By Dr. M. J. Millan (auth.), PD Dr. Th. v. Arnim, A. Maseri M.D., F.R.C.P. (eds.)
"Silent Ischemia, present innovations and administration" comprises the court cases of a convention held in Rottach-Egern, West Germany, March five to 7, 1987. we're so much thankful to the authors for the hassle to supply manuscripts prior to the assembly, to the sponsor, Bayer AG, for his or her beneficiant aid and to the publishers for his or her effective collaboration, all of that have made the looks of this ebook attainable. whilst discussing silent myocardial ischemia, the 1st query is: "why is it silent?". To technique this question, a deeper glance needs to be taken into the pathophysiology of cardiac discomfort and the excitatory and inhibitory mechanisms concerned. It should be borne in brain that - in contradiction to what the poets have instructed us so superbly for lots of centuries - the center is a visceral and never a delicate organ. If asymptomatic ischemia didn't hold prognostic value equivalent to the symp tomatic manifestations of ischemia, then the matter of silent ischemia will be very educational and with no effects for therapy. for this reason experiences on analysis of silent ischemia are of serious significance, as their effects should still point out how aggressively sufferers are to be managed.
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There are other opioid receptors (42) which can be antagonised by naloxone only in very high concentrations or which are naloxone-insensitive. One should bear in mind that measurements of endorphins in the serum only give a limited idea of the endogenous processes; measurements inside the liquor would give a better picture of the modulatory role of endorphin systems in these patients. An activation of the humoral endogenous opioid system seems to be responsible for the pain intensity in myocardial infarction (46), even though these results are also still contradictory (43).
5. Descending inhibitory control of cardiac pain (18). Cortex PAG = Formatio reticularis lateralis periaequeductal gray Formatio reticularis medialis NRM= nucleus raphe magnus Tractus spinothalamicus Ramus Ramus comm. griseus albus @ comm. Visceral pain Table 1. Fundamental principles of multiple endogenous opiate and nonopiate analgesia systems. Classes of Analgesia Neural/Opiate Neural/Nonopiate Hormonal/Opiate Hormonal/Nonopiate Similarity to opiates (Naloxon) J, o J, o Endocrine lesions (Hypophysectomy 0 0 Neural lesions (PAG lesion) J, J, J, 0 J, 0 system has a low resting tone, which may possibly be permanently raised in certain individuals (5).
Clinicians know how to use a symptom when present; the question is also how to accept its absence. Pathophysiology, based on recent findings, can appreciate, as one face of reality, what appears to be a failure with respect to a more protective pathophysiological doctrine. References 1. Baker DG, Coleridge HM, Coleridge JCG , Nerdrum T (1980) Search for a cardiac nociceptor : stimulat ion by bradykin in of sympathetic afferent nerve endings in the heart of the cat. J Physiol 306: 519-536 2. Biagini A, L'Abbate A, Emdin M, Testa R, Mazzei MG; Carpeggiani C, Michelassi C, Andreotti F, Marchesi C, Benassi A (1986) Electrocardiographic monitoring: temporal versus spatial information and data processing.
Silent Ischemia: Current Concepts and Management by Dr. M. J. Millan (auth.), PD Dr. Th. v. Arnim, A. Maseri M.D., F.R.C.P. (eds.)