Cardiological evaluation of patients with a cerebral ischemic event: the relation between heart and brain

In this study several aspects of the cardiological evaluation of patients with cerebral ischemia are described; its usefulness for diagnosis and treatment is discussed. The aim of this thesis is to approach the clinical and epidemiological aspects of patients with cerebral ischemic events, while recogoizing the existence of beanbrain interactions in atherosclerotic disease [22]. The general idea is that the organism shonld be considered as a whole; the philosophical term for this idea is 'holism' [23, 24, 25]. In biology the holistic idea can be confirmed by the existence of generalized diseases such as atherosclerosis [26, 27, 28]. A cerebral ischemic event can be considered as a 'Gestalt'. 1bis 'Gestalt' consists of a figure and a background [21]. In the figure the special or local relationship of atherosclerosis with one patt of the organism is expressed: in cerebral ischemia the brain is the affected organ. The figure, however, may never be considered apatt from its background. In brain ischemia, the background is formed by atherosclerosis existiog in the whole organism; coronary sclerosis is pan of this background. The extent to which the specific or local charaCter of an event manifests itself, depends on the influence of the local event on the phenomenon as a whole and vice vers

Regional cardioprotection by subselective intracoronary nifedipine is not due to enhanced collateral flow during coronary angioplasty

Twelve patients with proximal stenosis of the left anterior descending artery, normal myocardial wall motion but without angiographically demonstrable collateral circulation, were studied during transluminal occlusion. Prior to the first transluminal occlusion before crossing the lesion with the balloon, patients were randomly given 0.2 mg nifedipine or its solvent in the left mainstem. The same dose was repeated via the balloon catheter, positioned across the lesion, immediately prior to the second transluminal occlusion. In all patients great cardiac venous flow and ST-elevation were monitored during and after each transluminal occlusion. The lactate extraction ratio A-GCV/A (A = arterial, GCV = great cardiac vein) was determined prior to the angioplasty procedure, 10-15 seconds after each transluminal occlusion and 10 minutes after the third transluminal occlusion. Great cardiac venous flow rose significantly to an average of 160% of basal flow when nifedipine was administered into the mainstem before the angioplasty procedure while its solvent had no effect. During each transluminal occlusion, great cardiac venous flow diminished on average by 30% in those who received nifedipine and by 28% in t