collaterals. PMID:24532503
[The correlation between flow pattern during cardiopulmonary bypass and patency of the coronary artery bypass grafts].
Hagiwara, H; Shirakawa, M; Nakayama, T; Asai, T; Nakayama, M; Ito, T; Yano, Y
Recently the availability of transit time flow measurement (TTFM) is reported especially in off-pump coronary artery bypass grafting (CABG). But little is known about TTFM findings in on-pump CABG. We examined the correlation between the TTFM flow pattern and the angiography findings in on-pump CABG. The subjects consisted of 52 patients who underwent on-pump CABG and angiography early after operation. In these patients, 55 internal thoracic artery (ITA), 17 gastroepiploic artery (GEA), 13 saphenous vein graft (SVG) and 41 radial artery (RA) were tested with TTFM during cardiopulmonary bypass (CPB). TTFM demonstrated a diastolic filling pattern in 53 ITA, 16 GEA, 13 SVG and 36 RA. The angiography revealed that all these grafts were perfectly patent with the exception of a GEA with a flow competition pattern. TTFM revealed an abnormal flow pattern in 2 ITA (these 2 grafts were revised during CPB and the angiography demonstrated their perfect patency), 1 GEA (to and fro pattern), 0 SVG and 5 RA (the abnormal pattern was due to graft spasm in 3 of 5, and the angiography revealed their perfect patency, however, the angiography detected stenosis in the remaining 2 grafts). The present study found that the TTFM flow pattern during CPB correlated well with the angiography findings. TTFM during CPB was useful to detect graft failure, and grafts were revised safely during CPB. PMID:16004331
[Nutritional epidemiology of coronary disease].
Ferri�res, J
The nutritional epidemiology of coronary disease is complex because nutrition is composed of a large number of factors which are susceptible to interfere with each other and to affect the coronary risk after a long period of exposure. The methodology of nutritional studies relies on known and validated enquiry techniques, but they are difficult to perform in the general population. The lipid nutritional hypothesis of coronary disease was centred on cholesterol and the saturated fatty acids. This lipid theory has allowed great advances in the pathophysiological and therapeutic areas. The concepts of a French paradox and global diet have allowed research in nutritional epidemiology to be refocused on other nutrients (lipids and non-lipids) and on alimentary fashions and lifestyle in general. The success of proposed diets at the population level depends strictly on correctly validated scientific data, and on the cultural and social context of where the prevention messages warrant dissemination. PMID:14655545
Open labelled evaluation of injection Manyana (a combination of diclofenac + pitofenone + fenpiverinium) in ureteric, biliary and intestinal spasm--a preliminary report.
Golhar, K B; Gupta, R L
To study the efficacy and safety of a parenteral formulation of 'Manyana' (a combination of diclofenac + pitofenone + fenpiverinium) in ureteric, biliary and intestinal colic, an open labelled study was conducted at two centres. A total of 206 patients were enrolled and evaluated for decrease in pain with time on a visual analogue scale. A statistically significant difference was observed in pain within 30 minutes of drug administration and the pain relief lasted for as long as 24 hours post dosing. The study shows definite synergism between the antispasmodics pitofenone and fenpiverinium with the NSAID-diclofenac, reducing the prostaglandin levels and also the spasm related to colic. PMID:10638099
The control of muscle spasm and arthritic pain through sympathetic block at the nasal ganglion and the use of the adenylic nucleotide
Simon L. Ruskin
Summary��1. Muscle spasm and arthritic pain can be controlled directly through influencing the sympathetic at the spheno-palatine ganglion.\\u000a \\u000a 2. Increasing the supply of the energy rich phosphate bond in the form of the Ferrous adenylate (Ironyl) is an aid in the\\u000a correction of the delta state of the myofibril.\\u000a \\u000a \\u000a \\u000a 3. The dramatic nature of the results is its greatest handicap.
[Drug-eluting coronary stents].
Fontos, G�za
The first method of percutaneously treating a diseased vessel was developed by Dotter and Judkins in 1964. Andreas Gr�ntzig performed the first coronary angioplasty in 1977. In 1985 Palmaz et al. implanted the first balloon-mounted stent in a peripheral artery. Puel and Sigwart implanted the first human coronary stent in March 1986; it was a self-expanding mesh-like device. Schatz et al. applied some small modifications to the original Palmaz stent, which resulted in the first coronary stent available on the market, called Palmaz-Schatz stent. In 1987 Sigwart was the first to suggest the use of coronary stents in acute vessel occlusions during unsuccessful PTCA. Using the device it became possible to cover the intimal flap and to prevent elastic recoil. Because of the high incidence of subacute stent thromboses and the bleeding complications (aggressive anticoagulation regimens) these times the coronary stents were implanted only in order to avoid emergency CABG surgery. In 1993 BENESTENT and STRESS trials have proved that elective stent implantation can significantly reduce the incidence of restenosis. The dual antiplatelet therapy and the high pressure stent implantation technique dramatically reduced the incidence of subacute stent thrombosis. The treatment of coronary artery disease has undergone revolutionary changes in the past decade but remained the leading cause of mortality in the developed world. The most important limitation of PCI has been in-stent restenosis, which occurs in 20-40% of stent implantations. Clinically it results in recurrent ischemic episodes most often requiring repeat revascularisation (rePCI or CABG). With the use of drug-eluting stents the incidence of in-stent restenosis can be reduced dramatically, based on the currently available clinical trials it remains below 10%. PMID:17297752
Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial).
Bolognese, Leonardo; Falsini, Giovanni; Schwenke, Carsten; Grotti, Simone; Limbruno, Ugo; Liistro, Francesco; Carrera, Arcangelo; Angioli, Paolo; Picchi, Andrea; Ducci, Kenneth; Pierli, Carlo
Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. Four hundred seventy-five consecutive, unselected patients who underwent primary percutaneous coronary intervention were randomized to iopromide (n = 239) or iodixanol (n = 236). All patients received high-dose N-acetylcysteine and hydration. The primary end point was the proportion of patients with serum creatinine (sCr) increases ?25% from baseline to 72 hours. Secondary end points were Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, increase in sCr ?50%, increase in sCr ?0.5 or ?1 mg/dl, and 1-month major adverse cardiac events. The primary end point occurred in 10% of the iopromide group and in 13% of the iodixanol group (95% confidence interval -9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion grade of 0 or 1 was present in 14% of patients in the 2 groups. No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction who underwent primary percutaneous coronary intervention, iopromide was not inferior to iodixanol in the occurrence of CI-AKI; no significant differences were found in terms of tissue-level reperfusion and major adverse cardiac events between the 2 contrast agents. PMID:21943940
Ticagrelor for acute coronary syndromes.
Bansilal, Sameer; Bonaca, Marc P; Sabatine, Marc S
Ticagrelor is a potent P2Y12 adenosine diphosphate receptor antagonist characterized by a rapid onset, consistent and reversible antiplatelet effect, and an acceptable safety profile compared with existing adenosine diphosphate receptor blockers. In the large Phase III trial, PLATO, ticagrelor significantly reduced the composite of cardiovascular death, myocardial infarction, or stroke as well as cardiovascular and all-cause mortality compared with clopidogrel in patients presenting with acute coronary syndromes. With its favorable impact on mortality, ticagrelor changes the landscape of anti-thrombotic therapy for patients with acute coronary syndromes. PMID:24147518
[Non-ST acute coronary syndromes].
Collet, J Ph; Choussat, R; Montalescot, G
Acute coronary syndromes are the first cause of death in France. Unstable angina is the most frequent acute coronary syndrome. Risk stratification to predict morbimortality and the risk of major hemorrhage is the key step of the medical approach. Combined antithrombotic therapy (aspirine + clopidogrel + LMWH) has led to a substantial reduction of major coronary events with a good tolerance because of the short duration of such aggressive strategy. This combined antithrombotic also allowed to increase the benefit of an early invasive strategy including coronary angiogram with stent percutaneous coronary intervention. PMID:12500603
Antiarrhythmic Effect of Magnolol and Honokiol during Acute Phase of Coronary Occlusion in Anesthetized Rats: Influence of L-NAME and Aspirin
Shen Kou Tsai; Cheng Hsiung Huang; Shiang Suo Huang; Li Man Hung; Chuang Ye Hong
This study was designed to evaluate the in vivo effect of magnolol and honokiol on the acute phase of coronary ligation in the presence of nitric oxide inhibitor (L-NAME) or cyclooxygenase inhibitor (aspirin). After Sprague-Dawley rats were anesthetized with urethane, the changes of ventricular arrhythmia induced by coronary ligation for 30 min were determined with or without pretreatment with study
Women and Coronary Heart Disease
Susan Mather
Cardiovascular disease (CVD), encompassing both coronary heart disease (CHD) and cerebrovascular disease, is a major health\\u000a burden worldwide in men and women. Although historically considered a �man�s disease,� this myth is quickly fading and for\\u000a good reason.
Comparison of Electron Beam Computed Tomography With Intracoronary Ultrasound and Coronary Angiography for Detection of Coronary Atherosclerosis
Dietrich Baumgart; Axel Schmermund; Guenter Goerge; Michael Haude; Junbo Ge; Michael Adamzik; Cornelia Sehnert; Klaus Altmaier; Dietrich Groenemeyer; Rainer Seibel; Raimund Erbel
Objectives. This analysis compared the results of electron beam computed tomography (EBCT) with those of coronary angiography and intracoronary ultrasound (ICUS) for the in vivo detection of coronary atherosclerotic plaques.Background. EBCT is a new imaging modality for identification of coronary calcifications. Coronary angiography depicts advanced changes in coronary morphology, whereas ICUS is an established diagnostic tool that detects the early
Acute myocardial infarction secondary to thyrotoxicosis.
Timurkaynak, Timur; Aydogdu, Gulten; Cengel, Atiye
Angina and myocardial infarction have been reported in hyperthyroidism with normal coronary arteries, presumably secondary to thyroid-induced coronary artery spasm. We report the case of a very young female patient with an atypical presentation of acute myocardial infarction mimicking pulmonary embolization secondary to thyrotoxicosis. Hyperthyroidism should be kept in mind in younger patients in the differential diagnosis of coronary artery disease. PMID:12542124
Abnormal coronary vascular response to exercise in dogs with severe right ventricular hypertrophy.
Murray, P A; Vatner, S F
Measurements of right coronary artery blood flow, aortic and right ventricular (RV) pressures and heart rate were radiotelemetered during strenuous, spontaneous exercise in normal dogs and dogs with severe RV hypertrophy induced by chronic (5-6 mo) pulmonary artery stenosis. With fixed pulmonic stenosis, dogs with RV hypertrophy exhibited a decrease (P less than 0.01) in arterial pressure during exercise. Under these conditions, exercise increased right coronary artery blood flow and decreased right coronary vascular resistance less (P less than 0.05) in dogs with RV hypertrophy compared with normal. This attenuated response of right coronary artery blood flow of dogs with RV hypertrophy was not observed when arterial pressures remained at preexercise values during exercise. However, regardless of changes in arterial pressures during exercise, all dogs with RV hypertrophy demonstrated a striking postexercise coronary hyperemia (P less than 0.01), suggesting a perfusion deficit of the hypertrophied right ventricle during exercise. These results imply a fundamental defect in the ability of the coronary circulation of the severely hypertrophied right ventricle to provide sufficient nutrient supply in the face of elevated metabolic demands of exercise. PMID:6453133
Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with angiographically proven coronary artery disease
Axel Kuettner; Andreas F. Kopp; Stephen Schroeder; Thilo Rieger; Juergen Brunn; Christoph Meisner; Martin Heuschmid; Tobias Trabold; Christof Burgstahler; Jens Martensen; Wolfgang Schoebel; Hans-Konrad Selbmann; Claus D. Claussen
ObjectivesThe aim of the present study was to evaluate the diagnostic accuracy in detecting high-grade coronary stenoses in patients with known coronary artery disease (CAD) using multidetector computed tomography (MDCT).
Coronary Artery Disease | Coronary Artery Disease | NIH MedlinePlus the Magazine
... this page please turn Javascript on. Feature: Coronary Artery Disease Coronary Artery Disease Past Issues / Fall 2010 Table of Contents ... exercise routine produced a strong heart!" Fast Facts Arteries are blood vessels that carry oxygen-rich blood ...
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Cardiovascular Disease: Coronary Artery Disease and Coronary Artery Calcification
Srinivasan Beddhu
\\u000a Coronary artery disease is common in chronic kidney disease (CKD) and dialysis patients. There is strong evidence that kidney\\u000a disease is an independent risk factor for atherosclerosis. In addition, traditional risk factors such as obesity, hypertension\\u000a and diabetes, as well as nontraditional factors such as inflammation and oxidative stress, likely contribute to the excess\\u000a risk of atherosclerosis in CKD. It
Melatonin inhibits nitric oxide signaling by increasing PDE5 phosphorylation in coronary arteries
Shukla, Praveen; Sun, Chengwen
Melatonin inhibits nitric oxide (NO)-induced relaxation of coronary arteries. We tested the hypothesis that melatonin increases the phosphorylation of phosphodiesterase 5 (PDE5), which increases the activity of the enzyme and thereby decreases intracellular cGMP accumulation in response to NO and inhibits NO-induced relaxation. Sodium nitroprusside (SNP) and 8-Br-cGMP caused concentration-dependent relaxation of isolated coronary arteries suspended in organ chambers for isometric tension recording. In the presence of melatonin, the concentration-response curve to SNP, but not 8-Br-cGMP, was shifted to the right. The effect of melatonin on SNP-induced relaxation was abolished in the presence of the PDE5 inhibitors zaprinast and sildenafil. Melatonin markedly inhibited the SNP-induced increase in intracellular cGMP in coronary arteries, an effect that was also abolished by zaprinast. Treatment of coronary arteries with melatonin caused a nearly fourfold increase in the phosphorylation of PDE5, which increased the catalytic activity of the enzyme and thereby increased the degradation of cGMP to inactive 5?-GMP. Melatonin-induced PDE5 phosphorylation was markedly attenuated in the presence of the PKG1 inhibitors DT-2 or Rp-8-Br-PET-cGMPS and in those arteries in which PKG1 expression was first downregulated by 24-h incubation with SNP before exposure to melatonin. The selective MT2 receptor antagonist 4-phenyl-2-propionamidotetralin completely blocked the stimulatory effect of melatonin on PDE5 phosphorylation as well as the inhibitory effect of melatonin on SNP-induced relaxation and intracellular cGMP. Thus, in coronary arteries, melatonin acts via MT2 receptors and PKG1 to increase PDE5 phosphorylation, resulting in decreased cGMP accumulation in response to NO and impaired NO-induced vasorelaxation. PMID:23086989
Coronary risk factors in patients underwent coronary artery bypass grafting.
Safaei, Nasser; Alikhah, Hossein; Abadan, Younes
Coronary Artery Disease (CAD) risk increases with increasing number of risk factors. This study was aimed to assess different coronary risk factors among Coronary Artery Bypass Grafting (CABG) surgery patients. A total of 700 patients younger than 45 or older than 65 years and underwent CABG in Tabriz Shahid Madani Heart Center since 2003 to 2007 were enrolled. We examined the probable differences of CAD risk factors between male and female groups and age groups. We also assessed the change of risk factors presentation in last 5 years. There was not significant difference between risk factor numbers in <45 and >65 years groups, but smoking and dyslipidemia was more prevalent in patients < 45 than > 65 years old. Hypertension and diabetes mellitus was more prevalent in patients > 65 old than < 45 years old; also differences were found between males and females patients, so that dyslipidemia, diabetes and hypertension were more prevalent in women than men. Some risk factors were recognized as acting more on one gender than the other. Also, the majority of patients have one or more risk factors, but different age and gender groups may have different risk factors that suggest the need for exact programming for appropriate prophylactic and therapeutic interventions in all groups. PMID:21913494
Tissue Factor Expression in Coronary Circulation as a Prognostic Factor for Late Restenosis after Coronary Angioplasty
Osamu Mizuno; Uichi Ikeda; Yukihiro Hojo; Hideyuki Fujikawa; Taka-aki Katsuki; Kazuyuki Shimada
We investigated changes in blood coagulation in the coronary circulation after percutaneous transluminal coronary angioplasty (PTCA) and its clinical significance. We examined 43 patients with ischemic heart disease who underwent elective PTCA of isolated stenotic lesions in the left coronary artery. Ten patients underwent PTCA alone, 15 received percutaneous transluminal rotational atherectomy (PTRA) and 18 stent implantation. Blood samples were
Staged carotid and coronary surgery for concomitant carotid and coronary artery disease
Pedro E. Antunes; Gabriel Anacleto; J. M. Ferr�o de Oliveira; Lu??s Eug�nio; Manuel J. Antunes
Objective: To demonstrate that staged, consecutive, carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are safe, perhaps preferable, alternative for the treatment of patients with severe carotid and coronary artery disease. Methods: During an 8-year period ending December 1999, 77 (2.1%) of 3633 consecutive patients who were referred for isolated coronary surgery were found to have significant carotid disease
Staged carotid and coronary surgery for concomitant carotid and coronary artery disease
Pedro E. Antunes; Gabriel Anacleto; J. M. Ferrao; Manuel J. Antunes
Objective: To demonstrate that staged, consecutive, carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) are safe, perhaps preferable, alternative for the treatment of patients with severe carotid and coronary artery disease. Methods: During an 8-year period ending December 1999, 77 (2.1%) of 3633 consecutive patients who were referred for isolated coronary surgery were found to have significant carotid disease
Clinical Features and Coronary Backgrounds of Coexistent Peripheral Vascular Disease in Japanese Coronary Artery Disease Patients
Yoshihiko Seino; Takayuki Takita; Keiji Tanaka; Teruo Takano; Hirokazu Hayakawa; Hidemasa Okumura
By use of noninvasive tests (Doppler segmental pressure study, supraorbital Doppler flow analysis, and segmental plethysmography), coexistent carotid (CTD) or lower extremity peripheral vascular disease (PVD) were diagnosed and cor related with subjective symptoms, coronary risk factors (CRFs), coronary ar teriograms (CAGs), cardiac hemodynamics. and infarct size in 121 consecutive patients with documented coronary artery disease (CAD). PVD was found
Robotically enhanced totally endoscopic right internal thoracic coronary artery bypass to the right coronary artery.
Aybek, T; Dogan, S; Andressen, E; Mierdl, S; Westphal, K; Moritz, A; Wimmer-Greinecker, G
Computer-enhanced telemanipulation systems allow totally endoscopic coronary artery bypass grafting. This report demonstrates the feasibility of a coronary artery anastomosis between the right internal thoracic artery and the right coronary artery using the daVinci surgical system (Intuitive Surgical, Inc, Mountain View, CA). PMID:11178295
Behavior patterns and coronary heart disease
NASA Technical Reports Server (NTRS)
Townsend, J. C.; Cronin, J. P.
The relationships between two behavioral patterns, cardiac risk factors, and coronary heart disease are investigated. Risk factors used in the analysis were family history of coronary disease, smoking, cholesterol, obesity, systotic blood pressure, diastolic blood pressure, blood sugar, uric acid, erythrocyte sedimentation rate, and white blood unit. It was found that conventional, non-behavioral pattern risk factors alone were not significantly related to coronary heart disease.
Concomitant subclavian and coronary artery disease
Thomas J Takach; George J Reul; Igor Gregoric; Zvonimer Krajcer; J. Michael Duncan; James J Livesay; Denton A Cooley
Background. Proximal subclavian artery occlusive disease in the presence of a patent internal mammary artery used as a conduit for a coronary artery bypass graft procedure may cause reversal of internal mammary artery flow (coronary-subclavian steal) and produce myocardial ischemia.Methods. We reviewed outcome to determine whether subclavian artery revascularization can provide effective protection from and treatment for coronary-subclavian steal. Between
Functional and molecular characterization of receptor subtypes mediating coronary microvascular dilation to adenosine.
Hein, T W; Wang, W; Zoghi, B; Muthuchamy, M; Kuo, L
Adenosine is a potent vasodilator of the coronary microvessels and is implicated in the regulation of coronary blood flow during metabolic stress. However, the receptor subtypes and the vasodilatory mechanism responsible for the dilation of coronary microvessels to adenosine remain unclear. In the present study, using an isolated-vessel preparation we demonstrated that porcine coronary arterioles (50-100 microm) dilated concentration-dependently to adenosine, CPA (adenosine A1 receptor agonist) and CGS21680 (adenosine A2A receptor agonist). These vasodilations were not altered by the A1 receptor antagonist CPX, but were abolished by the selective A2A receptor antagonist ZM241385, indicating that activation of A2A receptors mediates these vasodilatory responses. The protein kinase A inhibitor Rp-8-Br-cAMPS abolished coronary arteriolar dilations to adenylyl cyclase activator forskolin and cAMP analog 8-Br-cAMP, but failed to inhibit adenosine- and CGS21680-induced dilations. The calcium-activated potassium channel inhibitor iberiotoxin also did not affect vasodilations to adenosine and CGS21680. In contrast, the ATP-sensitive potassium (K(ATP)) channel inhibitor glibenclamide abolished vasodilations to adenosine and CGS21680 but did not affect vasodilations to forskolin and 8-Br-cAMP. In addition, the cAMP level in coronary microvessels was not increased by adenosine or CGS21680. The results from RT/PCR and in situ hybridization indicated that adenosine A2A receptor mRNA was encoded in coronary arterioles and the left anterior descending (LAD) artery but not in cardiomyocytes, whereas the A1 receptor transcript was detected in the LAD artery and cardiomyocytes but not in arterioles. Similarly, adenosine A1 and A2A proteins were expressed in the LAD artery, but only A2A receptors were expressed in coronary arterioles. Collectively, these functional data suggest that coronary arteriolar dilation to adenosine is primarily mediated by the opening of K(ATP) channels through activation of A2A receptors. This conclusion is corroborated by the molecular data showing that coronary arterioles only express adenosine A2A receptors. Furthermore, the dilation of coronary microvessels to adenosine A2A receptor activation appears to be independent of cAMP signaling. PMID:11162132
[Sports and coronary heart disease].
Brugger, P; Berghold, F; Kullich, W
The effectivity of an endurance physical training must not be ignored any longer as it is known that physical activity as well in the job as in the leisure time diminishes the risk of coronary artery disease and their consequences. The training should be put through according to the vigorous exercise training with 70 to 80% of the maximal work load in a dynamic work continuously for at least 10 minutes. The optimum duration appears to be about 30 to 40 minutes a day, repeated 3 to 4 times weekly. The best sports for coronary patients are jogging, cycling or bicycle ergometry, country cross skiing, walking in the mountains as well as at diminished performance capacity, gymnastic, walking, golf and with some restrictions swimming. PMID:3062914
Coronary air embolism treated with aspiration catheter
Patterson, M S; Kiemeneij, F
Coronary air embolism remains a recognised complication of coronary catheterisation despite a strong emphasis on prevention. Current treatment consists of supportive measures with 100% oxygen and analgesia. Recent case reports describe the use of mechanical treatments aimed at dispersing or removing the air embolus with variable success. A case of coronary air embolism causing an acute coronary syndrome is described that was definitively treated with an aspiration system. The effectiveness of the aspiration system in the distal section of an obtuse marginal artery indicates that such dedicated aspiration systems may prove useful in the standard treatment of air embolism. PMID:15831621
Relationship between myocardial bridging and coronary arteriosclerosis.
