Cardiologia (Rome, Italy)
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Recent clinical trials demonstrate that thrombolytic therapy reduces morbidity and mortality of pulmonary embolism compared with heparin anticoagulation. Anticoagulant therapy fail to lyse thrombus that embolizes from the deep leg veins and from the pelvic veins. ⋯ The benefit of thrombolytic therapy is easier to appreciate among patients with massive pulmonary embolism. Further trials are necessary to assess the efficacy and the safety of the different dosages of thrombolytic therapy in pulmonary embolism.
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Early reperfusion with thrombolytic therapy in acute myocardial infarction results in myocardial salvage. However, it is apparent that patients remain at substantial risk for vascular reocclusion and residual ischemia (either peri-infarct or at a distance). Vascular reocclusion is promoted by local factors (residual thrombus, high shear rate, exposure of deep arterial tissues) as well as by systemic factors (activation of platelets and coagulation factors). ⋯ The well-acknowledged role of beta-blockers after myocardial infarction holds true even after thrombolytic therapy, since this treatment decreases the occurrence of new ischemic events. The process of left ventricular remodeling after myocardial infarction is presently investigated and a positive effect has been shown in patients with large myocardial infarction being treated with converting-enzyme inhibitors and/or nitrates. The results of large-scale clinical trials currently underway are eagerly awaited.
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Cardiologia (Rome, Italy) · Dec 1991
[Angina due to anatomical anomalies and to functional changes in the epicardial coronary vessels].
Myocardial ischemia with normal coronary arteries can be due to anatomic or functional reasons. The more severe congenital coronary anomalies in the adulthood are the origin of the left main of the left coronary artery from the right aortic sinus, with a course between the aorta and the pulmonary trunk, and the origin of the left main from the pulmonary trunk. ⋯ We report the hemodynamic, angiographic and stress test data of 30 patients affected by chest pain, with myocardial ischemia and normal coronary arteries. In 8 patients the response of epicardial coronary arteries to intracoronary infusion of acetylcholine was evaluated.