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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prevention of sudden arrhythmic cardiac death must be preceded by identification of the high-risk patient to whom appropriate therapy can be given. The most common disease state associated with sudden cardiac death is coronary artery disease. Factors which identify a high-risk subset include: left ventricular dysfunction; frequent and complex arrhythmias on Holter monitoring; abnormal signal-averaged electrocardiograms; angina, ST depression, and exertional hypotension or ventricular arrthythmias on exercise testing; inducible sustained arrhythmias at electrophysiologic testing, or a combination of these factors. Other conditions which are known to be associated with sudden death include: dilated or congestive cardiomyopathy, hypertrophic cardiomyopathy, mitral valve prolapse, valvular heart disease, Wolff-Parkinson-White syndrome, myocarditis, congenital heart disease, electrolyte abnormalities, long QT syndromes, proarrhythmic effects of drugs, and less common conditions such as myocardial tumors and pulmonary hypertension. If the primary abnormality responsible for the tendency toward arrhythmias cannot be corrected, appropriate therapy should be administered to attempt to reduce the patient's risk of sudden arrhythmic cardiac death.
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PMID:Definition of patients at high risk of sudden arrhythmic cardiac death. 327 Nov 94

Two patients experienced new onset or worsening of panic disorder during treatment with propranolol for tachycardia or palpitations associated with a diagnosis of mitral valve prolapse. Both patients had a family history of panic disorder; one also had a family history of mitral valve prolapse and depression. As antidepressant drugs can treat both depression and panic disorder, it would not be inconsistent that propranolol might exacerbate either disorder. Other possible interpretations of these two cases are discussed.
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PMID:Exacerbation of panic disorder during propranolol therapy. 337 42

Inferolateral ST depression, T wave inversion, and QT prolongation have been frequently described in reports of largely symptomatic mitral valve prolapse (MVP) patients, but not in a recent population-based survey of mainly asymptomatic subjects with MVP. To learn if there is a relationship between these ECG changes and symptoms, physical findings or hemodynamic sequelae, we reviewed ECGs from 119 patients, ages 18 to 60 years who had MVP diagnosed by echocardiography. Seventy-four percent had symptoms characteristic of MVP. ST-T changes were found as frequently in asymptomatic patients (29%) as in those symptomatic (27%), and did not identify those with hemodynamic sequelae of MVP (apical systolic murmurs, Doppler-defined mitral regurgitation, or left atrial enlargement). QT prolongation was found more frequently in the symptomatic group (25% vs 10%) but did not predict syncope. When compared to the expected 0.9% prevalence of ST abnormalities in a normal population, ST-T changes and QT prolongation are indeed frequent in MVP, but are not useful in identifying clinically important subsets.
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PMID:Repolarization abnormalities in mitral valve prolapse. 359 11

To investigate still uncertain aspects of the diagnosis of ischemic heart disease (IHD) in women, between 1969 and 1984, repeated exercise studies were performed in 706 asymptomatic women (between the ages of 17 and 63 years). On observation of pathologic ST-segment depression of more than 0.1 mV, the exercise study was repeated after administration of 0.8 mg nitroglycerin. Pathologic ST-segment depression was seen in 310 women (44%). In 217 patients (31%), nitroglycerin had no effect (NTG negative); in 93 women (13%), there was normalization of the ST-segment changes (NTG positive). Additionally, in selected subgroups of patients, pulmonary artery pressure was measured at rest and during exercise and ECG mapping performed (n = 114); radionuclide ventriculograms (n = 64) and 201-thallium scintigrams (n = 99) were obtained and coronary angiography (n = 85) was performed. In the NTG-negative women, ejection fraction, myocardial perfusion and coronary arteries were normal. NTG-positive women had lower mean ejection fractions but still within normal limits and indications of impaired myocardial perfusion. High-grade coronary stenoses were found in 25%. No patient with pathologic ST-segment depression had mitral valve prolapse. NTG-positive women had significantly more risk factors than NTG-negative women. In the former group, pulmonary artery pressure measurements showed pathologic exercise hemodynamics, only in 25% of whom IHD with significant stenosis was found to be the cause. For this condition, differential diagnostic considerations include cardiomyopathy or small vessel disease.
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PMID:[New aspects in the diagnosis of ischemic heart disease in females]. 365 37

Right ventricular endomyocardial biopsies were performed in nine patients with mitral valve prolapse (MVP), and the histological features were compared with the clinical findings. All of them had atypical anterior chest pain and/or dangerous ventricular arrhythmias, but the grade of MVP was mild. Five patients had non-specific ST-T changes on resting 12 leads ECG, four had ischemic ST depression on treadmill exercise ECG, and five had dangerous arrhythmias on 24 hour Holter monitoring ECG. Resting echocardiography showed normal left ventricular function in all, but exercise echocardiography revealed reduced increment of % fractional shortening (delta % FS) in five patients. Right ventricular endomyocardial biopsy findings disclosed endocardial thickening and interstitial myocardial fibrosis in eight patients, myocardial hypertrophy in two, myocardial degeneration in five, and myocardial disarray in five, although these changes were mild. These results suggest that in patients with MVP, there is a subgroup with endomyocardial abnormalities, and these might have some relations to the variety of clinical findings in MVP.
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PMID:[Right ventricular endomyocardial biopsy findings in idiopathic mitral valve prolapse: comparison with clinical findings]. 368 Oct 3