Sun, Jian Ling; Huang, Wei Min; Guo, Ji Hong; Li, Xiao Ying; Ma, Xian Lin; Wang, Chong Yu
The objective of the study was to explore the prevalence and characteristics of myocardial bridging in patients who underwent coronary angiography and to also evaluate the correlation between bridged coronary segments and atherosclerosis. For this purpose, clinical materials of 1,500 patients who had received coronary angiography were retrospectively analyzed. The location and length of the myocardial bridge were recorded as well as the extent and location of coronary artery stenosis was described. Segments proximal and distal to the bridging were evaluated for coronary arteriosclerosis as were the remaining coronary segments. We found that myocardial bridging was present in 179 (11.9 %) patients. Bridges were frequently (84.9 %) localized in the mid-distal segment of the left anterior descending (LAD) artery. Myocardial bridging was not considered a significant risk factor for coronary atherosclerosis (odds ratio 0.58) compared with traditional cardiovascular risk factors. The incidence of coronary arteriosclerosis in the distal segments was significantly less affected than the proximal segments (P < 0.01). It was, therefore, concluded that myocardial bridging frequently localized in the mid-distal segment of the LAD artery. The presence of myocardial bridging promotes proximal atherosclerosis but it is not an additional risk factor for coronary atherosclerosis. PMID:23076634
Coronary Microvascular Dysfunction in the Setting of Chronic Ischemia is Independent of Arginase Activity
Sodha, Neel R.; Boodhwani, Munir; Clements, Richard T.; Feng, Jun; Xu, Shu Hua; Sellke, Frank W.
Background Chronic myocardial ischemia induces endothelial dysfunction in the coronary microcirculation resulting in impaired nitric oxide signaling. This dysfunction has wide ranging effects including impaired tissue perfusion and is implicated in impairment of the angiogenic process in settings of endothelial dysfunction. We hypothesized chronic myocardial ischemia results in increased activity of Arginase I, diminishing bioavailability of L-arginine, the substrate for endothelial nitric oxide production. Methods Chronic myocardial ischemia was induced for 7-weeks in 6 Yucatan miniswine utilizing an ameroid constrictor placed around the left circumflex coronary artery. Ischemic and non-ischemic tissue was harvested at the 7-week timepoint. Expression of Arginase I, eNOS, and phospho-eNOS was assessed utilizing western blotting. Arginase activity was measured. Immunofluorescent staining assessed expression of Arginase I between ischemic and non-ischemic microvessels. Coronary microvascular relaxation studies were performed. Results Arginase I expression, activity, and staining was similar between ischemic and non-ischemic territories. Significant impairments in coronary microvascular relaxation were observed in microvessels from the ischemic territory in response to endothelial dependent agents, but remained similar between territories in response to endothelial independent agents. Regression analysis between arginase activity and degree of microvascular vasorelaxation demonstrated no significant correlation. Conclusions Coronary microvascular dysfunction in the setting of chronic myocardial ischemia occurs independently of Arginase I activity and expression. Alternative therapeutic strategies focusing away from arginine may be need for the treatment of this dysfunction. PMID:17707069
Screening for Coronary Artery Calcium
Nikolaos Alexopoulos; Dalton S. McLean; Stamatios Lerakis; Paolo Raggi
\\u000a The striking improvement in cardiovascular therapies during the last several decades has caused a marked decrease in mortality\\u000a linked to atherosclerotic diseases in Western societies. Nonetheless, coronary artery disease (CAD) remains the main cause\\u000a of non-fatal events, and it is associated with substantial functional impairment in survivors of acute events, imposing a\\u000a very large economic burden on societies. The use
Black�White Differences in Severity of Coronary Artery Disease Among Individuals with Acute Coronary Syndromes
Whittle, Jeff; Conigliaro, Joseph; Good, C Bernie; Hanusa, Barbara H; Macpherson, David S
OBJECTIVE To determine whether the extent of coronary obstructive disease is similar among black and white patients with acute coronary syndromes. DESIGN Retrospective chart review. PATIENTS We used administrative discharge data to identify white and black male patients, 30 years of age or older, who were discharged between October 1, 1989 and September 30, 1995 from 1 of 6 Department of Veterans Affairs (VA) hospitals with a primary diagnosis of acute myocardial infarction (AMI) or unstable angina (UnA) and who underwent coronary angiography during the admission. We excluded patients if they did not meet standard clinical criteria for AMI or UnA or if they had had prior percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. MEASUREMENTS AND MAIN RESULTS Physician reviewers classified the degree of coronary obstruction from blinded coronary angiography reports. Obstruction was considered significant if there was at least 50% obstruction of the left main coronary artery, or if there was 70% obstruction in 1 of the 3 major epicardial vessels or their main branches. Of the 628 eligible patients, 300 (48%) had AMI. Among patients with AMI, blacks were more likely than whites to have no significant coronary obstructions (28/145, or 19%, vs 10/155 or 7%, P = .001). Similarly, among patients with UnA, 33% (56/168) of blacks but just 17% (27/160) of whites had no significant stenoses (P = .012). There were no racial differences in severity of coronary disease among veterans with at least 1 significant obstruction. Racial differences in coronary obstructions remained after correcting for coronary disease risk factors and characteristics of the AMI. CONCLUSIONS Black veterans who present with acute coronary insufficiency are less likely than whites to have significant coronary obstruction. Current understanding of coronary disease does not provide an explanation for these differences.
Cultured Porcine Coronary Artery Smooth Muscle Cells A New Model With Advanced Differentiation
Thomas Christen; Marie-Luce Bochaton-Piallat; Pascal Neuville; Sander Rensen; Mireille Redard; Guillaume van Eys; Giulio Gabbiani
Arterial intimal thickening after endothelial injury induced in rodents has proven to be a relatively unreliable model of restenosis for testing clinically useful compounds. The same has been found for cultured rat or rabbit vascular smooth muscle cells (SMCs). To test alternative possibilities, we have studied several differentiation features of porcine coronary artery SMCs, cultured up to the 5th passage
Negative pressure pulmonary oedema induced by direct suctioning of endotracheal tube adapter
Wei-Wu Paaag; Da-Peng Chang; Ching-Hsiung Lin; Min-Ho Huang
Purpose��Negative pressure pulmonary oedema (NPPE) is a well-recognized but rare complication secondary to upper airway obstruction\\u000a such as laryngeal spasm during emergence from general anaesthesia. Cauterization of the second and third thoracic sympathetic\\u000a ganglia is a treatment for hyperhidrosis of the hands. We report a case of NPPE induced by direct suctioning of the endotracheal\\u000a tube adapter during thoracic sympathetic
ABSORB: Postmarketing Surveillance Registry to Monitor the Everolimus-eluting Bioresorbable Vascular Scaffold in Patients With Coronary Artery Disease
Cardiovascular Diseases; Coronary Artery Disease; Myocardial Ischemia; Coronary Disease; Coronary Restenosis; Heart Diseases; Coronary Stenosis; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases
Infantile Spasms Is Associated with Deletion of the MAGI2 Gene on Chromosome 7q11.23-q21.11
Marshall, Christian R.; Young, Edwin J.; Pani, Ariel M.; Freckmann, Mary-Louise; Lacassie, Yves; Howald, C�dric; Fitzgerald, Kristi K.; Peippo, Maarit; Morris, Colleen A.; Shane, Kate; Priolo, Manuela; Morimoto, Masafumi; Kondo, Ikuko; Manguoglu, Esra; Berker-Karauzum, Sibel; Edery, Patrick; Hobart, Holly H.; Mervis, Carolyn B.; Zuffardi, Orsetta; Reymond, Alexandre; Kaplan, Paige; Tassabehji, May; Gregg, Ronald G.; Scherer, Stephen W.; Osborne, Lucy R.
Infantile spasms (IS) is the most severe and common form of epilepsy occurring in the first year of life. At least half of IS cases are idiopathic in origin, with others presumed to arise because of brain insult or malformation. Here, we identify a locus for IS by high-resolution mapping of 7q11.23-q21.1 interstitial deletions in patients. The breakpoints delineate a 500 kb interval within the MAGI2 gene (1.4 Mb in size) that is hemizygously disrupted in 15 of 16 participants with IS or childhood epilepsy, but remains intact in 11�of 12 participants with no seizure history. MAGI2 encodes the synaptic scaffolding protein membrane-associated guanylate kinase inverted-2 that interacts with Stargazin, a protein also associated with epilepsy in the stargazer mouse. PMID:18565486
A new mutation in MT-ND1 m.3928G>C p.V208L causes Leigh disease with infantile spasms.
Wray, Carter D; Friederich, Marisa W; du Sart, Desiree; Pantaleo, Sarah; Smet, Jo�l; Kucera, Cathlin; Fenton, Laura; Scharer, Gunter; Van Coster, Rudy; Van Hove, Johan L K
New mutations in mitochondrial DNA encoded genes of complex I are rarely reported. An infant developed Leigh disease with infantile spasms. Complex I enzyme activity was deficient and response to increasing coenzyme Q concentrations was reduced. Complex I assembly was intact. A new mutation in MT-ND1 m.3928G>C p.V208L, affecting a conserved amino acid in a critical domain, part of the coenzyme Q binding pocket, was present at high heteroplasmy. The unaffected mother did not carry measurable mutant mitochondrial DNA, but concern remained for gonadal mosaicism. Prenatal testing was possible for a subsequent sibling. The ND1 p.V208L mutation causes Leigh disease. PMID:24063851
Continuous intraoperative monitoring of abnormal muscle response in microvascular decompression for hemifacial spasm; a real-time navigator for complete relief.
Hirono, Seiichiro; Yamakami, Iwao; Sato, Motoki; Kado, Ken; Fukuda, Kazumasa; Nakamura, Takao; Higuchi, Yoshinori; Saeki, Naokatsu
Intermittent monitoring of abnormal muscle response (iAMR) has been reported to be useful for improving the surgical outcome of microvascular decompression (MVD) for hemifacial spasm (HFS). However, iAMR has not elucidated the relationship between AMR change and the corresponding surgical procedure, or the pathogenesis of AMR and HFS. The purpose of this study is to clarify the usefulness of continuous AMR monitoring (cAMR) for improving the surgical results of MVD and for understanding the relationship between AMR change and corresponding surgical procedure, and the pathogenesis of AMR and HFS. Fifty consecutive patients with HFS treated by MVD under cAMR monitoring, which continuously records AMR every minute throughout the surgical period, were retrospectively analyzed. The patients were assessed for the presence of HFS 1 week after the surgery and at final follow-up. Forty-six patients showed the complete disappearance of HFS. In 32, AMR disappeared abruptly and simultaneously with decompression of an offending vessel. AMR showed dynamic and various changes including temporary disappearance, or sudden, gradual, or componential disappearance before and during the decompression procedure, and even during the dural and skin closure after the initial decompression procedure. Facial spasm remained in four patients despite permanent AMR disappearance. cAMR monitoring improves the outcome of MVD. Although the main cause of HFS and AMR is vascular compression at the facial nerve, hyperexcitability of the facial nucleus is also involved in the pathogenesis of HFS and AMR. The proportional involvement of these causes differs between patients. PMID:24272304
Coronary CT angiography: Beyond morphological stenosis analysis.
Sun, Zhonghua
Rapid technological developments in computed tomography (CT) imaging technique have made coronary CT angiography an attractive imaging tool in the detection of coronary artery disease. Despite visualization of excellent anatomical details of the coronary lumen changes, coronary CT angiography does not provide hemodynamic changes caused by presence of plaques. Computational fluid dynamics (CFD) is a widely used method in the mechanical engineering field to solve complex problems through analysing fluid flow, heat transfer and associated phenomena by using computer simulations. In recent years, CFD is increasingly used in biomedical research due to high performance hardware and software. CFD techniques have been used to study cardiovascular hemodynamics through simulation tools to assist in predicting the behaviour of circulatory blood flow inside the human body. Blood flow plays a key role in the localization and progression of coronary artery disease. CFD simulation based on 3D luminal reconstructions can be used to analyse the local flow fields and flow profiling due to changes of vascular geometry, thus, identifying risk factors for development of coronary artery disease. The purpose of this article is to provide an overview of the coronary CT-derived CFD applications in coronary artery disease. PMID:24392188
Aneurysm of main left coronary artery.
Kessler, M; Hamby, R I; Hilsenrath, J
A 57-year-old man presented with exertional chest pain, and was found to have a saccular, lobulated aneurysm of the left main coronary artery associated with severe atherosclerotic vascular disease. This is the third similar case reported and the first case of atherosclerotic origin. All symptoms were relieved by coronary artery bypass surgery. Images PMID:7426179
Postpartum Coronary Vasospasm with Literature Review
Koneru, Jayanth; Alattar, Fadi; Alqaqa, Ashraf; Virk, Hirtaj; Shamoon, Fayez; Bikkina, Mahesh
Acute myocardial infarction during pregnancy or the postpartum period is rare. We report a case of a 39-year-old postpartum woman who developed non-ST-elevation myocardial infarction due to severe diffuse coronary vasospasm. To our knowledge, this is the first case of angiographically evidenced coronary vasospasm, in a postpartum woman, with resistance to intracoronary nitroglycerin. PMID:25105029
Situs Inversus Totalis and Single Coronary Ostium
Alexander Turchin; Stephen S Radentz; Allen Burke
Situs inversus totalis and single coronary ostium are rare congenital anomalies, and no ontogenic connection has been described between them. Only three cases of association of single coronary ostium and situs inversus have been reported in the literature, all found on angiography. Here we present the first case of this association discovered at autopsy. Based on the apparently higher than
Predicting the risk of coronary heart disease
T. H. S. Dent
This is the first of two articles reviewing recent findings about the risk of coronary heart disease. This paper is concerned with conventional risk factors; the second will review novel molecular biomarkers, genetic markers of risk and the future of risk prediction.Predicting exactly the future occurrence of coronary heart disease (CHD) is not possible, but the risk can be estimated
Coronary Heart Disease in Women: Update 2008
N K Wenger; L J Shaw; V Vaccarino
Coronary heart disease (CHD) remains the leading cause of mortality for US women, responsible for almost 250,000 deaths annually. Preventive heart-health behavioral changes by women and aggressive coronary risk reduction can decrease the number of women disabled and killed by CHD. Angina is the predominant initial and subsequent presentation of CHD in women; categorization of chest pain and risk stratification
Echocardiography and coronary CT angiography imaging of variations in coronary anatomy and coronary abnormalities in athletic children: detection of coronary abnormalities that create a risk for sudden death.
Attili, Anil; Hensley, Allison K; Jones, Fredrick D; Grabham, Jason; DiSessa, Thomas G
In a recent publication, Maron et�al. reported the causes of sudden death in athletes from data collected in the US National Registry of Sudden Death in Athletes at the Minneapolis Heart Institute Registry. It is not surprising that in this study, cardiovascular disease is reported as the most common cause of sudden death in athletes (56%). The most frequently encountered cardiac pathology was hypertrophic cardiomyopathy (36% of the population who died of cardiac disease). Coronary artery anomalies of wrong sinus origin were next in frequency (17%). Less common causes attributed to coronary pathology were Kawasaki disease, origin of the left coronary artery from the pulmonary artery, atherosclerotic coronary artery disease, and myocardial bridging of the left anterior descending artery. Echocardiographic imaging along with color and pulsed-wave Doppler has been widely employed to visualize the anatomy and function of the heart and proves to be a valuable instrument in the identification of coronary artery abnormalities. Moreover, coronary CT angiography provides additional confirmatory information. This article will discuss the scope, importance, and implications of echocardiographic and coronary CT angiography imaging of the major coronary anomalies and abnormalities in young athletes who are at risk of sudden death and who otherwise have a structurally normal heart. PMID:23167634
Coronary CT angiography: Beyond morphological stenosis analysis
Sun, Zhonghua
Rapid technological developments in computed tomography (CT) imaging technique have made coronary CT angiography an attractive imaging tool in the detection of coronary artery disease. Despite visualization of excellent anatomical details of the coronary lumen changes, coronary CT angiography does not provide hemodynamic changes caused by presence of plaques. Computational fluid dynamics (CFD) is a widely used method in the mechanical engineering field to solve complex problems through analysing fluid flow, heat transfer and associated phenomena by using computer simulations. In recent years, CFD is increasingly used in biomedical research due to high performance hardware and software. CFD techniques have been used to study cardiovascular hemodynamics through simulation tools to assist in predicting the behaviour of circulatory blood flow inside the human body. Blood flow plays a key role in the localization and progression of coronary artery disease. CFD simulation based on 3D luminal reconstructions can be used to analyse the local flow fields and flow profiling due to changes of vascular geometry, thus, identifying risk factors for development of coronary artery disease. The purpose of this article is to provide an overview of the coronary CT-derived CFD applications in coronary artery disease. PMID:24392188
Inflammation, Atherosclerosis, and Coronary Artery Disease
G�ran K. Hansson
ecent research has shown that inflammation plays a key role in coronary artery disease (CAD) and other manifestations of atherosclerosis. Immune cells dominate early atherosclerotic lesions, their effector molecules accelerate progression of the lesions, and activation of inflammation can elicit acute coronary syndromes. This review highlights the role of inflammation in the pathogen- esis of atherosclerotic CAD. It will recount
Experiments On Flow In A Coronary Artery
NASA Technical Reports Server (NTRS)
Back, Lloyd H.; Kwack, Eug-Yon; Liem, Timothy K.; Crawford, Donald W.
Report describes experiments on simulated flow of blood in atherosclerotic human coronary artery. Experiments performed on polyurethane cast made from S-shaped coronary artery of cadaver. Sucrose solution with viscosity of blood pumped through cast at physiologically realistic rates, and flow made pulsatile by mechanism alternately compressing and releasing elastic tube just upstream of cast.
Concomitant Cerebral and Coronary Subclavian Steal
Thomas J Takach; Martin L Beggs; Verlyn J Nykamp; George J Reul
We report the unusual presentation of simultaneous coronary and cerebrovascular insufficiency secondary to subclavian steal in a patient previously treated with coronary artery bypass grafting. Movement of the arm produced reversal of flow (�steal�) in both the left vertebral and left internal thoracic arteries and resulted in the onset of angina and neurologic symptoms.
Long lasting spasticity in controlled vasospastic angina
Ueda, O; Kohchi, K; Kishi, Y; Numano, F
OBJECTIVE�To evaluate changes in coronary artery spasticity in patients with vasospastic angina who had been stable for years under continuous drug treatment.?METHODS�Follow up coronary angiography was performed under intracoronary ergonovine provocation in 27�well controlled patients with vasospastic angina and no organic stenosis; the tests were done >�24 months after the initial coronary angiography, in which occlusive spasm had been induced by the same regimen of ergonovine provocation.?RESULTS�The mean (SD) follow up period was 47.2�(21.6) months. All patients had been free from angina attack for more than 24�months under treatment with antianginal drugs. During this follow up period, organic stenosis developed in only one case. Occlusive spasm was observed during follow up coronary angiography in 23�patients. Spasm with 90% narrowing was observed in three other patients, and diffuse significant narrowing was seen in the final patient. No significant difference was found in spasticity (p =�0.75) between the initial and the follow up tests.?CONCLUSIONS�Repeated ergonovine provocation during coronary angiography after a controlled period of several years showed that coronary spasm remains inducible in most patients. Discontinuance of drug treatment during the remission from anginal attacks achieved by medication may put the patient at high risk.???Keywords: vasospastic angina; ergonovine; angiography PMID:10212173
New Technologies in Coronary Artery Surgery
Taggart, David; Nir, Rony-Reuven; Bolotin, Gil
Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG) remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1) stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2) discussing the advantages and disadvantages of off-pump coronary artery bypass; 3) presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4) debating a novel external stenting technique for saphenous vein grafts. PMID:23908868
Measurement of vessel diameter of coronary arterial
NASA Astrophysics Data System (ADS)
Lu, Jianrong; Chen, Dongqing; Lu, Yangsheng; Cao, Maoyong
The heart is the most important organ to our life. The coronary artery is the only path through which blood is provided to the heart. In the vessels of the heart especially the coronary artery, fluency of blood is mainly determined by vascular diameter and blood pressure. If blood is obstructed thus flows not freely due to vascular straitness, coronary heart disease would have a high occurrence among the aged people. Therefore, measurement of vessel diameter of coronary artery and the vascular parameters are of great importance of reflecting the function of the heart and disease diagnosis. In this paper, one novel and simple method to measure the coronary arterial diameter is presented and the relative difference of vessel (Dpi) is defined as one clinic diagnosis criterion for the degree of vascular straitness.
New technologies in coronary artery surgery.
Taggart, David; Nir, Rony-Reuven; Bolotin, Gil
Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG) remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1) stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2) discussing the advantages and disadvantages of off-pump coronary artery bypass; 3) presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4) debating a novel external stenting technique for saphenous vein grafts. PMID:23908868
Takotsubo cardiomyopathy with secondary coronary embolus.
Heseltine, Thomas David; Karthikeyan, Vellore J; Morris, John
We describe the case of a 65-year-old patient who was admitted to our tertiary centre with cardiac sounding chest pain and inferior ST elevation. Coronary angiography revealed mild plaque disease in the left anterior descending artery. The right coronary artery was smooth with no plaques with the exception of an occluded distal branch with no flow. The left ventriculogram revealed a ballooned and akinetic apex typical of Takotsubo syndrome (TS). We suspected a coronary embolus secondary to TS. A serial rise and fall in biomarkers of myocardial necrosis was noted. The patient was treated for acute coronary syndrome and discharged home 72 h from admission. Distal thromboembolism has been described in the literature before. On a search of PubMed there are no examples of coronary artery embolus in the context of TS. PMID:24769664
Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in conscious dogs.
Heyndrickx, G R; Millard, R W; McRitchie, R J; Maroko, P R; Vatner, S F
The time relationship for recovery of mechanical function, the intramyocardial electrogram and coronary flow after brief periods of regional myocardial ischemia, was studied in conscious dogs. Total left vemtricular (LV) function was assessed with measurements of LV systolic and diastolic pressures, rate of change of LV pressure (dP/dt), and dP/dt/P. Regional LV function was assessed with measurements of regional segment length and velocity of shortening. An implanted hydraulic occluder on either the left anterior descending or circumflex coronary artery was inflated for 5- and 15-min periods on separate days. A 5-min occlusion depressed overall LV function transiently, but just before release of occlusion overall function had nearly returned to control. At this time regional function in the ischemic zone was still depressed to the point of absent shorteining or paradoxical motion during systole and was associated with marked ST segment elevation (+ 10 +/- 2.2 mV) at the site where function was measured. With release of occlusion and reperfusion the intramyocardial electrogram returned to normal within 1 min, and reactive hyperemia subsided by 5-10 min. In contrast to the rapid return to preocclusion levels for coronary flow and the electrogram, regional mechanical function remained depressed for over 3 h. A 15-min coronary occlusion resulted in an even more prolonged (greater than 6 h) derangement of function in the ischemic zone. Thus, brief periods of coronary occlusion result in prolonged impairement of regional myocardial function which could not have been predicted from the rapid return of the electrogram and coronary flow. These observations indicate that brief interruptions of coronary flow result either in a prolonged period of local ischemia or that alterations of mechanical induced by ischemia far outlast the repayment of the oxygen debt. PMID:1159098
Coronary heart disease risk factors in women.
Brochier, M L; Arwidson, P
Despite the obvious predominance of coronary heart disease in middle-aged men, cardiovascular disease including coronary heart disease and cerebrovascular accidents is currently the major cause of death in women (54% cardiovascular mortality, 46% coronary mortality; 28% of all deaths). Before menopause, coronary heart disease is infrequent which suggests that female hormones and metabolism offer protection. Without hormone replacement therapy after menopause women may develop coronary atherosclerosis. Ageing is among the non-modifiable risk factors for coronary heart disease in women, while genetic predisposition and environmental factors remain controversial. The modifiable risk factors are mostly common to both sexes and include heavy cigarette smoking (especially in women under oral contraception) dyslipidaemia, high blood pressure, and diabetes; some factors are peculiar to women. The delayed onset of coronary heart disease in women, roughly 10 years later than in men, and greater feminine longevity (81 years vs 74 in men on average) points to the potential benefit of post-menopause hormone replacement therapy together with reduction of other modifiable risk factors. After menopause, the protective HDL cholesterol decreases whereas high LDL cholesterol, high triglycerides and high blood pressure are major risk factors for coronary heart disease as well as for cerebrovascular accident. The role of hormone replacement therapy in the prevention of cardiovascular disease in women is still controversial despite the results of meta-analyses which suggest a 25% to 44% reduction in coronary heart disease following oestrogen therapy alone or in combination with progestogen, depending on the hormonal regime. In conclusion, menopause, now considered as the marker for the end of natural protection against coronary heart disease, should be followed by early and prolonged combined hormone replacement therapy in order to reduce the low compliance with long-term hormone replacement therapy. PMID:9519343
Coronary artery bypass in the context of polyarteritis nodosa.
