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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An autopsy case of primary systemic amyloidosis with severe cardiac amyloidosis in a 75-year-old Japanese man is reported. The initial signs were dyspnea and cough, followed by general fatigue and loss of appetite. Heart failure, pleural effusion, and liver cysts were found on physiological examination. Autopsy findings were primary systemic amyloidosis with severe diffuse cardiac amyloidosis and cardiac hypertrophy (585 g). Focal necrosis by infarction was found in the liver and spleen. The cause of amyloidosis was unknown.
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PMID:Primary systemic amyloidosis with severe cardiac amyloidosis. 407 77

Aortic stenosis is a heritable cardiac anomaly most common in German Shepherds, Boxers and Newfoundlands, and less common in Pugs, English Bulldogs, Boston Terriers, Fox Terriers, Schnauzers and Bassets. Clinical signs are associated with secondary left-sided heart failure and include coughing, moist rales, exercise intolerance, arrhythmias and a weak femoral pulse. It causes an ejection-type crescendo-decrescendo, systolic murmur best heard on the left side near the elbow. The ECG may be normal or may show signs of left ventricular hypertrophy, including an axis of less than 40 degrees, a QRS complex of greater than 60 seconds in duration, R waves greater than 3 mv in amplitude, ST segment slurring or depression, or T waves of an amplitude greater than 25% of that of R waves. A LAT radiograph usually reveals an enlarged cardiac silhouette, loss of the cranial cardiac waist, and normal pulmonary vasculature, while DV projections show an elongated cardiac silhouette, rounding of the left ventricular border, and a normal descending aorta. Nonselective angiocardiography reveals poststenotic dilatation of the aorta. Treatment of severely affected dogs involves surgical correction.
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PMID:Congenital cardiac disease in dogs. 648 69

Patent ductus arteriosus (PDA) is thought to be inherited and occurs twice as often in females as in males, most commonly in Poodles, Collies, Cocker Spaniels and Shetland Sheepdogs. About half of untreated dogs develop left-sided heart failure by 8 months of age. Clinical signs include coughing, decreased exercise tolerance, pulmonary edema, a "machinery" murmur in the pulmonic-aortic region, and a bounding pulse. An ECG may reveal an increased amplitude of the R wave and a lengthened P wave. Plain LAT films reveal loss of the cranial and caudal cardiac waists, increased sternal contact of the heart, increased width and straightened caudal border of the cardiac silhouette, elevated carina, and an enlarged left atrium. Changes on plain DV films include an elongated cardiac silhouette, enlarged right ventricle, and 3 bulges on the left side of the cardiac silhouette. Nonselective angiocardiography can be used for a definitive diagnosis and to demonstrate a reverse right-to-left PDA, in which the ascending aorta, brachiocephalic trunk and left subclavian artery are not opacified by contrast medium. Animals with a right-to-left shunt PDA are cyanotic in caudal body parts. Treatment of left-to-right shunt PDA involves ligation with 2 nonabsorbable sutures. A right-to-left shunt PDA should not be ligated but is treated by restricted exercise and periodic phlebotomy.
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PMID:Congenital cardiac disease in dogs. 673 21

A program of respiratory muscle sparing in 9 patients with late stage Duchenne muscular dystrophy is presented. Results indicate that regular efficient night-time support by body respirator provides a constant significant improvement in daytime gas exchange for periods averaging up to 2 years following the occurrence of moderately severe respiratory failure. Until now, the longest survival is more than 4 years at the age of 28. the average PaCO2 and PaO2 before night ventilation were 60.8mmHg and 59.3mmHg, respectively. The levels after the program was begun were 45.5 (PaCO2) and 74.6 (PaO2). These arterial blood gas levels are acceptable for good cardiopulmonary homeostasis. There have been no deaths or episodes of cardiac failure since the program began. The ease of integrating the program into the patient's lifestyle and home are important advantages. Cost of equipment is discussed. The view that these patients are terminal must be qualified. A case is also made for early aggressive conservative measures including body respirators, postural drainage, chest physiotherapy with abdominal assisted coughing, intratracheal suctioning and bronchoscopy to combat respiratory infection, and decreasing the need of tracheostomy and volume ventilators which can be so disabling to the chronic restrictive lung disease (CRLD) patient. Research and development into better design of body respirators is vitally needed. Acute care hospitals must prepare themselves for such patients who now attain more independent living and longer lifespan. For this reason there is a growing need for these facilities to acquire tank ventilators for handling such patients who may need hospitalization for acute medical complications.
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PMID:Night ventilation by body respirators for patients in chronic respiratory failure due to late stage Duchenne muscular dystrophy. 678 53

