EDUCATION IN HEART VOL 1 - PART 1 doc

[...]... expression in rabbit atheroma Circulation 19 99 ;10 0 :12 15–22 EDUCATION IN HEART Inflammatory cells 10 Accumulated subendothelial lipid, particularly if oxidised, exacerbates the local in ammatory reaction and maintains activation of the overlying endothelium This results in continued expression of selectins and adhesion molecules and also expression of chemokines, in particular monocyte chemoattractant proteins -1 . .. proteins -1 (MCP -1 ) Chemokines are proinflammatory cytokines that function in leucocyte chemoattraction and activation Atheroma prone mice lacking MCP -1 develop smaller atherosclerotic lesions than mice expressing MCP -1 , providing further evidence that in ammatory cells play an important part in lesion development Once captured, the in ammatory cells migrate into the subendothelial space where, under the in uence... in patients with “stabilised” unstable angina Circulation 19 95; 91: 2 319 –24 16 Ridker P, Cushman M, Stampfer M Inflammation aspirin and the risk of cardiovascular disease in apparently healthy men N Engl J Med 19 97;336:973–9 8 Davies M, Thomas A, Knapman P, et al Intramyocardial platelet aggregation in patients with unstable angina suffering sudden ischaemic cardiac death Circulation 19 86;73: 418 –27 17 ... in patients with established coronary artery disease, but effectively “normal” cholesterol concentrations 18 Scandinavian Simvastatin Survival Study Group Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian simvastatin survival study (4S) Lancet 19 94;344 :13 83–9 19 Williams JK, Sukhova GK, Herrington DM, et al Pravastatin has cholesterol-lowering independent... thrombus in plaque causing stable angina highlights the role of subclinical disruption or erosion in plaque growth The pathological changes in plaques causing unstable angina expose thrombus in an artery in which antegrade flow continues Platelet emboli into the myocardium cause microscopic foci of necrosis which are the basis of the increased concentrations of troponin T found in the blood in a proportion... etiologic approach to management Circulation 19 98;98:2 219 –22 13 Ambrose J, Winters S, Stern A, et al Angiographic morphology and the pathogenesis of unstable angina J Am Coll Cardiol 19 85;5:609 16 14 Mann J, Kaski J, Pereira W, et al Histological patterns of atherosclerotic plaques in unstable angina patients vary according to clinical presentation Heart 19 98;80 :19 –22 15 Chen L, Chester M, Redwood S, et al... the Heart website www.heartjnl.com EDUCATION IN HEART 16 Figure 3.2 Spectrum of acute coronary syndromes Schematic of the relation between the extent of myocardial necrosis, electrocardiographic markers, and cardiac enzymes (CK-MB and troponins) Troponins provide a more sensitive indicator of myocardial injury with a lower threshold indicating adverse prognostic outcome (troponin T 0. 01 ng/dl, troponin... patients with the highest levels of CRP gain most benefit from aspirin treatment 15 MAAS Investigators Effect of simvastatin on coronary atheroma: the multicentre anti-atheroma study (MAAS) Lancet 19 94;334:633–8 16 Shepherd J, Cobbe S, Ford I, et al Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia N Engl J Med 19 95;333 :13 01 7 17 LIPID Study Group Prevention of cardiovascular... with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels The long-term intervention with pravastatin in ischaemic disease (LIPID) study N Engl J Med 19 98;339 :13 49–57 • This is the largest and most recent of the secondary prevention studies with a statin, in this case pravastatin The results prove beyond any reasonable doubt that statins prevent heart attacks... enhance the in ammatory activity of the plaque, but the primary stimulus remains the conversion of plasma LDL in the intima to a proinflammatory product .19 In keeping with this view is the consistent message from animal models of atherosclerosis that reducing plasma lipid concentrations strikingly reduces all the in ammatory processes in the plaque.20 1 Stary H, Chandler A, Dinsmore R, et al A definition . also expression of chemokines, in particu- lar monocyte chemoattractant proteins -1 (MCP -1 ) . Chemokines are proinflammatory cytokines that function in leucocyte chemoat- traction and activation matrix protein turnover by producing specific metalloproteinases that de- grade matrix proteins in the cap 4 and proin- flammatory cytokines, in particular interferon  (INF ), that inhibit VSMC. disease 10 3 Jordi Soler-Soler, Enrique Galve 16 . Timing of aortic valve surgery 10 8 Catherine M Otto 17 Cardiac valve surgery in the octogenarian 11 6 René Prêtre, Marko I Turina 18 Anticoagulation in