Yanagawa, Bobby; Kumar, Pawan; Tsuneyoshi, Hiroshi; Kachel, Erez; Massad, Ehab; Moussa, Fuad; Cohen, Gideon N
A 46-year-old man with polyarteritis nodosa and multiple myocardial infarctions treated with multiple percutaneous coronary interventions presented again with atypical angina. Coronary angiography revealed triple-vessel coronary artery disease. This patient underwent four-vessel coronary artery bypass graft and recovered uneventfully. A review of the literature and discussion of the surgical management of this patient is presented. PMID:20103362
The spokane heart study: weibull regression and coronary artery disease
Nairanjana Dasgupta; Peijin Xie; Monte O. Cheney; Lyle Broemeling; C. Harold Mielke Jr
Coronary artery calcium is a marker of coronary artery disease and measures the progression of atherosclerosis. It is measured by electron beam computed tomography, and the measured amount of coronary artery calcium is highly skewed to the right and left censored. The distribution of coronary artery calcium appears to be Weibull. We propose a Weibull regression model and we analyze
Nonsurgical Management of Left Main Coronary Artery Aneurysms
Lima, Brian; Varma, Shalendra K.; Lowe, James E.
Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. Thrombosis within the aneurysm can lead to distal embolization and myocardial infarction. These lesions can extend into adjacent coronary branches and can occur in the presence or absence of obstructive coronary disease. Depending on the severity of coexistent coronary stenoses, patients with left main coronary artery aneurysms can be effectively managed either operatively or medically. We report the cases of 2 patients who were treated medically for large left main coronary aneurysms and concomitant right coronary artery ectasia. PMID:17041701
Coronary MR angiography revealed: how to optimize image quality.
Ishida, Masaki; Sakuma, Hajime
Magnetic resonance (MR) imaging of the coronary arteries has been challenging, owing to the small size of the vessels and the complex motion caused by cardiac contraction and respiration. Free-breathing, whole-heart coronary MR angiography has emerged as a method that can provide visualization of the entire coronary arterial tree within a single 3-dimensional acquisition. Although coronary MR angiography is noninvasive and without radiation exposure, acquisition of high-quality coronary images is operator dependent and is generally more difficult than computed tomographic angiography. This article explains how to optimize acquisition of coronary MR angiography for reliable assessment of coronary artery disease. PMID:25476680
Coronary artery ectasia � A sample from Saudi Arabia
Almansori, Mohammed Atiq; Elsayed, Hisham Ali
Introduction Coronary artery ectasia is an uncommon disease that has been increasingly noticed as the increase in utilization of coronary angiograms. The aim of this study is to characterize coronary artery ectasia in the population of Saudi Arabia. Methods This is a retrospective study involved all patient with invasive coronary angiogram that was done at a tertiary hospital in Saudi Arabia from January 2011 to December 2013. Results A total of 1115 coronary angiograms were reviewed. Coronary artery ectasia was found in 67 patients (6% of all coronary angiograms). The right coronary artery was involved in 73% of cases. And 43% of the cases had severe ectasia. Conclusion The prevalence of coronary artery ectasia in Saudi Arabia among patient who went for coronary angiography is higher than what has been published in previous studies and a significant number of patients have severe disease. PMID:26136630
Low-intensity interval exercise training attenuates coronary vascular dysfunction and preserves Ca2+-sensitive K+ current in miniature swine with LV hypertrophy
Tharp, Darla L.; Ivey, Jan R.; Ganjam, Venkataseshu K.; Bowles, Douglas K.
Coronary vascular dysfunction has been observed in several models of heart failure (HF). Recent evidence indicates that exercise training is beneficial for patients with HF, but the precise intensity and underlying mechanisms are unknown. Left ventricular (LV) hypertrophy can play a significant role in the development of HF; therefore, the purpose of this study was to assess the effects of low-intensity interval exercise training on coronary vascular function in sedentary (HF) and exercise trained (HF-TR) aortic-banded miniature swine displaying LV hypertrophy. Six months postsurgery, in vivo coronary vascular responses to endothelin-1 (ET-1) and adenosine were measured in the left anterior descending coronary artery. Baseline and maximal coronary vascular conductance were similar between all groups. ET-1-induced reductions in coronary vascular conductance (P < 0.05) were greater in HF vs. sedentary control and HF-TR groups. Pretreatment with the ET type A (ETA) receptor blocker BQ-123 prevented ET-1 hypersensitivity in HF animals. Whole cell voltage clamp was used to characterize composite K+ currents (IK+) in coronary smooth muscle cells. Raising internal Ca2+ from 200 to 500 nM increased Ca2+-sensitive K+ current in HF-TR and control, but not HF animals. In conclusion, an ETA-receptor-mediated hypersensitivity to ET-1, elevated resting LV wall tension, and decreased coronary smooth muscle cell Ca2+-sensitive IK+ was found in sedentary animals with LV hypertrophy. Low-intensity interval exercise training preserved normal coronary vascular function and smooth muscle cell Ca2+-sensitive IK+, illustrating a potential mechanism underlying coronary vascular dysfunction in a large-animal model of LV hypertrophy. Our results demonstrate the potential clinical impact of exercise on coronary vascular function in HF patients displaying pathological LV hypertrophy. PMID:21841018
Coronary calcium does not accurately predict near-term future coronary events in high-risk adults
Robert C. Detrano; Nathan D. Wong; Terence M. Doherty; Robert M. Shavelle; Weiyi Tang; Leonard E. Ginzton; Matthew J. Budoff; Kenneth A. Narahara
Background�Prognostic risk models have had limited success in predicting coronary events in subjects with multiple risk factors. We and others have proposed an alternative approach using radiographically detectable coronary calcium. We evaluated and compared the predictive value of these 2 approaches for determining coronary event risk in asymptomatic adults with multiple coronary risk factors. In addition, we assessed the predictive
Spontaneous coronary artery thrombosis in the setting of active lupus mesenteric vasculitis.
Reddy, Yogesh N V; Sundaram, V; Tam, M; Parikh, S A
A 33-year-old male with systemic lupus erythematosus (SLE) presented with acute abdominal pain and was found to have lupus mesenteric vasculitis on imaging and during exploratory laparotomy. Post laparotomy he continued to have persistent nausea and dyspepsia and an electrocardiogram showed evidence of an inferior ST elevation myocardial infarction (STEMI). Emergency cardiac catheterization showed evidence of thrombotic right coronary artery occlusion. His coronaries were otherwise normal with no evidence of underlying coronary artery disease. Extensive workup with trans-esophageal echo, serologies for antiphospholipid antibody syndrome (APS) and bubble study was negative. This effectively ruled out Libman-Sacks endocarditis, APS-induced arterial thrombus and paradoxical emboli as potential causes of his STEMI. By exclusion of other causes, the etiology of his STEMI was felt to be secondary to in-situ coronary artery thrombosis in the setting of active SLE. To the best of our knowledge, this is the first report of a patient with SLE presenting with both lupus mesenteric vasculitis and in-situ coronary arterial thrombosis in the absence of APS. PMID:25672373
Chemokines in patients with ischaemic heart disease and the effect of coronary angioplasty.
Economou, E; Tousoulis, D; Katinioti, A; Stefanadis, C; Trikas, A; Pitsavos, C; Tentolouris, C; Toutouza, M G; Toutouzas, P
Percutaneous coronary transluminal angioplasty (PTCA) may release inflammatory mediators such as chemokines. Monocyte chemoattractant protein-1 (MCP-1) and eotaxin (EOX) are monocyte- and eosinophil-specific chemokines involved in the inflammation and pathogenesis of coronary atherosclerosis. A total of 28 patients undergoing elective PTCA, 20 coronary artery disease (CAD) patients undergoing coronary angiography and 28 healthy controls were studied. In PTCA patients before the procedure, MCP-1 plasma levels (441+/-64 pg/ml) were similar to those of CAD patients (430+/-24 pg/ml), and significantly higher compared with controls (145+/-17 pg/ml, P<0.01). MCP-1 rose significantly after 3 and 6 months following PTCA (696+/-89 and 876+/-86 pg/ml, respectively, P<0.01 vs. before PTCA). EOX plasma levels (155+/-14 pg/ml) were similar to those of CAD patients (157+/-14 pg/ml), but significantly higher compared with controls (83.2+/-10 pg/ml, P<0.05). EOX rose significantly 24 h (273+/-41 pg/ml, P<0.05) but not 3 months after PTCA (160+/-20 and 158+/-19 pg/ml, respectively). These findings indicate that chemokine-induced monocyte- and eosinophil-specific chemoattraction is stimulated in patients with coronary artery disease. MCP-1 levels remain significantly elevated for at least 6 months following elective PTCA, suggesting an inflammatory stimulation. PMID:11532547
Prospective coronary angioscopy assessment of allograft coronary artery disease in human cardiac transplant recipients
NASA Astrophysics Data System (ADS)
Jain, Ashit; Ventura, Hector O.; Collins, Tyrone J.; Ramee, Stephen R.; White, Christopher J.
Annual angiographic assessment to determine the presence or progression of allograft coronary artery disease (CAD) has been unable to modify the natural history of this disease. Coronary angioscopy is a sensitive method to detect the early presence of coronary artery disease and in a retrospective analysis severity of CAD by angioscopy correlated with the time since transplantation. The purpose of this study was to prospectively evaluate progression of coronary artery disease over a one year period in 40 cardiac transplant recipients. The progression of coronary artery disease as assessed by angioscopy is directly related to time after transplantation and therefore angioscopy may be the method of choice for detection and evaluation of therapeutic regimens to control allograft coronary artery disease.
Rare case of coronary to pulmonary vein fistula with coronary steal phenomenon
Barsoum, Emad A; Saiful, Faisal B; Asti, Deepak; Morcus, Rewais; Khoueiry, Georges; Lafferty, James; McCord, Donald A
Coronary artery fistulas are abnormal connections between coronary artery territories and cardiac chambers or major vessels, most of them are congenital. Patients with coronary artery fistula can be asymptomatic or present with different symptoms like angina. Cardiac computed tomography (CT) is one of the best modalities for diagnosis. We present an elderly patient that presented with angina symptoms, non invasive stress test was positive for ischemic heart disease, coronary angiogram could not reveal any obstructive lesions, but an abnormal branch of the left descending coronary artery (LAD), cardiac CT showed fistula that connect left anterior descending coronary artery to left superior pulmonary vein. Our case is extremely rare as most of the reported cases were fistulas between LAD and pulmonary artery, but in our case the fistula between LAD and left superior pulmonary vein. In addition, our patients� symptoms resolved with anti-ischemic medical treatment without any surgical intervention. PMID:25068029
Coronary 64-slice CT angiography predicts outcome in patients with known or suspected coronary artery disease
Oliver Gaemperli; Ines Valenta; Tiziano Schepis; Lars Husmann; Hans Scheffel; Lotus Desbiolles; Sebastian Leschka; Hatem Alkadhi; Philipp A. Kaufmann
The aim of this study was to assess the prognostic value of 64-slice CT angiography (CTA) in patients with known or suspected\\u000a coronary artery disease (CAD). Sixty-four-slice coronary CTA was performed in 220 patients [mean age 63?�?11�years, 77 (35%)\\u000a female] with known or suspected CAD. CTA images were analyzed with regard to the presence and number of coronary lesions.\\u000a Patients
The relative anatomy of the coronary arterial and venous systems: implications for coronary interventions.
Spencer, Julianne H; Sundaram, Cassandra C; Iaizzo, Paul A
An anatomical understanding of human coronary arterial and venous systems is necessary for device development and therapy applications that utilize these vessels. We investigated the unique use of contrast-CT scans from perfusion-fixed human hearts for three-dimensional visualization and analysis of anatomical features of the coronary systems. The coronary arterial and venous systems of eleven perfusion-fixed human hearts were modeled using contrast-CT and Mimics software. The coronary arteries that coursed near the major coronary veins, how close coronary arteries were to coronary veins, and the size of adjacent coronary arteries were recorded and analyzed. The majority of coronary veins were within 5 mm of a coronary artery somewhere along its length. Interventricular veins elicited the largest occurrence of overlaps. There was significant variability in the percentage of each vein that coursed within 0.5, 1, 2, and 5 mm of a nearby artery. The left marginal veins and anterior interventricular vein had the largest portion of the vein that coursed near a coronary artery. The right coronary artery most often coursed near the middle cardiac vein. The inferior veins of the left ventricle elicited the most variation in adjacent arteries. The left circumflex artery and/or branches of the circumflex artery coursed near the left marginal vein in all cases where there was an artery near the marginal vein. The wide variation of measurements reinforces the importance of a precise understanding of individualized cardiac anatomy in order to provide the highest quality care to cardiac patients. PMID:24860940
Angiographic coronary diffuseness and outcomes in dialysis patients undergoing coronary artery bypass grafting surgery
Daniel Wong; Greg Thompson; Karen Buth; John Sullivan; Imtiaz Ali
Objective: Pre-operative dialysis-dependent renal failure (DDRF) is a predictor of morbidity and mortality following coronary artery bypass grafting surgery (CABG). Whether this is due in part to a more diffuse coronary atherosclerotic burden in these patients is unknown. The purpose of this study was to compare coronary atherosclerotic disease burden in patients with and without pre-existing DDRF undergoing CABG. Methods:
Angiographic coronary diffuseness and outcomes in dialysis patients undergoing coronary artery bypass grafting surgery
Daniel Wong; Greg Thompson; Karen Buth; John Sullivan; Imtiaz Ali
Objective: Pre-operative dialysis-dependent renal failure (DDRF) is a predictor of morbidity and mortality following coronary artery bypass grafting surgery (CABG). Whether this is due in part to a more diffuse coronary atherosclerotic burden in these patients is unknown. The purpose of this study was to compare coronary atherosclerotic disease burden in patients with and without pre-existing DDRF undergoing CABG. Methods:
Acute coronary artery occlusion likely due to thrombus occurring during coronary angiography: report of a case.
Bonafede, N; Schwartz, L
Twenty-five years ago, fatalities due to acute thrombotic coronary occlusion occurring during coronary angiography were reported not infrequently, but are thought to have been eliminated by changes in technique and equipment. We present a case with documentation of a normal coronary arterial tree just before the time of an abrupt occlusion, which had the angiographic features of clot. The likely source of the thrombus was the arterial sheath. Measures for prevention of this complication are discussed. PMID:9554781
Unusual Malignant Coronary Artery Anomaly: Results of Coronary Angiography, MR Imaging, and Multislice CT
Apitzsch, Jonas, E-mail: email@example.com [RWTH Aachen University, Department of Diagnostic Radiology (Germany); Kuehl, Harald P. [RWTH Aachen University, Department of Cardiology (Germany); Muehlenbruch, Georg; Mahnken, Andreas H. [RWTH Aachen University, Department of Diagnostic Radiology (Germany)
We report the case of a man with an uncommon anomaly of the origin and course of the left coronary artery. Clinical, coronary angiography, magnetic resonance imaging, and multislice computed tomography findings of this intermittently symptomatic 49 year-old patient with the rare anomaly of his left coronary artery stemming from the right sinus of Valsalva and taking an interarterial and intraseptal course are presented. The diagnostic value of the different imaging modalities is discussed.
Influence of Risk Factors on Coronary Flow Reserve in Patients with 1Vessel Coronary Artery Disease
Maria Lucia Eufrasia Vicario; Lorenzo Cirillo; Giovanni Storto; Teresa Pellegrino; Nicola Ragone; Luca Fontanella; Mario Petretta; Domenico Bonaduce; Alberto Cuocolo
Coronary artery disease (CAD) risk factors influence the hyper- emic response in patients without coronary artery stenosis. The aim of this study was to evaluate the influence of risk factors on coronary flow reserve (CFR) estimated by 99mTc-sestamibi car- diac imaging in patients with 1-vessel CAD. Methods: Forty- eight patients with 1-vessel CAD were enrolled in the study. Systemic hypertension,
Wave speed in human coronary arteries is not influenced by microvascular vasodilation: implications for wave intensity analysis.
Rolandi, M Cristina; De Silva, Kalpa; Lumley, Matthew; Lockie, Timothy P E; Clapp, Brian; Spaan, Jos A E; Perera, Divaka; Siebes, Maria
Wave intensity analysis and wave separation are powerful tools for interrogating coronary, myocardial and microvascular physiology. Wave speed is integral to these calculations and is usually estimated by the single-point technique (SPc), a feasible but as yet unvalidated approach in coronary vessels. We aimed to directly measure wave speed in human coronary arteries and assess the impact of adenosine and nitrate administration. In 14 patients, the transit time ?t between two pressure signals was measured in angiographically normal coronary arteries using a microcatheter equipped with two high-fidelity pressure sensors located ?s�=�5�cm apart. Simultaneously, intracoronary pressure and flow velocity were measured with a dual-sensor wire to derive SPc. Actual wave speed was calculated as DNc�=�?s/?t. Hemodynamic signals were recorded at baseline and during adenosine-induced hyperemia, before and after nitroglycerin administration. The energy of separated wave intensity components was assessed using SPc and DNc. At baseline, DNc equaled SPc (15.9���1.8 vs. 16.6���1.5�m/s). Adenosine-induced hyperemia lowered SPc by 40�% (p�<�0.005), while DNc remained unchanged, leading to marked differences in respective separated wave energies. Nitroglycerin did not affect DNc, whereas SPc transiently fell to 12.0���1.2�m/s (p�<�0.02). Human coronary wave speed is reliably estimated by SPc under resting conditions but not during adenosine-induced vasodilation. Since coronary wave speed is unaffected by microvascular dilation, the SPc estimate at rest can serve as surrogate for separating wave intensity signals obtained during hyperemia, thus greatly extending the scope of WIA to study coronary physiology in humans. PMID:24515727
Allergic acute coronary syndrome (Kounis syndrome)
Chhabra, Lovely; Masrur, Shihab; Parker, Matthew W.
Anaphylaxis rarely manifests as a vasospastic acute coronary syndrome with or without the presence of underlying coronary artery disease. The variability in the underlying pathogenesis produces a wide clinical spectrum of this syndrome. We present three cases of anaphylactic acute coronary syndrome that display different clinical variants of this phenomenon. The main pathophysiological mechanism of the allergic anginal syndromes is the inflammatory mediators released during a hypersensitivity reaction triggered by food, insect bites, or drugs. It is important to appropriately recognize and treat Kounis syndrome in patients with exposure to a documented allergen. PMID:26130889
Pharmacological approaches to coronary microvascular dysfunction.
Guarini, Giacinta; Huqi, Alda; Morrone, Doralisa; Capozza, Paola; Todiere, Giancarlo; Marzilli, Mario
In recent decades coronary microvascular dysfunction has been increasingly identified as a relevant contributor to several cardiovascular conditions. Indeed, coronary microvascular abnormalities have been recognized in patients suffering acute myocardial infarction, chronic stable angina and cardiomyopathies, and also in patients with hypertension, obesity and diabetes. In this review, we will examine pathophysiological information needed to understand pharmacological approaches to coronary microvascular dysfunction in these different clinical contexts. Well-established drugs and new pharmacological agents, including those for which only preclinical data are available, will be covered in detail. PMID:25004087
Efficacy and tolerance of repeated oral doses of tolperisone hydrochloride in the treatment of painful reflex muscle spasm: results of a prospective placebo-controlled double-blind trial.
Pratzel, H G; Alken, R G; Ramm, S
The efficacy and safety of oral tolperisone hydrochloride (Mydocalm) in the treatment of painful reflex muscle spasm was assessed in a prospective, randomized, double-blind, placebo-controlled trial. A total of 138 patients, aged between 20 and 75 years, with painful reflex muscle spasm associated with diseases of the spinal column or proximal joints were enrolled in eight rehabilitation centers. Patients were randomized to receive either 300 mg tolperisone hydrochloride or placebo for a period of 21 days. Both treatment groups recovered during the 3 weeks rehabilitation program. However, tolperisone hydrochloride proved to be significantly superior to placebo: the change score of the pressure pain threshold as the primary target parameter significantly increased during therapy with tolperisone hydrochloride (P = 0.03, valid-case-analysis) compared to the results obtained on placebo treatment. The overall assessment of efficacy by the patient also demonstrated significant differences in favor of tolperisone hydrochloride. Best results were seen in patients aged between 40 and 60 years with a history of complaints shorter than 1 year and with concomitant physical therapy. The evaluation of safety data, i.e., adverse events, biochemical and hematological laboratory parameters, demonstrated no differences between tolperisone hydrochloride and placebo. As a conclusion tolperisone hydrochloride represents an effective and safe treatment of painful reflex muscle spasm without the typical side effects of centrally active muscle relaxants. PMID:8951937
Presurgical evaluation of hemifacial spasm and spasmodic torticollis caused by a neurovascular conflict from AICA with 3T MRI integrated by 3D drive and 3D TOF image fusion: A case report and review of the literature
Alafaci, Concetta; Granata, Francesca; Cutugno, Mariano; Grasso, Giovanni; Salpietro, Francesco M.; Tomasello, Francesco
Background: Hemifacial spasm (HS) and spasmodic torticollis (ST) are well-known disorders that are caused by a neurovascular conflict. HS is characterized by irregular, involuntary muscle contractions on one side of the face due to spasms of orbicularis oris and orbicularis oculi muscles, and is usually caused by vascular compression of the VII cranial nerve. ST is an extremely painful chronic movement disorder causing the neck to involuntary turn to the side, upward and/or downward. HS is usually idiopathic but it is rarely caused by a neurovascular conflict with the XI cranial nerve. Case Description: We present a case of a 36-year-old woman with a 2-year history of left hemifacial spasm and spasmodic torticollis. Pre-surgical magnetic resonance imaging MRI examination was performed with 3TMRI integrated by 3Ddrive and 3DTOF image fusion. Surgery was performed through a left suboccipital retrosigmoid craniectomy. The intraoperative findings documented a transfixing artery penetrating the facial nerve and a dominant left anteroinferior cerebellar artery (AICA) in contact with the anterior surface of the pons and lower cranial nerves. Microvascular decompression (MVD) was performed. Postoperative course showed the regression of her symptoms. Conclusions Transfixing arteries are rarely reported as a cause of neurovascular conflicts. The authors review the literature concerning multiple neurovascular conflicts. PMID:25101203
Coronary Perforation and Covered Stents: An Update and Review
Al-Mukhaini, Mohammed; Panduranga, Prashanth; Sulaiman, Kadhim; Riyami, Abdulla Amour; Deeb, Mohammed; Riyami, Mohamed Barkat
Coronary perforation is a rare complication of percutaneous coronary intervention. We present two different types of coronary intervention, but both ending with coronary perforation. However, these perforations were tackled successfully by covered stents. This article reviews the incidence, causes, presentation, and management of coronary perforation in the present era of aggressive interventional cardiology. Coronary perforations are classified as type I (extraluminal crater), II (myocardial or pericardial blushing), and III (contrast streaming or cavity spilling). Types I and II coronary perforations are caused by stiff or hydrophilic guidewires. Type I has a benign prognosis, whereas type II coronary perforations have the potential to progress to tamponade. Type III coronary perforations are caused by balloons, stents, or other intracoronary devices and commonly lead to cardiac tamponade necessitating pericardial drainage. However, type III perforations can be managed with covered stents without need for surgical intervention. PMID:22121463
Stress-induced cardiomyopathy.