Loss or reversal of the normal sequence of atrioventricular contraction, such as occurs during ventricular pacing, can significantly reduce cardiac output. Opinions vary regarding the size of the pacemaker population that might benefit from preservation of active atrial transport during cardiac pacing. An assessment of 260 consecutive patients who underwent implantation of a permanent transvenous pacemakers by the authors between 1970 and 1979 revealed 19 patients who had clinical symptoms or hypotension when active atrial transport was lost. Thirteen patients were symptomatic with syncope, dizziness, shock, heart failure or cough; six were asymptomatic but had systolic blood pressures lowered to the 80-100 mm Hg range. In all instances but one, attempts were made to restore atrial transport by one or more of the following methods: replacement of the pulse generator with a slower, single rate generator to minimize pacer competition with the normal sinus mechanism; slowing the rate of a programmable unit; implantation of an atrial pacing system; implantation of an atrioventricular sequential pacemaker system. Restoration of the normal sequence of chamber activation by any of these methods eliminated the symptoms and stabilized arterial blood pressure. We conclude that preservation of active atrial transport was clinically important in 7.3 percent of our heterogeneous permanent pacemaker population.
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PMID:Preservation of active atrial transport; an important clinical consideration in cardiac pacing. 705 43

The successful introduction of angiotensin converting enzyme (ACE) inhibitors in the treatment of patients with essential hypertension or heart failure has increased interest in the (patho)physiological role of the renin-angiotensin system (RAS). ACE is not only involved in the formation of angiotensin II from angiotensin I, but also inactivates vasoactive substances such as bradykinin and substance P. Accumulation of these substances during treatment with ACE inhibitors may contribute to both their therapeutic action and certain adverse effects associated with their use, such as cough and angioneurotic oedema. Renin inhibitors offer an alternative approach to inhibit the RAS. The major advantage of these, still experimental, drugs is their high specificity for the RAS since angiotensinogen is the only known substrate of renin. The currently available renin inhibitors are pseudopeptides that are rapidly taken up by the liver and excreted in the bile. Consequently, these drugs are subjected to a considerable first pass effect which limits their oral bioavailability. Additionally, plasma elimination half-life times are short and the duration of action is limited. Despite these shortcomings, single oral or intravenous administration results in a 80 to 90% inhibition of plasma renin activity and a slight reduction in blood pressure in patients with hypertension. The extent of blood pressure reduction is dependent on the patient's salt balance. After 1 week of oral treatment with the renin inhibitor remikiren, the antihypertensive effect was reduced in salt-repleted hypertensive patients. Subsequent intravenous administration of the drug did not further affect blood pressure, indicating that it was not the first pass effect that was limiting the efficacy of remikiren.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical pharmacokinetics and efficacy of renin inhibitors. 758 99

One hundred and three hospitalised urban pre-school Nigerian children aged 2 weeks to 4 years with various acute lower respiratory tract infection (ALRI), were studied prospectively over a 9- month period (August 1985 - April 1986). Overlapping seasonal peaks, corresponding to the rainy/early harmattan months of August through November were most noticeable for the two major viral ALRI syndromes namely, bronchiolitis and croup. The overall M:F ratio was 1.1:1, but a corresponding ratio of 1.6:1 was recorded in the infants. The commonest ALRI symptoms were cough, breathlessness and fever while chest wall retraction, nasal flaring, tachypnoea and auscultatory crepitations were the most frequently recognised physical findings. Grunting respiration was recognised in 26 patients, majority of whom had pleural effusion and/or severe bronchopneumonia. Bronchopneumonia was the single commonest ALRI diagnosis, recorded alone or in combination with another lower respiratory syndrome, in 64 (61.2%) of the 103 cases. The croup:bronchiolitis: pneumonia ratio was 1:2.3:8.3. Nasopharyngitis was recorded in 42 (40.7%) of cases, and was frequently associated with the presumably viral ALRI syndromes of croup and bronchiolitis. Pleural effusion, frequently purulent, was the commonest respiratory complication, while heart failure and anaemia were the most frequently recognised associated conditions, found predominantly in patients with pneumonia and bronchiolitis. There was an overall ALRI case-fatality of 7.8%, representing 8 deaths, in 3 of whom measles was a co-morbid condition. All the 8 deaths had a final diagnosis of pneumonia with or without other ALRI syndromes/associated complications. While subjects with complicating pleural effusion recorded the longest mean duration of hospitalisation, those with bronchiolitis had the shortest duration of hospitalisation and no death. The epidemiologic, as well as the diagnostic and therapeutic implications of our observations are discussed.
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PMID:Acute lower respiratory infections in hospitalised urban pre-school Nigerian children: a clinical overview. 762