Most previous research on mitral valve prolapse investigated its prevalence in patients whose primary diagnosis was one of the anxiety disorders. This study explored the inverse, i.e., the prevalence of anxiety disorders in patients manifesting mitral valve prolapse. There were no significant differences between patients (N = 48) and control subjects (N = 49) in panic disorder, phobic disorder, or generalized anxiety disorder or in the Zung depression score. The patient group scored significantly higher than control subjects on the Zung Anxiety Scale but significantly lower than Zung's patients with "anxiety neurosis". These results cast doubt on the hypothesis that mitral valve prolapse is etiologically related to the pathogenesis of the anxiety disorders.
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PMID:Prevalence of anxiety disorders in patients with mitral valve prolapse. 395 70

A woman with a long history of premenstrual tension syndrome (PMS) received verapamil for treatment of mitral valve prolapse. Associated with verapamil therapy was a decreased severity in many symptoms of PMS, including agitation, depression, emotional outbursts, and irritability. A possible mechanism is discussed.
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PMID:Verapamil in the treatment of premenstrual syndrome: case report. 395 85

Mitral valve prolapse ( MVP ) , responsible for most of the symptoms which had previously been interpreted as being due to neurocirculatory disorders or cardiac neurosis , is being recognised more often and has an incidence of about 6-8 % in an unselected population . Although this condition was considered for a long time to be a benign auscultatory abnormality , it may be the cause of serious cardiac complication . Arrhythmias predominate with an incidence of 60 to 80 % on continuous electrocardiography . In a series of 245 patients with mitral valve prolapse confirmed on echocardiography , 52 patients chosen at random were studied to determine the incidence pf ST changes , disturbances of heart rate , QT interval , changes of QRS , arrhythmias with resting , exercise and continuous ECG over 24 hours ( HMS = Holter Monitoring System ) . Abnormalities of ventricular repolarisation , especially flattening of the T wave and , less commonly , St depression were observed in about one third of the patients . These changes were more common in the inferior but were also found in the left precordial leads . 73 % of the 52 patients had a heart rate of 75/mn and their QT intervals showed the following changes : 30.7 % Had a duration greater than the 120 th percentile ; 19.2 % had a duration greater than the upper limit of normal . The other 50 % had a QT interval of around the 100 th percentile . None had a duration of less than the 90 th percentile . In 22.5 % patients , QRS changes due to conduction defects were recorded ( 15 % right bundle branch block - RBBB - , 7.5 % incomplete RBBB ) . HMS is the method of choice for detection of arrhythmias . Resting ECG only showed premature ventricular contractions ( PVCs ) in 12.5 % , compared to 32.5 % on exercise ECG and 62.5 % on HMS . 50 % PVCs were monomorphic , 5 % polymorphic , 7.5 % in salvos and 7.4 % supraventricular in origin . The circadian variation of PVC was striking with a high incidence during periods of activity . There was no statistical correlation between the incidence of PVCs , age , sex , type of MVP and the symptoms and auscultatory findings . The theories on the pathogenesis of the arrhythmias are divided between that based on an underlying cardiomyopathy ( confirmed by the presence of degenerated myocytes on electron microscopy ) and the mechanical hypothesis ( chordae tendinae irritating the endocardium or traction on the papillary muscle with resulting ischaemia ) which provide a better explanation of the clear predominance of monomorphic PVCs . The treatment of Barlow's syndrome is discussed . In our opininon , therapy is only required for ventricular arrhythmias detected by a sufficiently sensitive method such as HMS . Most authors use beta blockers , eventually in association with quinidine Therapeutic successes have also been observed with mexiletine , amiodarone , aprindine and less commonly with disopyramide .
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PMID:[Electrocardiographical changes and rhythm disorders in Barlow's syndrome]. 615 62

Mitral valve prolapse is usually a benign affection, and yet but rather seldom, severe rhythmic troubles and even a sudden death may happen. The authors relate an observation about a seventeen years old young man presenting syncopes caused by ventricular fibrillation fit. The existence of a mitral valve prolapse is demonstrated by phonomecanogram and specially by echocardiogram which shows a telesystolic depression of the small valve. The observation is followed by commentaries about the frequency and clinic of Barlow syndrome. The rhythmic troubles liable to accompany this mitral damage are analysed and so is the evaluation of the risk of a sudden death by ventricular fibrillation.
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PMID:[Mitral valve prolapse and severe rhythmic trouble (author's transl)]. 625

Poor effort tolerance is observed in a small percentage of cases of idiopathic mitral valve prolapse (IMVP). The aim of this study was to assess the possible left ventricular dysfunction in such cases, responsible for poor effort tolerance. Left ventricular function and segmental wall motion were studied retrospectively in a group of 17 patients with IMVP. The patients, average age 53 +/- 12 years, had poor effort tolerance (ST segment depression of 2 to 4 mm in 15 cases, drop in blood pressure in 6 cases) justifying catheter and angiographic studies. All patients had IMVP confirmed on RAO left ventriculography. There was no associated mitral regurgitation or coronary artery disease. Left ventricular function was studied by parameters of global function (systolic and diastolic parameters, volume measurements) and by a quantitative study of segmental wall contraction. The method used for studying regional wall motion was an application of the Stanford method in which segmental shortening is studied over all the endocavitary contour of the LV during an angiographic cycle filmed at 50 frames/second in the RAO projection. The time and velocity amplitudes of wall motion were measured during systole and diastole. The same methodology was applied to 21 normal control subjects. The results showed abnormal volumic compliance and wall motion in the IMVP group. Asynergy was mainly confined to the antero-lateral wall of the LV. The amplitude of contraction was generally normal but the contraction was slower and finished earlier. In the same zone, relaxation was abnormally early and lasted longer.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Left ventricular global and segmental function in pure mitral valve prolapse with poor tolerance for exertion]. 643 25


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