Lisung, Fausto Gabriel; Shah, Ankit B; Levitt, Howard L; Coplan, Neil B
A woman in her early 70s presented with chest pain, dyspnoea and diaphoresis 30 min after her husband expired in our hospital. Cardiac markers were elevated and there were acute changes in ECG suggestive for acute coronary syndrome. Echocardiogram showed apical akinesis, basal segment hyperkinesis with an ejection fraction of 30%. Cardiac catheterisation was performed showing non-obstructive coronary arteries, leading to the diagnosis of stress-induced cardiomyopathy. The patient improved with medical management. Repeat echocardiogram 2 months later showed resolution of heart failure with an ejection fraction of 65-70%. PMID:25858931
The relaxing effect of Poncirus fructus and its flavonoid content on porcine coronary artery.
Yu, Dong-Jun; Jun, Jin-Hong; Kim, Tae-Jun; Suh, Dong-Kyun; Youn, Dong-Ho; Kim, Tae-Wan
Coronary artery disease is a common occurrence in human, and causes enormous social cost. Poncirus fructus (PF), the dried immature fruits of Poncirus trifoliata Rafinesquem, is used in the treatment of womb contraction and dyspepsia, as a prokinetic, and in improving blood circulation. This study was performed to investigate the effects of PF and some of its flavonoids components on the coronary from the pig. The arterial ring was suspended by a pair of stainless steel stirrups in an organ bath. The end of the upper stirrup was connected to an isometric force transducer. A dose-dependent induction of relaxation was observed by both water and 70% ethanol extracts of PF in the porcine coronary artery precontracted with U46619 (100 nM), a stable analogue of the potent vasoconstrictor thromboxane A2. The 70% ethanol extract showed more efficacy than the water extract. Pretreatment of the artery with L-NAME (100 �M), a nitric oxide synthase inhibitor, resulted in a significant reduction in the relaxation induced by PF extract. In addition, ODQ (10 �M), a soluble guanylate cyclase inhibitor, also significantly reduced the effects of PF extracts. Hesperidin, a flavonoid present in PF, induced very weak relaxation of the porcine coronary artery at a high concentration (100 �M), while its aglycone, hesperetin, demonstrated a dose-dependent relaxation. In conclusion, PF extracts induced relaxation in the porcine coronary artery, partially through the nitric oxide-cGMP pathway, and the aglycones of flavonoids might be also involved in the relaxation of the same artery. PMID:25806081
Accelerated coronary atherosclerosis and H syndrome
Shankarappa, Ravindranath K; Ananthakrishna, Rajiv; Math, Ravi S; Yalagudri, Sachin Dhareppa; Karur, Satish; Dwarakaprasad, Ramesh; Nanjappa, Manjunath C; Molho-Pessach, Vered
A 12-year-old boy with insulin dependent diabetes mellitus, presented with acute myocardial infarction. Intracoronary thrombolysis with urokinase restored TIMI III flow in the culprit vessel. After stabilisation with medical therapy, unusual clinical findings in the form of cutaneous hyperpigmentation and hypertrichosis, affecting the lower extremities, were appreciated. These and other phenotypic features were consistent with H syndrome, a recently described autosomal recessive genodermatosis, and confirmed by mutation analysis. Despite being on optimal medical therapy for coronary artery disease, the patient presented 3 months thereafter, with unstable angina which was successfully managed with percutaneous coronary intervention. An unusual occurrence of coronary artery disease with accelerated atherosclerosis in a child with H syndrome is presented herein. Identification of further patients with this novel disorder will clarify the possible association, suggested here, with increased risk for coronary or other vascular events. PMID:22679148
Predicting vascular complications in percutaneous coronary interventions
Winthrop D Piper; David J Malenka; Thomas J Ryan; Samuel J Shubrooks; Gerald T O�Connor; John F Robb; Karen L Farrell; Mary S Corliss; Michael J Hearne; Mirle A Kellett; Matthew W Watkins; William A Bradley; Bruce D Hettleman; Theodore M Silver; Paul D McGrath; John R O�Mears; David E Wennberg
ObjectivesUsing a large, current, regional registry of percutaneous coronary interventions (PCI), we identified risk factors for postprocedure vascular complications and developed a scoring system to estimate individual patient risk.
Multimodality Imaging Atlas of Coronary Atherosclerosis
Donnelly, Patrick
NEW HIGH-RESOLUTION IMAGING TECHNOLOGIES HAVE ENHANCED OUR UNDERSTANDING OF THE CORONARY atherosclerotic disease process, and this atlas provides a multimodality pictorial review of the development of histologically verified ...
Depression in Coronary Artery Disease
Safaie, Nasser; Jodati, Ahmad Reza; Raoofi, Mohammad; Khalili, Majid
Introduction Depression is one of the Common psychological disorders. From the cognitive point of view, the unhealthy attitudes increase the severity of the depression. The aim of this study was to investigate depression and unhealthy attitudes in coronary patients hospitalized at Tabriz Shahid Madani Heart Center. Methods One hundred twenty eight hospitalized patients having myocardial Infarctions were studied regarding unhealthy attitudes, severity of depression and demographic data. Results The study showed a significant relation between unhealthy attitudes, BDI (Beck Depression Inventory) and severe depression. Moreover, a significant relation existed between gender and depression (P=0.0001). In addition, the level of education increased the intensity of unhealthy attitudes (P=0.0001). Several researches in both outside and inside Iran support the idea. Conclusion Based on present study and more other investigations, it can be suggested to provide the necessary elements and parameters such as antidepressant medication, psychologists, complementary treatment for coping with negative mood and its unwanted consequences. PMID:24250990
Coronary angiography using synchrotron radiation
Thompson, A. C.; Rubenstein, E.; Zeman, H. D.; Hofstadter, R.; Otis, J. N.; Giacomini, J. C.; Gordon, H. J.; Brown, G. S.
Imaging of coronary arteries using a venous instead of an arterial injection of contrast agent could provide a much safer method to diagnose heart disease. The tunability, intensity, and collimation of synchrotron radiation x-ray beams makes possible imaging systems with greatly improved imaging sensitivity. A pair of fan x-ray beams, a movable patient chair, and a multielement x-ray detector are used to acquire a pair of x-ray images above and below the iodine /ital K/ edge. The logarithmic subtraction of these two images produces an image with excellent sensitivity to contrast agent and minimal sensitivity to bone and tissue. High-quality images from a dog and preliminary images from five humans have been obtained. Improvements are being made to the system to increase the effective radiation flux and to measure the position of both x-ray beams.
Computer quantitation of coronary angiograms
NASA Technical Reports Server (NTRS)
Ledbetter, D. C.; Selzer, R. H.; Gordon, R. M.; Blankenhorn, D. H.; Sanmarco, M. E.
A computer technique is being developed at the Jet Propulsion Laboratory to automate the measurement of coronary stenosis. A Vanguard 35mm film transport is optically coupled to a Spatial Data System vidicon/digitizer which in turn is controlled by a DEC PDP 11/55 computer. Programs have been developed to track the edges of the arterial shadow, to locate normal and atherosclerotic vessel sections and to measure percent stenosis. Multiple frame analysis techniques are being investigated that involve on the one hand, averaging stenosis measurements from adjacent frames, and on the other hand, averaging adjacent frame images directly and then measuring stenosis from the averaged image. For the latter case, geometric transformations are used to force registration of vessel images whose spatial orientation changes.
Early Outcomes of Double-Vessel Coronary Endarterectomy in Comparison with Single-Vessel Coronary Endarterectomy
Marzban, Mehrab; Karimi, Abassali; Ahmadi, Hossein; Davoodi, Saeed; Abbasi, Kyomars; Movahedi, Namvar; Salehiomran, Abbas; Abbasi, Seyed Hesameddin; Kawoosi, Yasaman; Yazdanifard, Parin
Our goal was to investigate the safety of single- and double-vessel coronary endarterectomy as an adjunct to coronary artery bypass grafting in patients with diffuse coronary disease. In reviewing the records of 9,443 patients who underwent isolated coronary artery revascularization over a 4-year period, we found 310 patients (3.28%) who underwent concomitant coronary artery endarterectomy, 39 of whom (12.6%) required double endarterectomy (Group 2) and the rest of whom required single endarterectomy (Group 1). Variables of these groups were compared by means of univariate analysis. In Group 1, 76.3% were men, with a mean age of 58.73 � 9.36 yr. Regarding postoperative myocardial infarction as evaluated by electrocardiography and the MB isoenzyme of creatine kinase, 13% of the patients in Group 1 and 15.4% in Group 2 were so affected. The early mortality rate was 3.3% in Group 1 and 10.3% in Group 2 (P <0.05). In univariate analysis, the following variables were significant: 3-vessel disease, postoperative atrial fibrillation, dialysis, length of hospital stay, and death. In multivariate analysis of endarterectomized arteries, the vascular combinations most strongly associated with death were left anterior descending coronary artery + right coronary artery and right coronary artery + diagonal. There was no association between endarterectomy of particular vessels and perioperative myocardial infarction. Although coronary endarterectomy has become a safe procedure, adding a 2nd endarterectomy worsens the prognosis dramatically, and surgeons should be especially cautious about such an addition if the 1st endarterectomy is in left anterior descending coronary artery or right coronary artery territory. PMID:18612488
Myocardial blood volume and coronary resistance during and after coronary angioplasty.
Inderm�hle, Andreas; Vogel, Rolf; Meier, Pascal; Zbinden, Rainer; Seiler, Christian
Animal experiments have shown that the coronary circulation is pressure distensible, i.e., myocardial blood volume (MBV) increases with perfusion pressure. In humans, however, corresponding measurements are lacking so far. We sought to quantify parameters reflecting coronary distensibility such as MBV and coronary resistance (CR) during and after coronary angioplasty. Thirty patients with stable coronary artery disease underwent simultaneous coronary perfusion pressure assessment and myocardial contrast echocardiography (MCE) of 37 coronary arteries and their territories during and after angioplasty. MCE yielded MBV and myocardial blood flow (MBF; in ml � min(-1) � g(-1)). Complete data sets were obtained in 32 coronary arteries and their territories from 26 patients. During angioplasty, perfusion pressure, i.e., coronary occlusive pressure, and MBV varied between 9 and 57 mmHg (26.9 � 11.9 mmHg) and between 1.2 and 14.5 ml/100 g (6.7 � 3.7 ml/100 g), respectively. After successful angioplasty, perfusion pressure and MBV increased significantly (P < 0.001 for both) and varied between 64 and 118 mmHg (93.5 � 12.8 mmHg) and between 3.7 and 17.3 ml/100 g (9.8 � 3.4 ml/100 g), respectively. Mean MBF increased from 31 � 20 ml � min(-1) � g(-1) during coronary occlusion, reflecting collateral flow, to 121 � 33 ml � min(-1) � g(-1) (P < 0.01), whereas mean CR, i.e., the ratio of perfusion pressure and MBF, decreased by 20% (P < 0.001). In conclusion, the human coronary circulation is pressure distensible. MCE allows for the quantification of CR and MBV in humans. PMID:21217067
Coronary drug project: Experience with niacin
K. G. Berge; P. L. Canner
Summary Niacin was one of the treatments compared in the Coronary Drug Project, a placebo-controlled, multicenter trial of lipid-lowering drugs in the secondary prevention of coronary heart disease. A total of 1119 men, aged 30�64 at entry, were randomized to niacin and 2789 to placebo by the end of recruitment in March 1969. Although side-effects interfered with adherence to the
Coronary drug project: experience with niacin
K. G. Berger; P. L. Canner
Summary��Niacin was one of the treatments compared in the Coronary Drug Project, a placebo-controlled, multicenter trial of lipid-lowering\\u000a drugs in the secondary prevention of coronary heart disease. A total of 1119 men, aged 30�64 at entry, were randomized to\\u000a niacin and 2789 to placebo by the end of recruitment in March 1969. Although side-effects interfered with adherence to the\\u000a niacin
Reoperative coronary artery bypass via left thoracotomy
Hirofumi Ide; Tatsuo Fujiki; Ken-ji Nonaka; Ryoichi Ishida; Kentarou Imamura; Ken-ichi Sudo
The patient was a 49-year-old woman. When she was 39 years old, she underwent coronary artery bypass grafting (left internal\\u000a thoracic artery to left anterior descending artery, saphenous vein graft to first diagonal branch). At the age 48, she had\\u000a effort angina. On coronary angiography, triple-vessel disease was found, and she was treated conservatively. Progression of\\u000a the disease was confirmed
Robotically enhanced coronary artery bypass surgery
Yugal K. Mishra; H. Wasir; Malhotra Rajneesh; K. K. Sharma; Y. Mehta; N. Trehan
Robotically enhanced telemanipulation surgery is a rapidly developing technique which enables totally endoscopic cardiac surgery\\u000a with utmost precision and perfection on both beating heart and arrested heart. Between December 2002 and September 2006, 268\\u000a patients underwent robotically enhanced coronary artery bypass surgery using the da Vinci telemanipulation system. Fourteen\\u000a patients underwent total endoscopic coronary artery bypass surgery. Of these 12
Epidemiologic guidance with coronary artery calcium scoring
Paolo Raggi; Leslee J. Shaw
The importance of screening for subclinical coronary artery disease is reinforced by the detection gap existing between the\\u000a currently used risk stratification tools and the persistently elevated rates of cardiovascular disease in Western countries.\\u000a Medicare data clearly indicate the extremely high cost of caring for patients with end-stage diseases, and early detection\\u000a may curb some of these expenses. Coronary artery
Relationship Between Coronary Plaque Formation and NAD(P)H Oxidase-derived Reactive Oxygen Species - Comparison of Intravascular Ultrasound Finding of Atherosclerotic Lesions with Histochemical Characteristics
Background: Oxidative stress induced by reactive oxygen species (ROS) in the vessel wall plays an essential role in atherogenesis. Recently, we demonstrated that the generation of ROS via NAD(P)H oxidase was correlated with plaque instability using coronary specimens obtained by directional coronary atherectomy (DCA). In this study, the relation between plaque formation and ROS generation was studied based on pre-interventional
Coronary artery surgery: indications and recent experience.
Robinson, P. S.; Coltart, D. J.; Jenkins, B. S.; Webb-Peploe, M. M.; Braimbridge, M. V.; Williams, B. T.
The comprehensive experience of coronary artery surgery in a Cardiothoracic Unit over a 31-month period is reviewed. Hospital mortality for elective bypass grafting was 3.9% overall and 2.5% in those with good pre-operative left ventricular function. Major influences on hospital mortality were pre-operative left ventricular function, extent of coronary artery disease and extent of the surgical procedure undertaken in terms of number of aortocoronary grafts inserted, coronary endarterectomy and particularly concomitant valve surgery or aneurysm resection. Follow-up experience shows 74% of grafted patients to be symptom-free and 85% symptomatically improved one year after surgery with 70% symptom-free and 80% improved at two years. Early post-operative deaths appear related to early graft closure and recurrence of symptoms postoperatively to late graft closure or progression of coronary disease in the native circulation. The study provides a guide to the relative risks of coronary artery surgery for symptomatic coronary artery disease and expected symptomatic results in the early follow-up period. PMID:310999
Oxidized LDL and Fructosamine Associated with Severity of Coronary Artery Atherosclerosis in Insulin Resistant Pigs Fed a High Fat/High NaCl Diet
Nichols, Timothy C.; Merricks, Elizabeth P.; Bellinger, Dwight A.; Raymer, Robin A.; Yu, Jing; Lam, Diana; Koch, Gary G.; Busby, Walker H.; Clemmons, David R.
Background Insulin-resistant subjects develop more severe and diffuse coronary artery atherosclerosis than insulin-sensitive controls but the mechanisms that mediate this atherosclerosis phenotype are unknown. Research Objective To determine the metabolic parameters that associate with the severity of coronary atherosclerosis in insulin resistant pigs fed a high fat/high NaCl diet. Key Methods The primary endpoint was severity of coronary atherosclerosis in adult pigs (Sus scrofa, n = 37) fed a high fat diet that also contained high NaCl (56% above recommended levels) for 1 year. Principal Findings Twenty pigs developed severe and diffuse distal coronary artery atherosclerosis (i.e., severe = intimal area as a percent medial area > 200% in at least 2 coronary artery cross sections and diffuse distal = intimal area as a percent medial area ? 150% over 3 sections separated by 2 cm in the distal half of the coronary artery). The other 17 pigs had substantially less coronary artery atherosclerosis. All 37 pigs had blood pressure in a range that would be considered hypertensive in humans and developed elevations in total and LDL and HDL cholesterol, weight gain, increased backfat, and increased insulin resistance (Bergman Si) without overt diabetes. Insulin resistance was not associated with atherosclerosis severity. Five additional pigs fed regular pig chow also developed increased insulin resistance but essentially no change in the other variables and little to no detectible coronary atherosclerosis. Most importantly, the 20 high fat/high NaCl diet -fed pigs with severe and diffuse distal coronary artery atherosclerosis had substantially greater increases (p< 0.05) in oxidized LDL (oxLDL) and fructosamine consistent with increased protein glycation. Conclusion In pigs fed a high fat/high NaCl diet, glycated proteins are induced in the absence of overt diabetes and this degree of increase is associated with the development of severe and diffuse distal coronary artery atherosclerosis. PMID:26147990
Maternal melatonin administration mitigates coronary stiffness and endothelial dysfunction, and improves heart resilience to insult in growth restricted lambs
Tare, Marianne; Parkington, Helena C; Wallace, Euan M; Sutherland, Amy E; Lim, Rebecca; Yawno, Tamara; Coleman, Harold A; Jenkin, Graham; Miller, Suzanne L
Intrauterine growth restriction (IUGR) is associated with impaired cardiac function in childhood and is linked to short- and long-term morbidities. Placental dysfunction underlies most IUGR, and causes fetal oxidative stress which may impact on cardiac development. Accordingly, we investigated whether antenatal melatonin treatment, which possesses antioxidant properties, may afford cardiovascular protection in these vulnerable fetuses. IUGR was induced in sheep fetuses using single umbilical artery ligation on day 105�110 of pregnancy (term 147). Study 1: melatonin (2 mg h?1) was administered i.v. to ewes on days 5 and 6 after surgery. On day 7 fetal heart function was assessed using a Langendorff apparatus. Study 2: a lower dose of melatonin (0.25 mg h?1) was administered continuously following IUGR induction and the ewes gave birth normally at term. Lambs were killed when 24 h old and coronary vessels studied. Melatonin significantly improved fetal oxygenation in vivo. Contractile function in the right ventricle and coronary flow were enhanced by melatonin. Ischaemia�reperfusion-induced infarct area was 3-fold greater in IUGR hearts than in controls and this increase was prevented by melatonin. In isolated neonatal coronary arteries, endothelium-dependent nitric oxide (NO) bioavailability was reduced in IUGR, and was rescued by modest melatonin treatment. Melatonin exposure also induced the emergence of an indomethacin-sensitive vasodilation. IUGR caused marked stiffening of the coronary artery and this was prevented by melatonin. Maternal melatonin treatment reduces fetal hypoxaemia, improves heart function and coronary blood flow and rescues cardio-coronary deficit induced by IUGR. PMID:24710061
Shear stress and advanced atherosclerosis in human coronary arteries.