The objective of this study was to test the efficacy and tolerability of a precise dosage regimen of enalapril in general medical practice, in combination with conventional therapy, in patients with mild-to-moderate (NYHA classes II and III) congestive heart failure (CHF). 17,546 patients were prospectively included in this multicentre study. After three months of treatment with enalapril, 53.9% of patients were asymptomatic (NYHA Class I) and 75.1% of patients improved by at least one class in the NYHA classification. 64.6% of patients reached maintenance dosage of 20 mg/day of enalapril and mean daily dosage for all patients was 16 mg. Outcome of functional symptoms according to NYHA class was more favourable with maintenance dosages of 15 and 20 mg/day of enalapril than with maintenance dosages of 5 and 10 mg/day of enalapril. Clinical and laboratory safety was good with low rates observed of the main adverse events: cough (1.74%), hypotension (0.34%), postular hypotension (0.30%), dizziness (0.31%) and hyperkaliema (0.13%); 1.4% of patients dropped out of the study because of such events. This extensive and open study confirms, in general medical practice, the feasibility, efficacy and tolerability of a dosage regimen of enalapril, which has been previously determined in controlled studies performed in specialized medical centres, for treatment of mild-to-moderate heart failure.
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PMID:Enalapril in the treatment of mild-to-moderate heart failure in general medical practice: a prospective and multicentre study concerning 17,546 patients. 767 58

The efficacy and safety of cilazapril in chronic heart failure have been extensively investigated in an international clinical program in patients with underlying chronic heart failure with ischemic heart disease or dilated cardiomyopathy. Cilazapril in single doses of 1.25-5 mg produced a significant dose-dependent reduction in pulmonary capillary wedge pressure and systemic vascular resistance and a significant increase in cardiac index. In placebo-controlled studies, 1-5 mg of cilazapril once daily for 12 weeks prolonged predose exercise test duration and improved New York Heart Association classification status and signs and symptoms of chronic heart failure, including paroxysmal nocturnal dyspnea. Up to 86% of patients receiving these dosages had improvement, with only 12% of patients requiring the higher dose, 5 mg. These data indicate that cilazapril is effective when administered once daily to patients with chronic heart failure receiving concomitant therapy with digitalis and/or a diuretic. The safety of cilazapril in patients with chronic heart failure has been evaluated in 1,163 patients administered from 0.5 to 15 mg once daily for treatment periods ranging from 1 day to 57 months. Cilazapril was administered to 500 patients for at least 6 months, 264 patients for at least 1 year, and 101 patients for at least 2 years. The most frequently occurring adverse events were dizziness, coughing, dyspnea, fatigue, angina pectoris, and headache. Cilazapril was equally well tolerated by young and elderly patients. Treatment was discontinued due to adverse events in 12.9% of patients, mainly as a result of coughing (1.7%) and dizziness (1%). Forty-four patients (3.8%) died during cilazapril therapy or during a period without treatment. Of these deaths, 93% were due to cardiac causes, especially rhythm disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heart failure therapy with cilazapril: an overview. 770 63

The abdominal pressure is a hydrostatic one, which can be measured in the bladder, the rectum and the stomach. In physiologic conditions, the abdominal pressure is variable, with peaks as high as 100 to 200 mmHg at the time of defecation, cough. The increase in abdominal pressure elicited by abdominal distension or compression acts directly on the abdominal compartment, indirectly on the thoracic compartment, and modifies the circulation and the ventilation. Venous return is decreased as the inferior vena cava is compressed. The systemic resistances are also increased as the abdominal vessels are compressed. Therefore the circulation is mainly distributed to the superior part of the body. Although the cardiac output is decreased, the usual haemodynamic parameters remain in the normal range: arterial pressure is increased, heart rate is unchanged, central venous pressure is increased, cardiac failure is unusual. The abdominal distension is also responsible for a restrictive respiratory syndrome, mainly due to the ascension of the diaphragm. The compression of the abdominal content explains renal effects and the decreased diuresis. A sustained increase in abdominal pressure occurs in several clinical conditions. During coelioscopy, abdominal pressure is a under control and the cardiovascular effects are minor. Insufflation with CO2 carries the risk of hypercapnia, gas embolism and pneumothorax. During abdominal tamponade, anuria is directly related to the level of pressures. At an abdominal pressure over 25 mmHg, anuria is common and decompression becomes essential. The G suit increases arterial pressure either by elevating vascular resistances or increasing blood content in the upper part of the body. Therefore cardiac tolerance can be decreased especially in cardiac patients. The adverse effects of abdominal pressure can also be observed in case of peritoneal dialysis and ascites. The risk of regurgitation associated with an increased abdominal pressure must also be kept in mind. The abdominal pressure plays an important role in anaesthesia as well as in surgery. Therefore its measurement, which is easy, should become a routine.
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PMID:[Intra-abdominal pressure]. 799 45


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