Gijsen, Frank; van der Giessen, Alina; van der Steen, Anton; Wentzel, Jolanda
The role of low and oscillating shear stress as a key factor for localizing early atherosclerotic plaques is generally accepted. Once more advanced plaques protrude into the lumen, the shear stress they are exposed to changes. The influence of shear stress on plaque composition in advanced atherosclerosis is not fully understood. In this review, we discuss our recent studies on the relationship between shear stress and plaque composition and the location of plaque rupture in human coronary arteries. We have shown that elevated shear stress levels can be found over plaques inducing only mild luminal narrowing and are not subjected to treatment. Regional exposure of certain plaque regions to high shear stress is therefore a condition that will pertain for a prolonged period of time. We have also shown that in more advanced atherosclerosis the necrotic core experiences higher shear stress. Low shear stress plaque regions can be found downstream of the plaque and are stiffer. High shear stress plaque regions can be found either at the upstream, shoulder or cap region of the plaque and are softer. The plaque regions with the highest strain levels are the regions that are exposed to the highest shear stress. The high shear stress plaque regions are the only plaque regions that get softer over time. Finally, high shear stress is also associated with the location of plaque rupture in non-culprit lesion in human coronary arteries. Combining our findings with data from literature, we can conclude that advanced coronary plaques grow in the distal regions. The distal plaque regions are exposed to low shear stress, are stiffer and have a stable plaque phenotype. The regions exposed to high shear stress are softer, and are associated with vulnerable plaque features. PMID:23261245
IL-1? is Crucial for Induction of Coronary Artery Inflammation in a Mouse Model of Kawasaki Disease
Lee, Young Ho; Schulte, Danica J.; Shimada, Kenichi; Chen, Shuang; Crother, Timothy R.; Chiba, Norika; Fishbein, Michael C.; Lehman, Thomas J.A.; Arditi, Moshe
Background Kawasaki disease (KD) is the most common cause of acute vasculitis and acquired cardiac disease in US children. Untreated, children may develop coronary artery aneurysms, myocardial infarction and sudden death as a result of the illness. Up to a third of KD patients fail to respond to intravenous gammaglobulin (IVIG), the standard therapy, and alternative treatments are being investigated. Genetic studies have indicated a possible role for IL-1? in KD. We therefore explored the role of IL-1? in a murine model of KD. Methods and Results Using an established mouse model of KD that involves injection of Lactobacillus casei cell wall extract (LCWE), we investigated the role of IL- 1? and caspase-1 (activated by the inflammasome and required for IL-1? maturation) in coronary arteritis, and evaluated the efficacy of IL-1 receptor antagonist (IL-1Ra) as a potential treatment. LCWE-induced IL-1? maturation and secretion was dependent on the NLRP3 inflammasome in macrophages. Both caspase1-deficient and IL-1R-deficient mice were protected from LCWE-induced coronary lesions. Injection of recombinant IL-1? to caspase-1-deficient mice restored the ability of LCWE to cause coronary lesions in response to LCWE. Furthermore, daily injections of the IL-1Ra prevented LCWE-mediated coronary lesions, up to three days after LCWE injection. Conclusions Our results strongly suggest that caspase-1 and IL-1? play critical roles in the development of coronary lesions in this KD mouse model, blocked by IL-1Ra. Therefore, anti-IL-1? treatment strategies may constitute an effective, more targeted treatment of KD to prevent coronary lesions. PMID:22361326
A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease
Eric J. Topol; Ferdinand Leya; Cass A. Pinkerton; Patrick L. Whitlow; Berthold Hofling; Charles A. Simonton; Ronald R. Masden; Patrick W. Serruys; Martin B. Leon; David O. Williams; Spencer B. King; B. Daniel; D. B. Mark; J. M. Isner; D. R. Holmes; S. G. Ellis; K. L. Lee; G. P. Keeler; L. G. Berdan; T. Hinohara; R. M. Califf
BACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with balloon angioplasty, which relies on dilation of the plaque and vessel wall. We compared the rate of restenosis after
Very high coronary calcium score unmasks obstructive coronary artery disease in patients with normal SPECT MPI
Jelena R Ghadri; Aju P Pazhenkottil; Rene N Nkoulou; Robert Goetti; Ronny R Buechel; Lars Husmann; Bernhard A Herzog; Mathias Wolfrum; Christophe A Wyss; Christian Templin; Philipp A Kaufmann
ObjectivesTo study the clinical impact of a very high coronary artery calcium score (CAC >1000) in patients with no known coronary artery disease (CAD) and normal single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The secondary aim was to evaluate whether triple vessel disease would support the notion of balanced ischaemia as an underlying mechanism of false negative
Improved Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Grafting With Coronary Endarterectomy
Oz M. Shapira; Gabriel Akopian; Ali Hussain; Mitchell Adelstein; Harold L. Lazar; Gabriel S. Aldea; Richard J. Shemin
Background. Coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) has been associated with increased morbidity and mortality. We sought to evaluate the impact of recent advances in operative and perioperative management on outcomes after CE. Methods. One hundred fifty-one consecutive patients undergoing first-time CABG with CE between 1991 and 1997 were compared with a concurrent group of 757 patients
LPA rs10455872 polymorphism is associated with coronary lesions in Brazilian patients submitted to coronary angiography
Background Polymorphisms in the LPA gene were associated with coronary artery disease (CAD). However, there are differences in the allelic frequencies, Lp(a) levels, and significant association with CAD according to ethnic groups. In this scenario, the main aim of this study was to assess the influence of the LPA polymorphisms on coronary lesions in Brazilian patients. Methods 1,394 consecutive patients submitted to coronary angiography to study suggestive CAD and twenty coronary segments were scored. Genotyping for the LPA rs10455872 and rs3798220 polymorphisms were performed by high resolution melting analysis. Results The frequencies of the rs10455872 G and rs3798220 C variant alleles were 6.4% and 6.2%, respectively. LPA rs10455872 G variant allele was associated with higher odds ratio of having coronary lesions in an adjusted model (OR?=?2.02, 95% CI?=?1.10-3.72, p?=?0.02). Scores of coronary lesions (extension, severity, and Gensini scores) were significantly different among rs10455872 genotype groups. Coronary lesions was not associated with LPA rs3798220 (OR?=?1.09, 95% CI?=?0.67-1.76, p?=?0.73) and scores of coronary lesions were not different among rs3798220 genotypes. Conclusions We confirmed the association of the LPA rs10455872 with CAD in a large sample of Brazilian patients. For the LPA rs3798220, our finding is consistent with studies which showed the lack of this genetic association. PMID:24776095
Update on using coronary calcium screening by computed tomography to measure risk for coronary heart disease
Brad H. Thompson; William Stanford
Coronary artery disease (CAD) is the number one killer of adults in the United States, claiming one-half million deaths annually. Early detection and prevention strategies clearly remain a top priority for health care providers in order to reduce the high mortality rate of heart disease. As an unequivocal reflection of arteriosclerosis, coronary arterial calcium (CAC) may provide a means to
Simulation of Blood Flow Coronary Artery with Consecutive Stenosis and Coronary-Coronary Bypass
Razavi, Seyed Esmail; Zanbouri, Ramin; Arjmandi-Tash, Omid
Introduction In this research the behavior of coronary arteries has been studied with symmetric and asymmetric consecutive stenosis, and grafted vessels. Methods The incompressible Navier-Stokes and energy equations were discretized with second-order upwind method. Assumptions such as Newtonian fluid, wall rigidity and steady-flow were used. Results All the calculations showed the same results with Newtonians and non- Newtonian fluids. It was found that the possibility of stenosis be reduced by increasing the graft angle. However, there exists further stenosis possibility. Among the three graft angles 20, 30 ? and 40, the 30 ? was found to be the reliable ones. Conclusion Based on these findings, it can be deduced that there would be a high risk of further atherosclerosis when the first stenose has the maximum percentage. PMID:23678413
Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise (see comments)
Verani, M.S.; Mahmarian, J.J.; Hixson, J.B.; Boyce, T.M.; Staudacher, R.A. (Baylor College of Medicine, Houston, TX (USA))
Pharmacological coronary vasodilation induced by dipyridamole is often used in association with thallium-201 myocardial scintigraphy to evaluate the presence and prognostic significance of coronary artery disease. Because dipyridamole acts by blocking the cellular uptake of adenosine, we investigated the usefulness of direct intravenous administration of adenosine, a physiological substance with an exceedingly short (less than 2 seconds) plasma half-life, to induce maximal controlled coronary vasodilation in conjunction with 201Tl scintigraphy. We studied 89 patients (44 men and 45 women; mean age, 64 +/- 10 years (SD)) who were unable to perform an exercise test and were referred for evaluation of suspected coronary artery disease. The intravenous infusion of adenosine began at an initial rate of 50 micrograms/kg/min and was increased by stepwise increments every minute to a maximal rate of 140 micrograms/kg/min. 201Tl was injected intravenously after 1 minute at the highest infusion rate, followed by immediate and delayed (4 hour) tomographic imaging. At the highest infusion rate, adenosine induced a significant (p less than 0.001) decrease in systolic (8.7 +/- 19.3 mm Hg) and diastolic (6.7 +/- 9.4 mm Hg) blood pressures as well as a significant (p = 0.0001) increase in heart rate (14.5 +/- 11.0 beats/min). Side effects occurred in 83% of the patients but resolved spontaneously within 1 or 2 minutes after discontinuing the adenosine infusion. Chest, throat, or jaw pain were the most frequent symptoms and occurred in 57% of the patients. Headache (35%) and flush (29%) were also common. Ischemic electrocardiographic changes occurred in 12% of the patients, and transient first-degree atrioventricular block occurred in 10%.
Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors
Chevli, Parag; Kelash, Fnu; Gadhvi, Pragnesh; Grandhi, Sreeram; Syed, Amer
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50) and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement. PMID:25317268
Infective endocarditis related to a coronary artery fistula with an unusual localization and ectatic coronary arteries.
Gerede, Demet Menekse; Acibuca, Aynur; Uzun, Caglar; Goksuluk, Huseyin; Ongun, Aydan; Kilickap, Mustafa; Erol, Cetin
Coronary artery fistulas (CAF) are a rare cardiac anomaly that can be either congenital or acquired. CAFs have clinical significance because of complications such as dyspnea on exertion, congestive heart failure, and cardiac tamponade. The literature also contains case reports of CAF presenting as bacterial endocarditis. We describe a 31-year-old man who presented with native valve infective endocarditis related to an unusual form of a CAF between the circumflex coronary artery and left ventricle. He also had giant coronary arteries, which were imaged with computed tomography angiography and transesophageal echocardiography. The diameter of the circumflex coronary artery and left main coronary artery was measured as 19 mm. Surgical intervention for heart valves was performed because of vegetations resistant to continued antibiotic treatment. At the same time, the CAF was treated with surgery. PMID:25362867
Spontaneous coronary artery dissection: a rare cause of acute coronary syndrome
Laghari, Abid Hussain; Khan, Aamir Hameed; Kazmi, Khawar Abbas
We present a case of a 71-year-old man, with a history of hypertension and dyslipidaemia, who presented with typical cardiac chest pain and palpitations of 2?h duration. The examination revealed irregular pulse of 138?bpm, blood pressure 115/75?mm?Hg, variable first and normal second heart sounds. The lungs were clear to auscultation. The ECG showed atrial fibrillation with a rapid ventricular rate. His heart rate was controlled with ? blockers and the acute coronary syndrome treatment protocol was initiated. His baseline blood reports were within normal limits and two serial troponin I tests were negative. Coronary angiogram showed dissection in the left coronary system extending into the branch vessels and 30�40% stenosis in the right coronary artery. The patient underwent coronary artery bypass graft as an emergent case. He suffered a mild stroke postsurgery with complete functional recovery. He is being followed up in the clinic and has performed well. PMID:23709531
Altered calcium sensitivity contributes to enhanced contractility of collateral-dependent coronary arteries
Heaps, Cristine L.; Parker, Janet L.; Sturek, Michael; Bowles, Douglas K.
Coronary arteries distal to chronic occlusion exhibit enhanced vasoconstriction and impaired relaxation when compared with nonoccluded arteries. In the present study, we tested the hypotheses that an increase in peak Ca2+ channel current density and/or increased Ca2+ sensitivity contributes to altered contractility in collateral-dependent coronary arteries. Ameroid occluders were surgically placed around the proximal left circumflex coronary artery (LCX) of female miniature swine. Segments of epicardial arteries (?1 mm luminal diameter) were isolated from the LCX and nonoccluded left anterior descending (LAD) arteries 24 wks following Ameroid placement. Contractile responses to depolarization (10-100 mM KCl) were significantly enhanced in LCX compared with size-matched LAD arterial rings (EC50; LAD=41.7�2.3, LCX=34.3�2.7 mM). However, peak Ca2+ channel current was not altered in isolated smooth muscle cells from the LCX compared with LAD (?5.29�0.42 vs. ?5.68�0.55 pA/pF, respectively). Furthermore, while half-maximal activation of Ca2+ channel current occurred at nearly the same membrane potential in LAD and LCX, half-maximal inactivation was shifted to a more positive membrane potential in LCX cells. Simultaneous measures of contractile tension and intracellular free Ca2+ (fura-2) levels in arterial rings revealed that significantly more tension was produced per unit change in fura-2 ratio in the LCX compared with the LAD in response to KCl-induced membrane depolarization, but not during receptor-agonist stimulation with endothelin-1. Taken together, our data indicate that coronary arteries distal to chronic occlusion display increased Ca2+ sensitivity in response to high KCl-induced membrane-depolarization, independent of changes in whole-cell peak Ca2+ channel current. Unaltered Ca2+ sensitivity in endothelin-stimulated arterial rings suggests more than one mechanism regulates Ca2+ sensitization in coronary smooth muscle. PMID:14978011
21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.
Code of Federal Regulations, 2013 CFR
...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...
21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.
Code of Federal Regulations, 2014 CFR
...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...
Spontaneous Coronary Artery Dissection: Not Just a Heart Attack
Spontaneous Coronary Artery Dissection: Not Just a Heart Attack Updated:May 15,2015 Sometimes a heart attack is not just a ... the result of spontaneous tearing in the coronary artery wall. The artery wall has three layers and ...
21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.
Code of Federal Regulations, 2011 CFR
...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...
21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.
Code of Federal Regulations, 2012 CFR
...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...
21 CFR 870.4310 - Cardiopulmonary bypass coronary pressure gauge.
Code of Federal Regulations, 2010 CFR
...cardiopulmonary bypass coronary pressure gauge is a device used in cardiopulmonary bypass surgery to measure the pressure of the blood perfusing the coronary arteries. (b) Classification. Class II (performance...
Effects of cardiac motion on right coronary artery hemodynamics.
Zeng, Dehong; Ding, Zhaohua; Friedman, Morton H; Ethier, C Ross
The purpose of this work was to investigate the effects of physiologically realistic cardiac-induced motion on hemodynamics in human right coronary arteries. The blood flow patterns were numerically simulated in a modeled right coronary artery (RCA) having a uniform circular cross section of 2.48 mm diam. Arterial motion was specified based on biplane cineangiograms, and incorporated physiologically realistic bending and torsion. Simulations were carried out with steady and pulsatile inflow conditions (mean ReD=233, alpha=1.82) in both fixed and moving RCA models, to evaluate the relative importance of RCA motion, flow pulsation, and the interaction between motion and flow pulsation. RCA motion with a steady inlet flow rate caused variations in wall shear stress (WSS) magnitude up to 150% of the inlet Poiseuille value. There was significant spatial variability in the magnitude of this motion-induced WSS variation. However, the time-averaged WSS distribution was similar to that predicted in a static model representing the time-averaged geometry. Furthermore, the effects of flow pulsatility dominated RCA motion-induced effects; specifically, there were only modest differences in the WSS history between simulations conducted in fixed and moving RCA models with pulsatile inflow. RCA motion has little effect on time-averaged WSS patterns. It has a larger effect on the temporal variation of WSS, but even this effect is overshadowed by the variations in WSS due to flow pulsation. The hemodynamic effects of RCA motion can, therefore, be ignored as a first approximation in modeling studies. PMID:12723683
Appropriateness of Percutaneous Coronary Intervention
Chan, Paul S.; Patel, Manesh R.; Klein, Lloyd W.; Krone, Ronald J.; Dehmer, Gregory J.; Kennedy, Kevin; Nallamothu, Brahmajee K.; Douglas Weaver, W.; Masoudi, Frederick A.; Rumsfeld, John S.; Brindis, Ralph G.; Spertus, John A.
Context Despite the widespread use of percutaneous coronary intervention (PCI), the appropriateness of these procedures in contemporary practice is unknown. Objective To assess the appropriateness of PCI in the United States. Design, Setting, and Patients Multicenter, prospective study of patients within the National Cardiovascular Data Registry undergoing PCI between July 1, 2009, and September 30, 2010, at 1091 US hospitals. The appropriateness of PCI was adjudicated using the appropriate use criteria for coronary revascularization. Results were stratified by whether the procedure was performed for an acute (ST-segment elevation myocardial infarction, non�ST-segment elevation myocardial infarction, or unstable angina with high-risk features) or nonacute indication. Main Outcome Measures Proportion of acute and nonacute PCIs classified as appropriate, uncertain, or inappropriate; extent of hospital-level variation in inappropriate procedures. Results Of 500 154 PCIs, 355 417 (71.1%) were for acute indications (ST-segment elevation myocardial infarction, 103 245 [20.6%]; non�ST-segment elevation myocardial infarction, 105 708 [21.1%]; high-risk unstable angina, 146 464 [29.3%]), and 144 737 (28.9%) for nonacute indications. For acute indications, 350 469 PCIs (98.6%) were classified as appropriate, 1055 (0.3%) as uncertain, and 3893 (1.1%) as inappropriate. For nonacute indications, 72 911 PCIs (50.4%) were classified as appropriate, 54 988 (38.0%) as uncertain, and 16 838 (11.6%) as inappropriate. The majority of inappropriate PCIs for nonacute indications were performed in patients with no angina (53.8%), low-risk ischemia on noninvasive stress testing (71.6%), or suboptimal (?1 medication) antianginal therapy (95.8%). Furthermore, although variation in the proportion of inappropriate PCI across hospitals was minimal for acute procedures, there was substantial hospital variation for nonacute procedures (median hospital rate for inappropriate PCI, 10.8%; interquartile range, 6.0%�16.7%). Conclusions In this large contemporary US cohort, nearly all acute PCIs were classified as appropriate. For nonacute indications, however, 12% were classified as inappropriate, with substantial variation across hospitals. PMID:21730241
Relationship between leukocyte count and angiographical characteristics of coronary atherosclerosis
En-zhi Jia; Zhi-jian Yang; Biao Yuan; Xiao-ling Zang; Rong-hu Wang; Tie-bing Zhu; Lian-sheng Wang; Bo Chen; Wen-zhu Ma
Aim:To explore the relationship between differential leucocyte count and coronary atherosclerosis.Methods:The study population consisted of 507 consecutive patients (376 male and 131 female) who underwent coronary angiography for suspected or known coronary atherosclerosis. The patients' smoking and drinking habits were investigated, and anthropometric measurements, serum measurements, and hematological measurements were conducted for every patient. The severity of coronary atherosclerosis was
Platelet hyperactivity during exercise leading to iterative coronary stent thrombosis: clinical implications
Olivier Ormezzano; Benoit Polack; G�rald Vanzetto; Mohamed Sahnoun; Jacques Machecourt
Exercise may induce platelet activation in spite of using antiplatelet treatment. We present a case where the initial acute\\u000a coronary syndrome and the iterative stent thrombosis always occurred after intense and prolonged physical effort. For this\\u000a patient the at rest response to platelet inhibition with antiplatelet treatments was assessed as adequate, but after exercise\\u000a the patient developed platelet activation which
Interval training for patients with coronary artery disease: a systematic review
Aimee K. Cornish; Suzanne Broadbent; Birinder S. Cheema
Interval training (IT) may induce physiological adaptations superior to those achieved with conventional moderate-intensity\\u000a continuous training (MCT) in patients with coronary artery disease (CAD). Our objectives were (1) to systematically review\\u000a studies which have prescribed IT in CAD, (2) to summarize the findings of this research including the safety and physiological\\u000a benefits of IT, and (3) to identify areas for
Gene expression in skeletal muscle of coronary artery disease patients after concentric and eccentric endurance training
J. Zoll; R. Steiner; K. Meyer; M. Vogt; H. Hoppeler; M. Fl�ck
Low-intensity concentric (CET) and eccentric (EET) endurance-type training induce specific structural adaptations in skeletal\\u000a muscle. We evaluated to which extent steady-state adaptations in transcript levels are involved in the compensatory alterations\\u000a of muscle mitochondria and myofibrils with CET versus EET at a matched metabolic exercise intensity of medicated, stable coronary\\u000a patients (CAD). Biopsies were obtained from vastus lateralis muscle before
Coronary stent implantation changes 3-D vessel geometry and 3-D shear stress distribution
Jolanda J. Wentzel; Deirdre M. Whelan; Willem J. van der Giessen; Heleen M. M. van Beusekom; Ivan Andhyiswara; Patrick W. Serruys; Cornelis J. Slager; Rob Krams
Mechanisms of in-stent restenosis are not fully understood. Shear stress is known to play a role in plaque and thrombus formation and is sensitive to changes in regional vessel geometry. Hence, we evaluated the regional changes in 3-D geometry and shear stress induced by stent placement in coronary arteries of pigs.Methods. 3-D reconstruction was performed, applying a combined angiographic and
Computational fluid dynamics in coronary artery disease.
Sun, Zhonghua; Xu, Lei
Computational fluid dynamics (CFD) is a widely used method in mechanical engineering to solve complex problems by analysing fluid flow, heat transfer, and associated phenomena by using computer simulations. In recent years, CFD has been increasingly used in biomedical research of coronary artery disease because of its high performance hardware and software. CFD techniques have been applied to study cardiovascular haemodynamics through simulation tools to predict the behaviour of circulatory blood flow in the human body. CFD simulation based on 3D luminal reconstructions can be used to analyse the local flow fields and flow profiling due to changes of coronary artery geometry, thus, identifying risk factors for development and progression of coronary artery disease. This review aims to provide an overview of the CFD applications in coronary artery disease, including biomechanics of atherosclerotic plaques, plaque progression and rupture; regional haemodynamics relative to plaque location and composition. A critical appraisal is given to a more recently developed application, fractional flow reserve based on CFD computation with regard to its diagnostic accuracy in the detection of haemodynamically significant coronary artery disease. PMID:25262321
Erythropoietin deficiency after coronary artery bypass procedures.
Levine, E A; Rosen, A L; Sehgal, L R; Gould, S A; Egrie, J C; Moss, G S
Erythropoietin is the primary regulator of erythropoiesis. Erythropoietin has been shown to increase exponentially in response to linear decreases in hematocrit in normal, unstressed animals. However, the effect of operation, with its attendant stress, on erythropoietin levels is unknown. The purpose of this study is to evaluate the effect of surgical stress on erythropoietin. Twenty otherwise healthy patients scheduled for elective surgical procedures were studied. The cholecystectomy group included 10 patients who underwent cholecystectomy for documented stone disease. Ten patients who underwent coronary artery bypass procedures constituted the coronary artery bypass grafting group. Patients were studied preoperatively as well as on the first and second postoperative days. The hematocrit and erythropoietin levels were similar in both groups preoperatively. The hematocrit in the coronary artery bypass grafting group was lower than that of the cholecystectomy group on postoperative day 1 (0.31 versus 0.36; p less than 0.003) and postoperative day 2 (0.30 versus 0.36; p less than 0.001). During the first two postoperative days the erythropoietin levels were similar between groups. The data show that postoperative erythropoietin levels are similar after coronary artery bypass grafting, despite more severe anemia, when compared with cholecystectomy. This suggests that after coronary artery bypass grafting there is a relative deficiency of erythropoietin. Administration of recombinant human erythropoietin to patients undergoing surgical procedures could correct the erythropoietin deficiency and accelerate postoperative erythropoiesis. PMID:2025080
Hypoxia�Reoxygenation Triggers Coronary Vasospasm in Isolated Bovine Coronary Arteries via Tyrosine Nitration of Prostacyclin Synthase
Zou, Ming-Hui; Bachschmid, Markus
The role of peroxynitrite in hypoxia�reoxygenation-induced coronary vasospasm was investigated in isolated bovine coronary arteries. Hypoxia�reoxygenation selectively blunted prostacyclin (PGI2)-dependent vasorelaxation and elicited a sustained vasoconstriction that was blocked by a cyclooxygenase inhibitor, indomethacin, and SQ29548, a thromboxane (Tx)A2/prostaglandin H2 receptor antagonist, but not by CGS13080, a TxA2 synthase blocker. The inactivation of PGI2 synthase, as evidenced by suppressed 6-keto-PGF1? release and a decreased conversion of 14C-prostaglandin H2 into 6-keto-PGF1?, was paralleled by an increased nitration in both vascular endothelium and smooth muscle of hypoxia�reoxygenation-exposed vessels. The administration of the nitric oxide (NO) synthase inhibitors as well as polyethylene-glycolated superoxide dismutase abolished the vasospasm by preventing the inactivation and nitration of PGI2 synthase, suggesting that peroxynitrite was implicated. Moreover, concomitant administration to the organ baths of the two precursors of peroxynitrite, superoxide, and NO mimicked the effects of hypoxia�reoxygenation, although none of them were effective when given separately. We conclude that hypoxia�reoxygenation elicits the formation of superoxide, which causes loss of the vasodilatory action of NO and at the same time yields peroxynitrite. Subsequently, peroxynitrite nitrates and inactivates PGI2 synthase, leaving unmetabolized prostaglandin H2, which causes vasospasm, platelet aggregation, and thrombus formation via the TxA2/prostaglandin H2 receptor. PMID:10429677
Quantitative angiographic assessment of coronary anastomoses performed without cardiopulmonary bypass
Nancy C. Poirier; Michel Carrier; Jacques Lesp�rance; Gilles C�t�; Michel Pellerin; Louis P. Perrault; L. Conrad Pelletier
Background: The quality of the anastomosis performed during coronary artery bypass grafting without cardiopulmonary bypass is a current concern, and myocardial wall restraining devices have been designed to optimize results. A quantitative angiographic analysis was performed to assess coronary anastomoses performed on beating hearts. Methods: We studied 34 patients who underwent coronary artery bypass grafting without cardiopulmonary bypass between February
Coronary artery bypass grafting after orthotopic heart transplantationq
M. Muscia; M. Pasic; R. Meyer; E. Wellnhoferb Loebe; Y. Weng
Objective: Graft coronary disease (GCD) remains the major determinant of long-term survival after heart transplantation. Therapeutic strategies for the prevention or retardation of GCD in the cardiac allograft are limited, and palliative surgical coronary revascularization has been attempted. The aim of this report was to retrospectively analyze our results of coronary artery bypass grafting after cardiac transplanta- tion. This paper
Coronary artery bypass grafting after orthotopic heart transplantation
M. Musci; M. Pasic; R. Meyer; M. Loebe; E. Wellnhofer; Y. Weng; H. Kuppe; R. Hetzer
Objective: Graft coronary disease (GCD) remains the major determinant of long-term survival after heart transplantation. Therapeutic strategies for the prevention or retardation of GCD in the cardiac allograft are limited, and palliative surgical coronary revascularization has been attempted. The aim of this report was to retrospectively analyze our results of coronary artery bypass grafting after cardiac transplantation. This paper correlates
Institutional report - Coronary Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin
Theo Kofidis; Hans Gerd Paeschke; Artur Lichtenberg; Maximilian Emmert; Felix Woitek; Vassilios Didilis; Axel Haverich; Uwe Klima
In the present study we identify parameters which influence the incidence of myocardial infarction (MI), need for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and cardiac mortality after minimal invasive coronary artery bypass grafting (MIDCABG). With a mean follow-up of 30\\
Generation of an Anatomically Based Geometric Coronary Model
N. P. Smith; A. J. Pullan; P. J. Hunter
A discrete anatomically accurate finite element model of the largest six generations of the coronary arterial network is developed. Using a previously developed anatomically accurate model of ventricular geometry the boundaries of the coronary mesh are defined from measured epicardial coronaries. Network topology is then generated stochastically from published anatomical data. Spatial information is added to this topological data using
Superdominant Right Coronary Artery with Double Posterior Descending Artery
Maheshwari, Monika; Mittal, S. R.
Coronary artery anomalies are rare entities. All angiographers and cardiac surgeons need to be familiar with these anatomic variants for proper surgical revasularisation in the presence of coronary artery disease. We report here an interesting case of superdominant right coronary artery with double posterior descending artery. PMID:25838874
Premature Coronary-Artery Atherosclerosis in Systemic Lupus Erythematosus
Yu Asanuma; Annette Oeser; Ayumi K. Shintani; Elizabeth Turner; Nancy Olsen; Sergio Fazio; MacRae F. Linton; Paolo Raggi; C. Michael Stein
background Premature coronary artery disease is a major cause of illness and death in patients with systemic lupus erythematosus, but little is known about the prevalence, extent, and caus- es of coronary-artery atherosclerosis. methods We used electron-beam computed tomography to screen for the presence of coronary- artery calcification in 65 patients with systemic lupus erythematosus (mean ( � SD) age,
A "normal" invasive coronary angiogram may not be normal.
N�rgaard, Bjarne L; Hansson, Nicolaj C; Christiansen, Evald H; Kaltoft, Anne; B�tker, Hans Erik; Lassen, Jens F; M�ng, Michael; Jensen, Jesper M
In clinical practice, a normal or near-normal invasive coronary angiogram is considered to be reliable evidence for the absence of hemodynamically significant coronary artery disease. We present 2 patients with near-normal coronary angiograms who had noninvasive evidence of vessel-specific ischemia confirmed by invasive measurement of fractional flow reserve. PMID:26088376
Diagnosis and Operation for Anomalous Circumflex Coronary Artery
Background. Origin of the left circumflex coronary artery from the right sinus of Valsalva is the most common anatomic variation of the coronary artery circulation. However, there are few reports about the operative approach to this anomalous vessel.Methods. Forty patients having this anomaly were identified from 10,216 adult cardiac catheterization procedures. Forty percent of the anomalous circumflex coronary arteries (ACCAs)
Management of Acute Coronary Syndrome in Diabetes Mellitus
Jim M. John; Deepak L. Bhatt
Diabetes mellitus is an increasingly prevalent condition in the modern era. Coronary artery disease is the major cause of mortality in this population. Despite advances in the therapeutic modalities available for management of coronary artery disease, diabetic patients tend to have worse short and long term outcomes. Acute coronary syndrome in this patient population should be managed aggressively with antithrombotic
Coronary slow flow: is it a disease or normal variant?
Cay, Serkan
The exact pathophysiological mechanism of coronary slow flow remains unclear although some possible mechanisms such as altered microvascular tone, diffuse vascular pathology, and acute release of coronary vasoconstrictor mediators have been proposed. Therefore we need new studies regarding responsible etiologies to answer the question 'Is coronary slow flow a disease or normal variant?' PMID:19297037
Coronary arteries form by developmental reprogramming of venous cells
Krasnow, Mark A.
ARTICLES Coronary arteries form by developmental reprogramming of venous cells Kristy Red-Horse1 , Hiroo Ueno2 , Irving L. Weissman2 & Mark A. Krasnow1 Coronary artery disease is the leading cause of death worldwide. Determining the coronary artery developmental program could aid understanding
Leow, Wee Kheng
TRACKING OF CORONARY ARTERIES IN ANGIOGRAM SEQUENCE BY STRUCTURAL MATCHING OF JUNCTIONS WANG YUMEI NATIONAL UNIVERSITY OF SINGAPORE 2011 #12;TRACKING OF CORONARY ARTERIES IN ANGIOGRAM SEQUENCE BY STRUCTURAL;Abstract Coronary artery disease is the most common form of heart disease and is a lead- ing cause of death
Concomitant Brachiocephalic and Coronary Artery Disease: Outcome and Decision Analysis
Thomas J. Takach; George J. Reul; J. Michael Duncan; Zvonimir Krajcer; James J. Livesay; Igor D. Gregoric; Roberto D. Cervera; David A. Ott; O. Howard Frazier; Denton A. Cooley
Background. In patients with coronary artery disease, concomitant brachiocephalic disease may affect outcome and influence decision making regarding operative stag- ing, technique, and choice of conduit. Methods. Eighty consecutive patients (mean age, 59.3 years; 60.0% male) with concomitant brachiocephalic and coronary artery disease were identified either before (group A, n 48) or after (group B, n 32) coronary artery bypass
Myocardial Thievery: The Coronary-Subclavian Steal Syndrome
Thomas J. Takach; George J. Reul; Denton A. Cooley; J. Michael Duncan; James J. Livesay; David A. Ott; Igor D. Gregoric
Coronary-subclavian steal syndrome entails the reversal of blood flow in a previously constructed internal mam- mary artery coronary conduit, which produces myocar- dial ischemia. The most frequent cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. Although coronary-subclavian steal was initially reported to be rare, the increasing documen- tation of this phenomenon and its potentially cata-
Methods to investigate coronary microvascular function in clinical practice.
Lanza, Gaetano A; Camici, Paolo G; Galiuto, Leonarda; Niccoli, Giampaolo; Pizzi, Carmine; Di Monaco, Antonio; Sestito, Alfonso; Novo, Salvatore; Piscione, Federico; Tritto, Isabella; Ambrosio, Giuseppe; Bugiardini, Raffaele; Crea, Filippo; Marzilli, Mario
A growing amount of data is increasingly showing the relevance of coronary microvascular dysfunction (CMVD) in several clinical contexts. This article reviews techniques and clinical investigations of the main noninvasive and invasive methods proposed to study coronary microcirculation and to identify CMVD in the presence of normal coronary arteries, also trying to provide indications for their application in clinical practice. PMID:23222188
Optimizing antiplatelet therapy in patients with acute coronary syndromes: a role for monitoring platelet reactivity.
Holmes, M B; Schneider, D J
Platelet activation is seminal in the thrombosis underlying acute coronary syndromes. Furthermore, high levels of platelet reactivity are associated with an increased risk of future cardiovascular events both in apparently healthy subjects and men with overt coronary artery disease. We have developed a sensitive and specific assay of platelet reactivity using minimally altered whole blood to assess activation of glycoprotein IIb/IIIa and expression of P-selectin (a measure of alpha granule degranulation). This assay reliably identifies subjects with increased platelet reactivity who may benefit from more aggressive inhibition of platelet function on a long-term basis. In addition, this assay is sensitive to the effects of antiplatelet agents such as glycoprotein IIb/IIIa inhibitors. Abciximab, tirofiban and eptifibatide all inhibit fibrinogen binding in a concentration of dependent manner. However, marked variation in the extent of inhibition was seen between individuals. We have postulated that greater inhibition of agonist-induced fibrinogen binding in some and limited inhibition in others may account, in part, for tendencies to bleeding and recurrent thrombosis. This type of assay should allow for determination of platelet reactivity and titration of dosage to the needs of each individual. The assay has the potential to improve the care of patients with acute coronary syndromes and of those undergoing percutaneous coronary intervention as well as assist in the design of clinical trials utilizing antiplatelet drugs. PMID:10745617
[Prevention of coronary heart disease: smoking].
Heitzer, T; Meinertz, T
Smoking is the leading preventable cause of illness and premature death in Germany, claiming over 110,000 lives a year because it directly increases the risk of dying from heart disease, stroke, emphysema and a variety of cancers. The overwhelming majority of smokers begin tobacco use before they reach adulthood. Among those young people who smoke, the average age is now 13-14. In Germany, about 39% of male and 31% of female adults (age 18-60 years) continue to smoke, despite information about the unequivocally negative health consequences of smoking. The exact mechanisms of smoking-related vascular disease are not yet known. Smoking causes acute hemodynamic alterations such as increase in heart rate, systematic and coronary vascular resistance, myocardial contractility, and myocardial oxygen demand. These short-term effects could lower the ischemic threshold in smokers with coronary artery disease and contribute to the increased risk for acute cardiovascular events. Endothelial damage is thought to be an initiating event in atherosclerosis and early studies have demonstrated that long-term smoking has direct toxic effects with structural changes of human endothelial cells. Recent research has shown the importance of the functional role of the endothelium in regulating vascular tone, platelet-endothelial interactions, leukocyte adhesion and smooth muscle cell proliferation via synthesis and release of a variety of substances such as nitric oxide. There is strong evidence that smoking leads to endothelial dysfunction mainly by increased inactivation of nitric oxide by oxygen-derived free radicals. Smoking also increases oxidative modification of LDL and is associated with lower HDL plasma levels. Smoking induces a systemic inflammatory response with increased leukocyte count and elevation of the C-reactive protein level. Importantly, the prothrombotic effects of smoking have been repeatedly demonstrated to cause alterations in platelet function, imbalance of antithrombotic vs prothrombotic factors, and decrease of fibrinolytic activity. Given the enormous health hazard of tobacco use, complete abstinence from smoking should be achieved. Smoking cessation counselling should be given to healthy subjects and even more vigorously to patients with manifested disease. Every effort should be undertaken to prevent children and adolescents from starting to smoke. Brief tobacco dependence treatment is effective, and every smoker should be offered at least brief treatment at every office visit. More intensive treatment is more effective in producing long-term abstinence from tobacco. Nicotine replacement therapy (nicotine patches or gum), clinician-delivered social support, and skills training are the three most effective components of smoking cessation treatment. A framework for tobacco control measures is necessary to reduce tobacco consumption and exposure to tobacco smoke. Recommendations on specific tobacco control interventions are: 1. increase in tobacco taxes; 2. comprehensive tobacco advertising bans; 3. legislation prohibiting smoking in work and public places; 4. prohibiting the sales of tobacco products to persons under 18; 5. comprehensive disclosure of the physical, chemical and design characteristics of all tobacco products; 6. training of health professionals to promote smoking prevention and cessation interventions; and 7. development of a national network of smoking cessation treatment services. PMID:16258791
Mechanism of actions of sumatriptan on coronary flow before and after endothelial dysfunction in guinea-pig isolated heart
Ellwood, Amanda J; Curtis, Michael J
The mechanism of action of sumatriptan on coronary flow was examined before and after two different forms of endothelial ablation in guinea-pig isolated hearts. The mechanism was assessed in terms of the influence of the integrity of the coronary endothelium, the role of release of nitric oxide (NO) from the endothelium, and the receptor subtypes mediating the effects.Continuous perfusion with sumatriptan reduced coronary flow, but the concentration-response curve was v-shaped. Sumatriptan (0.001�0.1??M) caused a concentration-dependent decrease in coronary flow with the maximum effect achieved at 0.23�0.04??M. The pEC50 was 8.49�0.07. At higher concentrations (0.1�10??M) there was a concentration-dependent diminution of the vasoconstrictor effect. Endothelial ablation by saponin removed the diminution in the vasoconstrictor effect. In contrast, pretreatment with NG-nitro L-arginine methyl ester (L-NAME) (100??M, 45?min perfusion) did not affect it. This was despite both saponin and L-NAME being effective in reducing basal release of NO into the coronary effluent (measured by chemiluminescence) to the same extent (71�3 and 73�2%, respectively).GR127935, a selective 5-hydroxytryptamine1D (5-HT1D) receptor antagonist (3 and 10?nM), which by itself had no effect on coronary flow or NO release, antagonized the vasoconstrictor response to sumatriptan and unmasked a sumatriptan-induced concentration-dependent increase in coronary flow and NO release. These increases in coronary flow and NO release were abolished by pretreatment with either saponin or L-NAME.Mesulergine, a 5-HT2 receptor antagonist which had no effect by itself on basal coronary flow or NO release, inhibited the vasodilator response to sumatriptan that occurred in the presence of GR127935, and actually enhanced the vasoconstrictor response, increasing the maximum fall in coronary flow from ?3.9�0.4 to ?5.2�0.4?ml?min?1?g?1 (P<0.05). The diminution of vasoconstrictor effect of sumatriptan was abolished by mesulergine and by pretreatment with saponin, but not by L-NAME.In conclusion, guinea-pig coronary arteries constrict to low concentrations of sumatriptan, causing a reduction in coronary flow. This effect appears to be caused by 5-HT1D agonism with the receptors located on the coronary vascular smooth muscle. With higher concentrations of sumatriptan this is partially offset by a weaker vasodilator effect, which is caused by low affinity 5-HT2 agonism. Although this effect is endothelium-dependent, it is not caused by the release of NO. Interestingly, when the vasoconstrictor effect of sumatriptan was inhibited by the 5-HT1D antagonist GR127935, a high affinity vasodilator effect of sumatriptan was unmasked. This is 5-HT2 receptor mediated and is caused by release of NO from the coronary endothelium.In man, sumatriptan and 5-HT may both be capable of causing pathogenic coronary vasoconstriction. The implications of the present data are that the scope for this may depend greatly on (i) the extent of underlying endothelial dysfunction, (ii) the extent of endothelial 5-HT2 receptor-mediated release of vasodilator autacoids (which include NO) and (iii) the extent of smooth muscle 5-HT1D receptor-mediated vasoconstriction. PMID:9134215
MR-based coronary artery blood velocity measurements in patients without coronary artery disease
M. Schiemann; F. Bakhtiary; V. Hietschold; A. Koch; A. Esmaeili; H. Ackermann; A. Moritz; T. J. Vogl; N. D. Abolmaali
To evaluate the feasibility of MR-based coronary blood velocity measurements (MRvenc) in patients without coronary artery\\u000a disease (CAD). Eighty-three patients with angiographically excluded CAD received MRvenc of the proximal segments of both coronary\\u000a arteries (CAs). Using a retrospectively ECG-gated breath-hold phase-contrast FLASH sequence with high temporal resolution,\\u000a flow data were technically acquirable in 137\\/166 (83%) CAs. Quantification and analysis of
Optical coherence tomography following percutaneous coronary intervention with Excimer laser coronary atherectomy.
Rawlins, John; Talwar, Suneel; Green, Mark; O'Kane, Peter
The indications for Excimer laser coronary atherectomy (ELCA) have been refined in modern interventional practice. With the expanding role for optical coherence tomography (OCT) providing high-resolution intra-coronary imaging, this article examines the appearance of the coronary lumen after ELCA. Each indication for ELCA is discussed and illustrated with a clinical case, followed by detailed analysis of the OCT imaging pre and post ELCA. The aim of the article is to provide information to interventional cardiologists to facilitate decision making during PCI, when ELCA has been used as part of the interventional strategy. PMID:24238883
Status quo of hybrid coronary revascularization for multi-vessel coronary artery disease.
Harskamp, Ralf E; Zheng, Zhe; Alexander, John H; Williams, Judson B; Xian, Ying; Halkos, Michael E; Brennan, J Matthew; de Winter, Robbert J; Smith, Peter K; Lopes, Renato D
Hybrid coronary revascularization (HCR) combines bypass grafting of the left anterior descending (LAD) coronary artery with percutaneous coronary intervention (PCI) of non-LAD vessels. HCR has been performed as an alternative to CABG or multi-vessel PCI in thousands of patients since the late 1990s. In this review article, we provide an overview on patient selection, procedural sequence and timing, use of surgical techniques and anti-platelet agents. Additionally, patient recovery, satisfaction, costs and clinical outcomes of individual studies after HCR are evaluated. Future directions are also discussed, including the need for adequately powered randomized trials. PMID:24446561
The role of the ECG in diagnosis, risk estimation, and catheterization laboratory activation in patients with acute coronary syndromes: a consensus document.
Birnbaum, Yochai; Nikus, Kjell; Kligfield, Paul; Fiol, Miguel; Barrab�s, Jose Antonio; Sionis, Alessandro; Pahlm, Olle; Niebla, J Garcia; de Luna, Antonio Bay�s
The electrocardiogram (ECG) is the most widely used imaging tool helping in diagnosis and initial management of patients presenting with symptoms compatible with acute coronary syndrome. Acute ischemia affects the configuration of the QRS complexes, the ST segments and the T waves. The ECG should be read along with the clinical assessment of the patient. ST segment elevation (and ST depression in leads V1 -V3 ) in patients with active symptoms usually indicates acute occlusion of an epicardial artery with ongoing transmural ischemia. These patients should be triaged for emergent reperfusion therapy per current guidelines. However, many patients have ST segment elevation secondary to nonischemic causes. ST depression in leads other than V1 -V3 usually are indicative of subendocardial ischemia secondary to subocclusion of the epicardial artery, distal embolization to small arteries or spasm supply/demand mismatch. ST depression may also be secondary to nonischemic etiologies, such as left ventricular hypertrophy, cardiomyopathies, etc. Knowing the clinical scenario, comparison to previous ECG and subsequent ECGs (in cases that there are changes in the quality or severity of symptoms) may add in the diagnosis and interpretation in difficult cases. This review addresses the different ECG patterns, typically seen in patients with active symptoms, after resolution of symptoms and the significance of such changes when seen in asymptomatic patients. PMID:25262661
Do conventional risk factors predict subclinical coronary artery disease? Results from the Prospective Army Coronary Calcium Project
Allen J. Taylor; Irwin Feuerstein; Henry Wong; William Barko; Michael Brazaitis; Patrick G. O'Malley
Background Recent guidelines recommend against the routine use of coronary artery calcification (CAC) detection because the additive value over clinical prediction tools is uncertain. We compared CAC, with use of electron-beam computed tomography (EBCT), with clinical and serologic coronary risk factors for the identification of patients with increased coronary heart disease risk. Methods and Results We studied 630 active-duty US
Continuous recording of coronary sinus oxygen saturation during atrial pacing in patients with coronary artery disease or with syndrome X
T Crake; R Canepa-Anson; L Shapiro; P A Poole-Wilson
Coronary sinus oxygen saturation was measured continuously during incremental atrial pacing in 34 patients undergoing cardiac catheterisation. In eleven patients with normal coronary arteriograms, negative exercise tests, and no ST segment depression on the electrocardiogram, an increase in the rate of atrial pacing transiently decreased coronary sinus oxygen saturation but within 20 s oxygen saturation returned to the control value.
Right coronary artery arising as a terminal extension of the left circumflex artery (a rare coronary artery anomaly)
Tanr?verdi, Halil; ?eleci, Deniz; Kuru, �m�r; Semiz, Ender
A single coronary artery is a very rare type of coronary artery anomaly that may present in various forms. A patient is presented in whom the right coronary artery coursed as the terminal branch of the left circumflex artery. This is the second case of this anomaly in the literature. PMID:17622398
Mild renal insufficiency is associated with reduced coronary flow in patients with non-obstructive coronary artery disease
A R Chade; D Brosh; S T Higano; R J Lennon; L O Lerman; A Lerman
Patients with chronic kidney disease (CKD) have increased risk for cardiovascular events. However, the association between these pathophysiological processes is unclear. Therefore, this study was designed to determine the association between early CKD and coronary microvascular disease in patients with normal or mildly diseased coronary arteries. A total of 605 patients with normal or mildly diseased coronary arteries based on
The Effect of Aortic Valve Replacement on Coronary Flow Reserve in Patients with a Normal Coronary Angiogram
Attila Nemes; Tam�s Forster; Zsolt Kov�cs; Attila Thury; Imre Ungi; Mikl�s Csan�dy
Background: In patients with aortic stenosis and a normal coronary angiogram, a coronary flow reserve (CFR) is impaired. The aim of the present study was to examine the effect of aortic valve replacement (AVR) on the CFR after a long-term follow-up. Patients and Methods: 30 patients with aortic stenosis and a normal coronary angiogram were enrolled in the study. CFR
Novel oral anticoagulants in acute coronary syndrome.
Costopoulos, Charis; Niespialowska-Steuden, Maria; Kukreja, Neville; Gorog, Diana A
Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide with a prevalence that has now reached pandemic levels as a consequence of the rapid modernization of the developing world. Its presentation as an acute coronary syndrome (ACS) is a frequent reason for hospital admission and of profound implications for personal, societal and global health. Despite improvements in the management of ACS with anti-platelet and anticoagulant therapy and revascularization techniques, many patients continue to suffer recurrent ischemic events. The need to reduce future cardiovascular events has led to the development of novel therapies to prevent coronary thrombosis, targeting thrombin-mediated pathways. These include direct Xa inhibitors (apixaban, rivaroxaban and darexaban), direct thrombin inhibitors (dabigatran) and PAR 1 antagonists (vorapaxar and atopaxar). This article critically reviews the comparative mechanisms of action, the risks and benefits, together with the clinical evidence base for the use of these novel oral agents in the management of ACS patients. PMID:22989603
Visualization of Coronary Arteries from Intravenous Angiograms
NASA Technical Reports Server (NTRS)
Selzer, Robert H.
Under most circumstances, the coronary arteries are not satisfactorily visualized in intravenous angiograms. The objective of this study is to develop computer image enhancement methods that will improve the quality of the latent coronary images to a degree sufficient to detect an obstructive lesion. Such a technique, if successful, could be used as a first step alternative to conventional coronary angiography for individuals with ambiguous noninvasive cardiac tests. The determination of no lesion from the intravenous procedure would relieve the need for the conventional angiogram, while verification of an obstructive lesion could be followed by a conventional angiogram. The nature of the imaging problem and a description of the methods and initial processing results are described in this paper.
[Differentiated antiplatelet therapy for acute coronary syndromes].
Sch�fer, A; Arntz, H R; Boudriot, E; Garlichs, C; Hoffmann, S; Ince, H; Klingenheben, T; Weil, J; Zugck, C; Helms, T M; Silber, S
Dual antiplatelet therapy is the cornerstone of maintenance medication following invasive treatment of patients with acute coronary syndromes (ST elevation myocardial infarction, non-ST elevation myocardial infarction, unstable angina). Over the last decade, P2Y12 inhibition in addition to low-dose acetylsalicylic acid has been intensively debated. The debate was enriched by the results of the large phase III clinical trials for prasugrel (TRITON) and ticagrelor (PLATO) compared to clopidogrel in patients with acute coronary syndromes. This article summarizes the critical details und subanalyses of both study programmes and highlights on clinical decision making when using the three P2Y12 blockers in acute coronary syndromes. A special focus is on higher risk patients such as those with ST elevation myocardial infarction and those with coexisting diabetes, but also on minimizing relevant bleedings, which are common during more intense platelet inhibition. PMID:24430955
Coronary and systemic arterial physiology and immunohistochemical markers related to early coronary arterial lesions in beagle dogs given the potassium channel opener, ZD6169, or the endothelin receptor antagonist, ZD1611.
Jones, Huw Bowen; Bj�rkman, Jan-Arne; Schofield, Jason
We evaluated immunohistochemistry (von Willebrand Factor [vWF] or fibrinogen) and systemic and coronary arterial physiological parameters in beagle dogs to investigate early arterial lesions induced by the potassium channel opener, ZD6169, or the endothelin receptor antagonist, ZD1611. Dogs given an oral dose of ZD6169 (experiment 1) were terminated 1 day later and showed arterial and myocardial lesions. Minimal arterial lesions exhibited few condensed medial smooth muscle cells only, with others showing segmental medial necrosis occasionally with medial/adventitial acute inflammation. Intercellular immunostaining was seen in ostensibly normal tissue, where no pathology was present in conventionally stained sections. vWF and fibrinogen are valuable tools for detecting disruption of arterial integrity. In experiment 2, 2 dogs were given a single high dose of ZD6169 or ZD1611 and BP/HR monitored by conventional measures or telemetry. Substantially reduced systolic/diastolic BP and increased HR occurred within 10 min of ZD6169 infusion: ZD1611 caused minor BP decrease and HR increase. In experiment 3, both drugs given to anaesthetized dogs induced markedly exaggerated systolic phasic forward and reverse flow in left descending and right coronary arteries. Diastolic coronary artery flows were unaffected with ZD1611 and increased slightly with ZD6169. In both coronary arteries, the ZD1611-induced increase in flows paralleled decreased resistance. PMID:23125115
Relaxing effects of cyclic GMP and cyclic AMP-enhancing agents on the long-lasting contraction to endothelin-1 in the porcine coronary artery.
Lillest?l, I K; Helle, K B; Aardal, S
In the coronary circulation, endothelin-1 (ET-1) evokes spasms which are difficult to treat when the endothelial integrity is compromised. This study compares several classes of relaxing agents on already established contractions to ET-1 in an in vitro model using ring segments of the porcine left descending coronary artery (pLAD). All segments were precontracted with 10 nmol/L ET-1. The calcium channel blocker isradipine was 300 times more potent than verapamil, but was only a partial relaxant; the maximal relaxation obtained was 52 +/- 2% (n = 6). Atrial natriuretic peptide (ANP) was an equally potent relaxant of the ET-1 contraction; however, it too was an incomplete relaxant, maximal relaxation being < 60%. A 50% relaxation of the ET-1 contraction was obtained with 0.28 +/- 0.24 mumol/L ANP, n = 4 (IC50). Comparison of cyclic nucleotide analogues revealed a 30 times higher potency for 8-bromo-cyclic guanosine monophosphate (8-Br-cGMP)(IC50 44 +/- 11 mumol/L, n = 6) than for 8-bromo-cyclic adenosine monophosphate (8-Bi-cAMP) (IC50 1600 mumol/L, n = 6). The cyclic nucleotide phosphodiesterase (PDE) inhibitor milrinone, a PDE 3-inhibitor with an IC50 2.4 +/- 1.8 mumol/L, (n = 6) was 10 times more potent than rolipram (PDE 4-inhibitor), zaprinast (PDE 5-inhibitor) and vinpocentine (PDE 1-inhibitor). Withdrawal of these analogues and inhibitors from segments continuously exposed to 10 nmol/l ET-1 revealed that vinpocentine and 8-Br-cGMP were irreversible relaxants, in contrast to milrinone and 8-Br-cAMP. In conclusion, this study has demonstrated that cGMP-enhancing agents, such as the naturally occurring ANP, the calcium channel blocker isradipine, and the synthetic inhibitor of PDE 3, were the most effective relaxants of ET-1 evoked contractions in pLAD in vitro. PMID:10088199
Maternal nutrient restriction during pregnancy impairs an endothelium-derived hyperpolarizing factor-like pathway in sheep fetal coronary arteries.
Shukla, Praveen; Ghatta, Srinivas; Dubey, Nidhi; Lemley, Caleb O; Johnson, Mary Lynn; Modgil, Amit; Vonnahme, Kimberly; Caton, Joel S; Reynolds, Lawrence P; Sun, Chengwen; O'Rourke, Stephen T
The mechanisms underlying developmental programming are poorly understood but may be associated with adaptations by the fetus in response to changes in the maternal environment during pregnancy. We hypothesized that maternal nutrient restriction during pregnancy alters vasodilator responses in fetal coronary arteries. Pregnant ewes were fed a control [100% U.S. National Research Council (NRC)] or nutrient-restricted (60% NRC) diet from days 50 to 130 of gestation (term = 145 days); fetal tissues were collected at day 130. In coronary arteries isolated from control fetal lambs, relaxation to bradykinin was unaffected by nitro-l-arginine (NLA). Iberiotoxin or contraction with KCl abolished the NLA-resistant response to bradykinin. In fetal coronary arteries from nutrient-restricted ewes, relaxation to bradykinin was fully suppressed by NLA. Large-conductance, calcium-activated potassium channel (BKCa) currents did not differ in coronary smooth muscle cells from control and nutrient-restricted animals. The BKCa openers, BMS 191011 and NS1619, and 14,15-epoxyeicosatrienoic acid [a putative endothelium-derived hyperpolarizing factor (EDHF)] each caused fetal coronary artery relaxation and BKCa current activation that was unaffected by maternal nutrient restriction. Expression of BKCa-channel subunits did not differ in fetal coronary arteries from control or undernourished ewes. The results indicate that maternal undernutrition during pregnancy results in loss of the EDHF-like pathway in fetal coronary arteries in response to bradykinin, an effect that cannot be explained by a decreased number or activity of BKCa channels or by decreased sensitivity to mediators that activate BKCa channels in vascular smooth muscle cells. Under these conditions, bradykinin-induced relaxation is completely dependent on nitric oxide, which may represent an adaptive response to compensate for the absence of the EDHF-like pathway. PMID:24816259
Bioresorbable scaffolds for percutaneous coronary interventions
Gogas, Bill D.
Innovations in drug-eluting stents (DES) have substantially reduced rates of in-segment restenosis and early stent thrombosis, improving clinical outcomes following percutaneous coronary interventions (PCI). However a fixed metallic implant in a vessel wall with restored patency and residual disease remains a precipitating factor for sustained local inflammation, in-stent neo-atherosclerosis and impaired vasomotor function increasing the risk for late complications attributed to late or very late stent thrombosis and late target lesion revascularization (TLR) (late catch-up). The quest for optimal coronary stenting continues by further innovations in stent design and by using biocompatible materials other than cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding, local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics have been recently developed. These devices have been utilized in selected clinical applications so far providing preliminary evidence of safety showing comparable performance with current generation drug-eluting stents (DES). Herein we provide a comprehensive overview of the current status of these technologies, we elaborate on the potential benefits of transient coronary scaffolds over permanent stents in the context of vascular reparation therapy, and we further focus on the evolving challenges these devices have to overcome to compete with current generation DES. Condensed Abstract:: The quest for optimizing percutaneous coronary interventions continues by iterative innovations in device materials beyond cobalt chromium, platinum chromium or stainless steel for engineering coronary implants. Bioresorbable scaffolds made of biodegradable polymers or biocorrodible metals with properties of transient vessel scaffolding; local drug-elution and future restoration of vessel anatomy, physiology and local hemodynamics were recently developed. These devices have been utilized in selected clinical applications providing preliminary evidence of safety showing comparable intermediate term clinical outcomes with current generation drug-eluting stents. PMID:25780795
Impact of Prediabetic Status on Coronary Atherosclerosis
Kurihara, Osamu; Takano, Masamichi; Yamamoto, Masanori; Shirakabe, Akihiro; Kimata, Nakahisa; Inami, Toru; Kobayashi, Nobuaki; Munakata, Ryo; Murakami, Daisuke; Inami, Shigenobu; Okamatsu, Kentaro; Ohba, Takayoshi; Ibuki, Chikao; Hata, Noritake; Seino, Yoshihiko; Mizuno, Kyoichi
OBJECTIVE To determine if prediabetes is associated with atherosclerosis of coronary arteries, we evaluated the degree of coronary atherosclerosis in nondiabetic, prediabetic, and diabetic patients by using coronary angioscopy to identify plaque vulnerability based on yellow color intensity. RESEARCH DESIGN AND METHODS Sixty-seven patients with coronary artery disease (CAD) underwent angioscopic observation of multiple main-trunk coronary arteries. According to the American Diabetes Association guidelines, patients were divided into nondiabetic (n = 16), prediabetic (n = 28), and diabetic (n = 23) groups. Plaque color grade was defined as 1 (light yellow), 2 (yellow), or 3 (intense yellow) based on angioscopic findings. The number of yellow plaques (NYPs) per vessel and maximum yellow grade (MYG) were compared among the groups. RESULTS Mean NYP and MYG differed significantly between the groups (P = 0.01 and P = 0.047, respectively). These indexes were higher in prediabetic than in nondiabetic patients (P = 0.02 and P = 0.04, respectively), but similar in prediabetic and diabetic patients (P = 0.44 and P = 0.21, respectively). Diabetes and prediabetes were independent predictors of multiple yellow plaques (NYPs ?2) in multivariate logistic regression analysis (odds ratio [OR] 10.8 [95% CI 2.09�55.6], P = 0.005; and OR 4.13 [95% CI 1.01�17.0], P = 0.049, respectively). CONCLUSIONS Coronary atherosclerosis and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable between prediabetic and diabetic patients. Slight or mild disorders in glucose metabolism, such as prediabetes, could be a risk factor for CAD, as is diabetes itself. PMID:23223344
[Survey of coronary stents development for restenosis prevention].
Chen, Jie; Ni, Zhonghua; Gu, Xingzhong
Coronary stents are playing an effective way of curing cardiovascular diseases while a major drawback of restenosis is in general still present. Restenosis is resulting from neointimal hyperplasia and thrombosis which induced by the vascular lesion, hemodynamic modification and the reduction or oscillation of wall shear stress (WSS). The crucial factors that would determine the restenosis were reviewed in this paper, including the material bio-compatibilities, surface treatments, stent configuration designs and hemodynamics analyses. In particular, the hemodynamics after stents implantation based on in vivo, in vitro or Computational Fluid Dynamics (CFD) methods was discussed. A novel CFD and experimental approach of dynamics in the stent-vascular coupling system was proposed. PMID:20352916
Ivabradine, coronary artery disease, and heart failure: beyond rhythm control
Scicchitano, Pietro; Cortese, Francesca; Ricci, Gabriella; Carbonara, Santa; Moncelli, Michele; Iacoviello, Massimo; Cecere, Annagrazia; Gesualdo, Michele; Zito, Annapaola; Caldarola, Pasquale; Scrutinio, Domenico; Lagioia, Rocco; Riccioni, Graziano; Ciccone, Marco Matteo
Elevated heart rate could negatively influence cardiovascular risk in the general population. It can induce and promote the atherosclerotic process by means of several mechanisms involving endothelial shear stress and biochemical activities. Furthermore, elevated heart rate can directly increase heart ischemic conditions because of its skill in unbalancing demand/supply of oxygen and decreasing the diastolic period. Thus, many pharmacological treatments have been proposed in order to reduce heart rate and ameliorate the cardiovascular risk profile of individuals, especially those suffering from coronary artery diseases (CAD) and chronic heart failure (CHF). Ivabradine is the first pure heart rate reductive drug approved and currently used in humans, created in order to selectively reduce sinus node function and to overcome the many side effects of similar pharmacological tools (ie, ?-blockers or calcium channel antagonists). The aim of our review is to evaluate the role and the safety of this molecule on CAD and CHF therapeutic strategies. PMID:24940047
... a clot blocks an artery. Variant Angina A spasm in a coronary artery causes variant angina. The spasm causes the walls of the artery to tighten ... those who don�t. The coronary arteries can spasm as a result of: Exposure to cold Emotional ...
Vascular grafting strategies in coronary intervention
NASA Astrophysics Data System (ADS)
Knight, Darryl; Gillies, Elizabeth; Mequanint, Kibret
With the growing need for coronary revascularizations globally, several strategies to restore blood flow to the heart have been explored. Bypassing the atherosclerotic coronary arteries with autologous grafts, synthetic prostheses and tissue-engineered vascular grafts continue to be evaluated in search of a readily available vascular graft with clinically acceptable outcomes. The development of such a vascular graft including tissue engineering approaches both in situ and in vitro is herein reviewed, facilitating a detailed comparison on the role of seeded cells in vascular graft patency.
Lifesaving Embolization of Coronary Artery Perforation
Katsanos, Konstantinos, E-mail: email@example.com [Guy's and St. Thomas' Hospitals, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom); Patel, Sundip [Guy's and St. Thomas' Hospitals, NHS Foundation Trust, Department of Interventional Cardiology (United Kingdom); Dourado, Renato; Sabharwal, Tarun [Guy's and St. Thomas' Hospitals, NHS Foundation Trust, Department of Interventional Radiology (United Kingdom)
Coronary artery perforation remains one of the most fearsome complications during cardiac catheterization procedures. Although emergent bypass surgery is the preferred treatment for cases with uncontrollable perforation, endovascular vessel sealing and arrest of bleeding with a combination of balloons, covered stents, or embolic materials have also been proposed. The authors describe a case of emergent lifesaving microcoil embolization of the distal right coronary artery in a patient with uncontrollable grade III guidewire perforation resulting in cardiac tamponade. The relevant literature is reviewed and the merits and limitations of the endovascular approach are highlighted.
Coronary Sinus to Left Atrium Communication
Justaniah, Almamoon; Mckee, Brady; Silver, Jonathan; Wald, Christoph; Flacke, Sebastian
Coronary sinus anomalies are rare. They can be associated with other vascular anomalies such as persistent left superior vena cava or can occur in isolation. We present a rare case of an isolated coronary sinus communication to the left atrium. This anomaly may be clinically relevant in the setting of significant left-to-right shunting or when shunt reversal results from right-sided heart failure. It may also be significant in cases of persistent atrial fibrillation after attempted pulmonary vein isolation. PMID:24421933
Modifications of Coronary Risk Factors
Albu, Jeanine; Gottlieb, Sheldon H.; August, Phyllis; Nesto, Richard W.; Orchard, Trevor J.
In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.59 mmol/L (<100 mg/dL) with an optional goal of <1.81 mmol/L (<70 mg/dL); plasma triglyceride level <1.70 mmol/L (<150 mg/dL); blood pressure level <130 mm Hg systolic and <80 mm Hg diastolic; and smoking cessation treatment for all active smokers. Algorithms were developed for the pharmacologic management of dyslipidemia and hypertension. Dietary prescriptions for the management of glycemia, plasma lipid profiles, and blood pressure levels were adapted from existing clinical practice guidelines. Patients with a body mass index >25 were prescribed moderate caloric restriction; after the trial was under way, a lifestyle weight-management program was instituted. All patients were formally prescribed both endurance and resistance/flexibility exercises, individually adapted to their level of disability and fitness. Pedometers were distributed as a biofeedback strategy. Strategies to achieve the goals for risk factors were designed by BARI 2D working groups (lipid, cardiovascular and hypertension, and nonpharmacologic intervention) and the ongoing implementation of the strategies is monitored by lipid, hypertension, and lifestyle intervention management centers. PMID:16813737
Isolated single coronary artery with dual right coronary artery distribution. A rare anatomical variation.
Andreou, A Y; Tryfonos, A; Christodoulou, C; Theodorou, S; Avraamides, P C
We present the case of a 76-year-old patient in whom coronary angiography, performed due to non-ST-segment elevation myocardial infarction, revealed an isolated single coronary (SCA) artery with dual right coronary artery (RCA) distribution. One RCA arose from the mid segment of the left anterior descending (LAD) artery and followed a prepulmonic course to the right, while the other RCA arose as the terminal extension of the left circumflex artery beyond the crux cordis. This is the second reported case of the combination of these two variants of SCA and the first such case in which the LAD-derived RCA originated as a single branch. Furthermore, this is the first report presenting a sinus node artery with origin from an ectopic LAD-connected RCA. The clinical implications of this rare coronary artery pattern are discussed. PMID:21994031
Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography
LaFramboise, William A
Background: More than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no ...
Statins and percutaneous coronary intervention: a complementary synergy.
Echeverri, Dar�o; Cabrales, Jaime
The inclusion of statins and stents in coronary disease management during the 1980s has marked a dramatic change in the natural history of the disease. Separately, each of these therapies have progressed rapidly and have achieved a prime position in the current armamentarium. The simultaneous use of statins in patients undergoing percutaneous coronary revascularization procedures with stent implantation has shown a significant beneficial synergistic effect by reducing ischemia and necrosis, and improving coronary blood flow in patients with stable coronary disease, as well as in acute coronary syndromes. The use of high dose statins in conjunction with coronary angioplasty with stent implantation has shown great efficacy and safety in patients with severe coronary disease. PMID:24079365
The 9p21 susceptibility locus for coronary artery disease and the severity of coronary atherosclerosis
Chen, Suet Nee; Ballantyne, Christie M; Gotto, Antonio M; Marian, Ali J
Background Case-control Genome-Wide Association Studies (GWAS) have identified single nucleotide polymorphisms (SNPs) at the 9p21 locus as risk factors for coronary artery disease (CAD). The locus does not contain a clear candidate gene. Hence, the results of GWAS have raised an intense interest in delineating the basis for the observed association. We analyzed association of 4 SNPs at the 9p21 locus with the severity and progression of coronary atherosclerosis, as determined by serial quantitative coronary angiograms (QCA) in the well-characterized Lipoprotein Coronary Atherosclerosis Study (LCAS) population. The LCAS is a randomized placebo-control longitudinal follow-up study in patients with CAD conducted to test the effects of fluvastatin on progression or regression of coronary atherosclerosis. Methods Extensive plasma lipid levels were measured at the baseline and 2 1/2 years after randomization. Likewise serial QCA was performed at the baseline and upon completion of the study. We genotyped the population for 4 SNPs, previously identified as the susceptibility SNPs for CAD in GWAS, using fluorogenic 5' nuclease assays. We reconstructed the haplotypes using Phase 2, analyzed SNP and haplotype effects using the Thesias software as well as by the conventional statistical methods. Results Only Caucasians were included since they comprised 90% of the study population (332/371 with available DNA sample). The 4 SNPs at the 9p21 locus were in tight linkage disequilibrium, leading to 3 common haplotypes in the LCAS population. We found no significant association between quantitative indices of severity of coronary atherosclerosis, such as minimal lumen diameter and number of coronary lesions or occlusions and the 9p21 SNPs and haplotypes. Likewise, there was no association between quantitative indices of progression of coronary atherosclerosis and the SNPs or haplotypes. Similarly, we found no significant SNP or haplotype effect on severity and progression of coronary atherosclerosis. Conclusion We conclude the 4 SNPs at the 9p21 locus analyzed in this study do not impart major effects on the severity or progression of coronary atherosclerosis. The effect size may be very modest or the observed association of the CAD with SNPs at the 9p21 locus in the case-control GWAS reflect involvement of vascular mechanisms not directly related to the severity or progression of coronary atherosclerosis. PMID:19173706
Quantitative relationship between coronary calcium content and coronary flow reserve as assessed by integrated PET\\/CT imaging
Zelmira Curillova; Bettina F. Yaman; Sharmila Dorbala; Raymond Y. Kwong; Arkadius Sitek; Georges El Fakhri; Constantinos Anagnostopoulos; Marcelo F. Di Carli
Purpose��To evaluate the relationship between coronary artery calcium (CAC) and coronary vasodilator function.\\u000a \\u000a \\u000a \\u000a Methods��We evaluated 136 patients without known coronary artery disease (CAD) undergoing vasodilator stress 82Rb PET\\/CT and CAC scoring who showed normal myocardial perfusion. The CAC score, resting and hyperemic myocardial blood flow\\u000a (MBF), coronary flow reserve (CFR) and coronary vascular resistance were analyzed.\\u000a \\u000a \\u000a \\u000a Results��Global and regional CAC
Spontaneous coronary artery dissection: a report of three cases and review of the literature.
Kearney, P.; Singh, H.; Hutter, J.; Khan, S.; Lee, G.; Lucey, J.
We describe the clinical course of three patients who developed spontaneous coronary artery dissection. All patients were young women, one 9 weeks pregnant. All presented with chest pain; one died suddenly proving refractory to resuscitation, another developed unstable angina culminating in myocardial infarction, cardiogenic shock and death, and the third patient underwent coronary artery bypass grafting following diagnosis of a spontaneous coronary dissection of the left anterior descending artery at angiography. Pathological findings in the two fatal cases are reported. This condition, although rare, is a prominent cause of ischaemic coronary events in young women, when it is frequently associated with pregnancy or the puerperium. Most patients die suddenly, but a clinical spectrum is seen including stable and unstable angina, myocardial infarction and cardiogenic shock. The left anterior descending artery is most frequently affected. The classical histological finding is that of a large haematoma occupying the outer third of the media resulting in complete compression of the true lumen. The cause of spontaneous dissection remains unclear but theories of aetiology include a medial eosinophilic angiitis, pregnancy-induced degeneration of collagen in conjunction with the stresses of parturition, and rupture of the vasal vasorum. The diagnosis must be considered when a patient presents with a suggestive clinical profile. Urgent angiography should be undertaken to establish the diagnosis and consideration given to the need for coronary artery bypass grafting, which has been successfully employed in a number of patients. The uneventful long-term survival of cases treated conservatively has been reported. Images Figure 1 Figure 2 PMID:8121872
Positive Association of Coronary Calcium Detected by Computed Tomography Coronary Angiography with Periprocedural Myocardial Infarction
Wang, Xinguo; Liu, Xuxia; Ge, Hailong; Yang, Qing; Liu, Xiaoli; Shi, Dongmei; Zhou, Yujie
Background Periprocedural myocardial infarction (PMI) may occur in approximately 5% to 30% of patients undergoing percutaneous coronary intervention. Whether the morphology of coronary plaque calcium affects the occurrence of PMI is unknown. Materials and Methods A total of 616 subjects with stable angina and normal baseline cardiac troponin I levels who had undergone computed tomography angiography (CTA) were referred to elective percutaneous coronary intervention. The morphology of coronary calcium was determined by CTA analysis. PMI was defined as an elevation in 24-h post-procedural cardiac troponin I levels of > 5 times the upper limit of normal with either symptoms of myocardial ischemia, new ischemic electrocardiographic changes, or documented complications during the procedure. Logistic regression was performed to identify the effect of the morphology of coronary calcium on the occurrence of PMI. Results According to the presence or morphology of coronary calcium as shown by CTA, 210 subjects were grouped in the heavy calcification group, 258 in the mild calcification group, 40 in the spotty calcification group and 108 in the control group. The dissection rate was significantly higher in the heavy calcification group than in the control group (7.1 % vs. 1.9%, p?=?0.03). The occurrence of PMI in the heavy calcification group was significantly higher than that in the control group (OR 4.38, 95% CI 1.80�10.65, p?=?0.001). After multivariate adjustment, the risk of PMI still remained significantly higher in the heavy calcification group than in the control group (OR 4.04, 95% CI 1.50�10.89, p?=?0.003). Conclusions The morphology of coronary calcium determined by CTA may help to predict the subsequent occurrence of PMI. A large amount of coronary calcium may be predictive of PMI. PMID:24358229
Comparison of standard coronary artery bypass grafting and minimary invasive direct coronary artery bypass grafting
Yasuhide Okawa; Hiroshi Baba; Masaki Hashimoto; Tsuneo Tanaka; Masahiko Toyama; Kouji Matsumoto; Kenichiro Azuma
Objectives: We studied indications and problems involved in minimally invasive coronary artery bypass grafting (MIDCAB)Methods: We compared patients profiles, graft patency, stenosis severity, morbidity, mortality, long-term survival and freedom from\\u000a cardiac accidents in 174 patients undergoing elective standard coronary artery bypass grafting (CABG) and 128 undergoing between\\u000a January 1996 and March 1999.Results: No statiscally difference was seen in gender, diabetes
Improved clinical outcomes in patients undergoing coronary artery bypass grafting with coronary endarterectomy
Oz M Shapira; Gabriel Akopian; Ali Hussain; Mitchell Adelstein; Harold L Lazar; Gabriel S Aldea; Richard J Shemin
Background. Coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) has been associated with increased morbidity and mortality. We sought to evaluate the impact of recent advances in operative and perioperative management on outcomes after CE.Methods. One hundred fifty-one consecutive patients undergoing first-time CABG with CE between 1991 and 1997 were compared with a concurrent group of 757 patients undergoing
Coronary anatomy, anatomic variations and anomalies: a retrospective coronary angiography study
Altin, Cihan; Kanyilmaz, Suleyman; Koc, Sahbender; Gursoy, Yusuf Cemil; Bal, U?ur; Aydinalp, Alp; Yildirir, Aylin; Muderrisoglu, Haldun
INTRODUCTION The incidence of coronary artery anomalies (CAAs) varies from 0.2% to 8.4%. Knowledge of such anatomical variations is important as coronary procedures are regularly performed these days. We aimed to find the coronary dominance pattern, intermediate artery (IMA) frequency and CAA incidence in our clinic, and compare them to those in the literature. METHODS The medical reports of 5,548 patients who had undergone coronary angiography (CAG) between 2005 and 2009 were retrospectively investigated. Dominance pattern and presence of IMA and CAA were recorded. CAAs were described using two different classifications: Angelini and Khatami�s classification, and a new modified classification that was derived from Angelini and Khatami�s classification. Some procedural details and clinical features of the patients with CAA were also investigated. RESULTS Coronary dominance pattern was: 81.6% right coronary artery, 12.2% circumflex artery and 6.2% co-dominant. IMA was present in 613 (11.0%) patients. The incidences of overall anomaly were 2.7% and 1.4%, according to the different classifications. Absent left main coronary artery, which was the most common anomaly in the present study, was found in 51 (0.9%) patients. Incidences of myocardial bridge, coronary arteriovenous fistulae and aneurysms were 1.1%, 0.2% and 0.3%, respectively. CONCLUSION CAAs are generally asymptomatic, isolated lesions. Some may lead to anginal symptoms, myocardial infarction or sudden death. We found that CAA was associated with increased radiation and contrast exposure in patients who underwent CAG. This risk could be reduced if appropriate catheters were designed and training programmes on ostial cannulation were developed. PMID:25502334
The intermediate coronary care unit. A stage in continued coronary care.
Resnekov, L
The concept of continued and progressive coronary care rather than intermediate coronary care is proposed. At each clinical stage the patient may be at risk and his management needs to be planned appropriately--prevention of the development of coronary disease, prehospital care, acute coronary care, subacute coronary care, and late hospital stay. Meticulous continued care once the patient leaves the hospital and returns home may be needed for a long time. Although the benefit of an intermediate coronary care unit has not yet been proved, significant patient risk continues beyond 12 days of hospital admission. High risk patient subsets are emerging requiring careful continued monitoring and the ability to undertake emergency measures as needed, and this is particularly so in patients suffering large anterior infarction, in those with infarction associated with cardiac failure, when infarction is associated with fascicular block and other types of conduction disturbances, and in patients who continue with rhythm disturbances after their admission to the hospital. Electrocardiograph leads III and VI displayed simultaneously should be routinely monitored in patients with fascicular blocks and acute anterior infarction as a guide to instituting prophylactic transvenous pacemaking. The continuation of intensive patient care and monitoring beyond the usual 2 to 5 days in a coronary care unit allows early mobilisation of patients in safety, thus speeding their ultimate rehabilitation. There is, as yet, no satisfactory study documenting the need for intermediate coronary care units, but much presumptive evidence is available to indicate that this is so. A carefully controlled randomised study would be invaluable. PMID:192257
Does Passive Smoking Impair Endothelium-Dependent Coronary Artery Dilation in Women? 1 1 This study was supported in part by Grant-in-Aid C09670730 from the Ministry of Education, Science, and Culture; by research grants for cardiovascular disease (7A-3, 9A-3) from the Ministry of Health and Welfare in Japan; and by the Smoking Research Foundation Grant for Biochemical Research, Tokyo, Japan
Hitoshi Sumida; Hajime Watanabe; Kiyotaka Kugiyama; Masamichi Ohgushi; Toshiyuki Matsumura; Hirofumi Yasue
Objectives. This study sought to examine whether passive smoking is associated with endothelial dysfunction in the coronary arteries.Background. Long-term exposure to cigarette smoking has been reported to suppress endothelium-dependent arterial dilation in humans. Endothelial dysfunction is an early feature of atherogenesis, and the impairment of acetylcholine (ACh)-induced coronary artery dilation indicates coronary endothelial dysfunction.Methods. We studied 38 women (40 to
Acute coronary syndrome in a patient with a single coronary artery arising from the right sinus of Valsalva.
Liesting, Crista; Brugts, Jasper Jan; Kofflard, Marcellinus Johannes Maria; Dirkali, Attila
Coronary artery anomalies are usually encountered as coincidental findings during coronary angiography or at autopsy. Life threatening symptoms, such as arrhythmias, syncope, myocardial infarction, or sudden death, can occur in up to 20% of patients. However, the majority of anomalies (80%) are benign and asymptomatic. A single coronary artery (SCA) is one of the most rarely seen coronary anomalies with an incidence of 0.05%. We report the case of a 55-year old male patient who presented with symptoms of chest pain associated with an acute myocardial infarction. Coronary angiography revealed an anomalous left main coronary artery (LMCA) originating from the right coronary ostium, and an occluded distal right coronary artery. The occluded distal right coronary artery was successfully treated by thrombosuction and stenting. In order to confirm the origin and course of the SCA, multi-slice computed tomography (MSCT) of the heart was performed after coronary angiography. MSCT showed that the anomalous LMCA originated from the right coronary artery ostium and then passed the interventricular septum, instead of being intra arterial, and under the right ventricular infundibulum. The anomalous LMCA was classified as R-II S subtype according to Lipton's classification. PMID:22953025
Coronary artery bypass surgery during pregnancy
S. Silberman; D. Fink; R. S. Berko; B. Mendzelevski; D. Bitran
A 32-year-old woman, in the 22nd week of pregnancy, underwent emergency coronary artery bypass grafting to the left anterior descending artery (LAD). She had suffered an acute myocardial infarction 10 days previously, and continued to suffer from intractable angina pectoris afterwards. Cardiac catheterization revealed spontaneous dissection of the LAD. The left internal mammary artery was used to bypass the LAD,
Trans-Fats and Coronary Heart Disease
Penny M. Kris-Etherton
A large body of data from epidemiologic, clinical trial, animal, and in vitro studies demonstrate adverse consequences of industrially synthesized trans fatty acids (TFAs) on the risk of coronary heart disease (CHD). A growing database of more recent research from virtually all experimental models demonstrates evidence of detrimental consequences of TFAs on the risk of diabetes. Evidence is accumulating about
Social class and coronary heart disease
G Rose; M G Marmot
Over the past 40 years in England and Wales the rise in mortality from coronary heart disease has continued unabated among working-class men, whereas among professional men the rate has changed little for the past 20 years. As a result it is now 26 per cent higher in social class V compared with social class I. The difference in women
Urinary Proteomic Biomarkers in Coronary Artery Disease
Lukas U. Zimmerli; Eric Schiffer; Petra Zurbig; David M. Good; Markus Kellmann; Laetitia Mouls; Andrew R. Pitt; Joshua J. Coon; Roland E. Schmieder; Karlheinz H. Peter; Harald Mischak; Walter Kolch; Christian Delles; A. F. Dominiczak
Urinary proteomics is emerging as a powerful non-invasive tool for diagnosis and monitoring of variety of human dis- eases. We tested whether signatures of urinary polypep- tides can contribute to the existing biomarkers for coronary artery disease (CAD). We examined a total of 359 urine samples from 88 patients with severe CAD and 282 con- trols. Spot urine was analyzed
Robotically-Assisted Coronary Artery Bypass Grafting
Folliguet, Thierry A.; Dibie, Alain; Philippe, Fran�ois; Larrazet, Fabrice; Slama, Michel S.; Laborde, Fran�ois
Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was 372 � 104 minutes and for MIDCAB was 220 � 69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results. PMID:20339505
Poor Oral Health and Coronary Heart Disease
K. J. Joshipura; E. B. Rimm; C. W. Douglass; D. Trichopoulos; A. Ascherio; W. C. Willett
A few recent studies have shown associations between poor oral health and coronary heart disease (CHD). The objective of this study was to examine the incidence of CHD in relation to number of teeth present and periodontal disease, and to explore potential mediators of this association, in a prospective cohort study. This study is a part of the ongoing Health
Coronary Artery Vasospasm Complicating Acute Myocarditis
Ferguson, David W.; Farwell, Allan P.; Bradley, William A.; Rollings, Robert C.
A 17-year-old boy had a 2-day prodrome of fever and mild sore throat followed by 2 episodes of severe anginal chest discomfort and substantial transient ST-segment elevations in the anterior leads of the electrocardiogram. A subsequent evaluation showed the 2 episodes were most likely coronary vasospasm complicating acute viral myocarditis. Images PMID:3176473
Coronary blood flow dynamics in rats
D. D. Matsievskii; L. M. Belkina; E. A. Tolmacheva
made it possible to measure the coronary blood flow by a contact method through the myocardial surface. A miniature piezoelectric crystal made of the titanozirconium salt of lead, 0.5 mm 2 in area, and working on a frequency of 26.8 MHz, was used as the sensitive element. This element, an emitter of ultrasound, receives ultrasound waves reflected from the blood
Inflammatory characteristics of premature coronary artery disease.
Puranik, R; Fox, O J; Sullivan, D S; Duflou, J; Bao, S
Although inflammation is a key process in atherogenesis, little is known about the inflammatory characteristics of culprit plaque in premature coronary artery disease (CAD). We investigated inflammation in coronary atheroma from subjects who died of premature CAD. From 2001-2005, we collected coronary plaque samples from consecutive cases of CAD (n=23) reported to the Department of Forensic Medicine which led to unexpected death in men aged <45 years. Coronary plaque from younger CAD decedents (<35 years, n=12) had lower levels of T cells (CD3+) (p=0.03), higher macrophage (CD 68+) (p=0.01) and T regulator cells (FOXP3+) (p=0.03) infiltration when compared to older CAD decedents (>35 years, n=11). Interestingly, there was no significant age-related difference between groups in the smooth muscle cell, apoA-I, myeloperoxidase and MMP-2 content within plaque. Hence, we demonstrate that higher expression of FOXP3 is associated with younger age at the time of fatal outcomes from CAD. These findings may have implications for plaque pathophysiology and thus warrant further investigation. PMID:19923021
Economics of coronary artery bypass grafting
Alan Williams
To decide whether the number of operations for coronary artery bypass grafting should be increased, maintained at the present levels, or decreased we need to know how cost effective they are relative to other claimants on the resources of the National Health Service. For this purpose effectiveness is taken to be the effect on life expectancy adjusted for the quality
Phlegmonous gastritis following coronary bypass surgery.
Radhi, J; Kamouna, M; Nyssen, J
Phlegmonous gastritis is a rare, rapidly progressive and potentially fatal gastric bacterial infection. A case of phlegmonous gastritis following a coronary bypass surgery is described. This condition was not diagnosed premortem due to the nonspecific nature of the gastrointestinal symptoms. Upper gastrointestinal endoscopy may be of value in establishing the diagnosis in emergencies with culture of gastric aspirate and biopsy. PMID:10625325
Refractory angina pectoris in end-stage coronary artery disease: Evolving therapeutic concepts
Frank C. Schoebel; O. Howard Frazier; Gilian A. J. Jessurun; Mike J. L. De Jongste; Kamuran A. Kadipasaoglu; Thomas W. Jax; Matthias P. Heintzen; Denton A. Cooley; Bodo E. Strauer; Matthias Leschke
Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortocoronary bypass grafting must be excluded on the basis of a recent coronary angiogram. This coronary syndrome, which represents end-stage coronary artery
Congenital coronary artery fistulae: a rare cause of heart failure in adults
Coronary artery fistulae are uncommon, reported in 0.25% of patients undergoing coronary angiography. Two patients with congenital coronary artery fistula and coronary artery disease who presented with symptoms of exacerbated congestive heart failure out of proportion to their atherosclerotic burden were successfully treated by epicardial fistula ligation and coronary artery bypass grafting with marked improvement in functional status. PMID:24886594
The non-invasive documentation of coronary microcirculation impairment: role of transthoracic echocardiography
Pawel Petkow Dimitrow; Maurizio Galderisi; Fausto Rigo
Transthoracic Doppler echocardiographic-derived coronary flow reserve is an useful hemodynamic index to assess dysfunction of coronary microcirculation. Isolated coronary microvascular abnormalities are overt by reduced coronary flow reserve despite normal epicardial coronary arteries. These abnormalities may occur in several diseases (arterial hypertension, diabetes mellitus, hypercholesterolemia, syndrome X, aortic valve disease, hypertrophic cardiomyopathy and idiopathic dilated cardiomyopathy). The prognostic role of
New concepts and paradigms in cardiovascular medicine: the noninvasive management of coronary artery disease
K. Lance Gould
Coronary atherosclerosis is a diffuse heterogeneous process that occurs throughout the length of epicardial coronary arteries. Myocardial infarction and unstable coronary syndromes are caused most commonly by plaque rupture of lipid rich, less severe coronary artery stenoses. Vigorous cholesterol lowering by low fat food and lipid active drugs, control of hypertension, and smoking abstinence stabilize plaque and markedly reduce coronary
Chaotic behavior of the coronary circulation.
Trzeciakowski, Jerome; Chilian, William M
The regulation of the coronary circulation is a complex paradigm in which many inputs that influence vasomotor tone have to be integrated to provide the coronary vasomotor adjustments to cardiac metabolism and to perfusion pressure. We hypothesized that the integration of many disparate signals that influence membrane potential of smooth muscle cells, calcium sensitivity of contractile filaments, receptor trafficking result in complex non-linear characteristics of coronary vasomotion. To test this hypothesis, we measured an index of vasomotion, flowmotion, the periodic fluctuations of flow that reflect dynamic changes in resistances in the microcirculation. Flowmotion was continuously measured in periods ranging from 15 to 40 min under baseline conditions, during antagonism of NO synthesis, and during combined purinergic and NOS antagonism in the beating heart of anesthetized open-chest dogs. Flowmotion was measured in arterioles ranging from 80 to 135 microm in diameter. The signals from the flowmotion measurements were used to derive quantitative indices of non-linear behavior: power spectra, chaotic attractors, correlation dimensions, and the sum of the Lyapunov exponents (Kolmogorov-Sinai entropy), which reflects the total chaos and unpredictability of flowmotion. Under basal conditions, the coronary circulation demonstrated chaotic non-linear behavior with a power spectra showing three principal frequencies in flowmotion. Blockade of nitric oxide synthase or antagonism of purinergic receptors did not affect the correlation dimensions, but significantly increased the Kolmogorov-Sinai entropy, altered the power spectra of flowmotion, and changed the nature of the chaotic attractor. These changes are consistent with the view that certain endogenous controls, nitric oxide and various purines (AMP, ADP, ATP, adenosine) make the coronary circulation more predictable, and that blockade of these controls makes the control of flow less predictable and more chaotic. PMID:18386090
Perceived efficacy of cannabidiol-enriched cannabis extracts for treatment of pediatric epilepsy: A potential role for infantile spasms and Lennox-Gastaut syndrome.
Hussain, Shaun A; Zhou, Raymond; Jacobson, Catherine; Weng, Julius; Cheng, Emily; Lay, Johnson; Hung, Phoebe; Lerner, Jason T; Sankar, Raman
There is a great need for safe and effective therapies for treatment of infantile spasms (IS) and Lennox-Gastaut syndrome (LGS). Based on anecdotal reports and limited experience in an open-label trial, cannabidiol (CBD) has received tremendous attention as a potential treatment for pediatric epilepsy, especially Dravet syndrome. However, there is scant evidence of specific utility for treatment of IS and LGS. We sought to document the experiences of children with IS and/or LGS who have been treated with CBD-enriched cannabis preparations. We conducted a brief online survey of parents who administered CBD-enriched cannabis preparations for the treatment of their children's epilepsy. We specifically recruited parents of children with IS and LGS and focused on perceived efficacy, dosage, and tolerability. Survey respondents included 117 parents of children with epilepsy (including 53 with IS or LGS) who had administered CBD products to their children. Perceived efficacy and tolerability were similar across etiologic subgroups. Eighty-five percent of all parents reported a reduction in seizure frequency, and 14% reported complete seizure freedom. Epilepsy was characterized as highly refractory with median latency from epilepsy onset to CBD initiation of five years, during which the patient's seizures failed to improve after a median of eight antiseizure medication trials. The median duration and the median dosage of CBD exposure were 6.8months and 4.3mg/kg/day, respectively. Reported side effects were far less common during CBD exposure, with the exception of increased appetite (30%). A high proportion of respondents reported improvement in sleep (53%), alertness (71%), and mood (63%) during CBD therapy. Although this study suggests a potential role for CBD in the treatment of refractory childhood epilepsy including IS and LGS, it does not represent compelling evidence of efficacy or safety. From a methodological standpoint, this study is extraordinarily vulnerable to participation bias and limited by lack of blinded outcome ascertainment. Appropriately controlled clinical trials are essential to establish efficacy and safety. PMID:25935511
Disruption of canonical TGF?-signaling in murine coronary progenitor cells by low level arsenic
Allison, Patrick; Huang, Tianfang; Broka, Derrick; Parker, Patti [Department of Pharmacology and Toxicology College of Pharmacy, Southwest Environmental Health Sciences Center, Steele Children's Research Center and Bio5 Institute, University of Arizona, Tucson, AZ 85721 (United States); Barnett, Joey V. [Department of Pharmacology, Vanderbilt Medical University, Nashville, TN (United States); Camenisch, Todd D., E-mail: email@example.com [Department of Pharmacology and Toxicology College of Pharmacy, Southwest Environmental Health Sciences Center, Steele Children's Research Center and Bio5 Institute, University of Arizona, Tucson, AZ 85721 (United States)
Exposure to arsenic results in several types of cancers as well as heart disease. A major contributor to ischemic heart pathologies is coronary artery disease, however the influences by environmental arsenic in this disease process are not known. Similarly, the impact of toxicants on blood vessel formation and function during development has not been studied. During embryogenesis, the epicardium undergoes proliferation, migration, and differentiation into several cardiac cell types including smooth muscle cells which contribute to the coronary vessels. The TGF? family of ligands and receptors is essential for developmental cardiac epithelial to mesenchymal transition (EMT) and differentiation into coronary smooth muscle cells. In this in vitro study, 18 hour exposure to 1.34 ?M arsenite disrupted developmental EMT programming in murine epicardial cells causing a deficit in cardiac mesenchyme. The expression of EMT genes including TGF?2, TGF? receptor-3, Snail, and Has-2 are decreased in a dose-dependent manner following exposure to arsenite. TGF?2 cell signaling is abrogated as detected by decreases in phosphorylated Smad2/3 when cells are exposed to 1.34 ?M arsenite. There is also loss of nuclear accumulation pSmad due to arsenite exposure. These observations coincide with a decrease in vimentin positive mesenchymal cells invading three-dimensional collagen gels. However, arsenite does not block TGF?2 mediated smooth muscle cell differentiation by epicardial cells. Overall these results show that arsenic exposure blocks developmental EMT gene programming in murine coronary progenitor cells by disrupting TGF?2 signals and Smad activation, and that smooth muscle cell differentiation is refractory to this arsenic toxicity. - Highlights: � Arsenic blocks TGF?2 induced expression of EMT genes. � Arsenic blocks TGF?2 triggered Smad2/3 phosphorylation and nuclear translocation. � Arsenic blocks epicardial cell differentiation into cardiac mesenchyme. � Arsenic does not block TGF?2 induced smooth muscle cell differentiation.
Coronary artery disease in congenital single coronary artery in adults: A Dutch case series
Said, Salah AM; de Voogt, Willem G; Bulut, Suat; Han, Jacques; Polak, Peter; Nijhuis, Rogier LG; op den Akker, Jeroen W; Slootweg, Andries
AIM: To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery (SCA) in adults. METHODS: We identified 15 patients with a SCA detected from four Dutch angiography centers in the period between 2010 and 2013. Symptomatic patients who underwent routine diagnostic coronary angiography (CAG) for suspected coronary artery disease and who incidentally were found to have isolated SCA were analyzed. RESULTS: Fifteen (7 females) with a mean age of 58.5 � 13.78 years (range 43-86) had a SCA. Conventional CAG demonstrated congenital isolated SCA originating as a single ostium from the right sinus of Valsalva in 6 patients and originating from the left in 9 patients. Minimal to moderate coronary atherosclerotic changes were found in 4, and severe stenotic lesions in another 4 patients. Seven patients were free of coronary atherosclerosis. Runs of non-sustained ventricular tachycardia were documented in 2 patients, one of whom demonstrated transmural ischemic changes on presentation. Myocardial perfusion scintigraphic evidence of transmural myocardial ischemia was found in 1 patient due to kinking and squeezing of the SCA with an interarterial course between the aorta and pulmonary artery. Multi-slice computed tomography (MSCT) was helpful to delineate the course of the anomalous artery relative to the aorta and pulmonary artery. Percutaneous coronary intervention was successfully performed in 3 patients. Eight patients were managed medically. Arterial bypass graft was performed in 4 patients with the squeezed SCA. CONCLUSION: SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary atherosclerosis. The availability and sophistication of MSCT facilitates the delineation of the course of a SCA. We present a Dutch case series and review of the literature. PMID:24772259
Stroke in patients undergoing coronary angiography and percutaneous coronary intervention: incidence, predictors, outcome and therapeutic options.
Werner, Nicolas; Zahn, Ralf; Zeymer, Uwe
In the present day, coronary angiography and percutaneous coronary intervention are considered to be safe procedures with low complication rates in general. Nevertheless due to their widespread use and their application in a continually aging population known to carry a higher risk for complications, periprocedural stroke affects thousands of patients undergoing coronary angiography and percutaneous coronary intervention worldwide every year. Stroke is reported to occur in 0.05-0.1% of diagnostic cardiac catheterizations and in 0.18-0.44% of patients treated with percutaneous coronary intervention in clinical routine today. Despite all improvements in pharmacological and technical issues, the rate of stroke after cardiac catheterization has remained almost constant over the last 20 years of invasive cardiology of invasive and interventional cardiology, which is most probably due to the immutability of the majority of risk factors before cardiac procedures. An advanced age, arterial hypertension, diabetes mellitus, coronary angiography performed under emergency conditions, history of stroke, renal failure, the use of an intra-aortic balloon pump, congestive heart failure and interventions at bypass grafts have been identified as risk factors for periprocedural stroke in large registries. Due to exceedingly high rates of mortality and disability stroke after coronary angiography still has an enormous impact on the patient's prognosis and on quality of life. If patients survive this devastating complication, most of them suffer from persistent neurological deficits such as motor or speech disorders. For its low incidence and consecutively missing data from randomized clinical trials, an evidence-based treatment could not yet be established, and treatment options are generally based on case series and small studies only. Nevertheless, intra-arterial thrombolysis and mechanical embolectomy seem to be promising and relatively safe approaches in the treatment of periprocedural ischemic stroke. Further research by randomized trials and large registries are needed to validate its efficacy and safety. PMID:23190068
63 FR 17327 - Food Labeling: Health Claims; Soluble Fiber From Certain Foods and Coronary Heart Disease...
Federal Register 2010, 2011, 2012, 2013, 2014
...Soluble Fiber From Certain Foods and Coronary Heart Disease; Correction AGENCY: Food and...seed husk and reduced risk of coronary heart disease (CHD). The document was published...Hypercholesterolemics: Psyllium and Coronary Heart Disease, the reference numbers used...
Giant coronary cameral fistula with coarctation of aorta in a neonate.
Awasthy, Neeraj; Sharma, Rajesh
A coronary cameral fistula (CCF) involves a sizable communication between a coronary artery and a cardiac chamber. We present a case of giant coronary cameral fistula associated with coarctation of aorta in a 13 days old neonate. PMID:26085776
Giant coronary cameral fistula with coarctation of aorta in a neonate
Awasthy, Neeraj; Sharma, Rajesh
A coronary cameral fistula (CCF) involves a sizable communication between a coronary artery and a cardiac chamber. We present a case of giant coronary cameral fistula associated with coarctation of aorta in a 13 days old neonate.