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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although depression and cognitive impairment have been associated with excess mortality following heart surgery, the relationship of these factors to death following treatment for cardiac arrhythmias is unknown. We prospectively examined the associations between biobehavioral factors, mortality, and arrhythmia manageability in 88 patients undergoing programed electrical stimulation for the diagnosis and treatment of supraventricular and ventricular tachyarrhythmias or syncope of unknown origin. Statistically significant relationships were identified between depression and mortality, and between cognitive impairment and mortality. No relationships were observed between cognitive impairment or psychologic profile and arrhythmia severity or treatment efficacy. Our data suggest that arrhythmia morbidity and mortality may in part be a function of cognitive and emotional impairments that lessen the individual's capacity to comply with lifesaving therapy, maintain a stable physiologic milieu, and continue an adaptive emotional life. Failure to recognize the clinical significance of these impairments in patients at risk for sudden cardiac death will contribute to the current difficulty reducing the death and disability associated with cardiac arrhythmias.
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PMID:Significance of depression and cognitive impairment in patients undergoing programed stimulation of cardiac arrhythmias. 361 69

We have reviewed the histories of 320 patients in whom a diagnosis of coronary heart disease was ultimately established and traced the symptoms back to their first appearance. In 51% the first symptom was effort angina. Difficulties in recognition arose when the symptom was localized to an unusual site, when its occurrence was dependent on a combination of exercise with cold or a recent meal, or when it was induced by excitement rather than by effort. In a quarter of the cases the onset of angina was abrupt, and in these there was usually evidence of acute infarction.In 43% of cases the first symptom was an attack of pain or discomfort in the torso occurring without any discernable precipitating factor. Again, diagnosis was difficult when the pain was in an atypical site and also when it was of brief duration associated with skeletal or abdominal disease which could cause pain at the same site, or if the patient was able to undertake strenuous exertion. In four patients cardiac pain was first experienced during a paroxysm of tachycardia. In 6% of cases the onset was marked by a symptom other than pain-most frequently dyspnoea, tiredness, faintness, or syncope.Clinical examination was of no direct value in diagnosis. Its importance lay in disclosing factors which had to be taken into account in interpreting the electrocardiogram. The electrocardiogram was invaluable, though by no means infallible. In over half of the patients the first tracing showed major abnormalities of coronary type, and nearly a quarter more showed minor S-T/T depression consistent with coronary disease. Ten per cent. showed miscellaneous abnormalities, such as left ventricular hypertrophy or bundle-branch block, and 15% no definite abnormality.There is as yet no completely reliable objective method of diagnosing early coronary heart disease, so that the recognition of symptoms remains of paramount importance.
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PMID:Earliest symptoms of coronary heart disease and their recognition. 502 16

A retrospective study of 55 patients with panic disorder referred for psychiatric consultation by primary care physicians is presented. Eighty-nine percent of the patients initially presented with one or two somatic complaints, and misdiagnosis often continued for months or years. The three most common presentations were cardiac symptoms (chest pain, tachycardia, irregular heart beat), gastrointestinal symptoms (especially epigastric distress), and neurologic symptoms (headache, dizziness/vertigo, syncope, or paresthesias). Eighty-one percent of patients had a presenting pain complaint. Hypertension and peptic ulcer were the most common medical diagnoses, and depression and alcoholism the most frequently associated psychiatric diagnoses.
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PMID:Panic disorder and somatization. Review of 55 cases. 637 87

Cardiac receptors include both mechanically and chemically sensitive receptors located in atria and in ventricles. Atrial receptors innervated by myelinated vagal afferent fibers reflexly regulate heart rate and intravascular volume. On the other hand, stimulation of ventricular receptors can cause either reflex bradycardia and hypotension or, alternatively, excitation of the cardiovascular system. The former response is mediated by vagal afferents, whereas the latter is mediated by sympathetic (spinal) afferents. Under normal circumstances, cardiac receptors sense changes in wall motion or diastolic pressure and perhaps provide a fine tuning of the cardiovascular system. However, under certain pathological conditions such as coronary ischemia, which cause release of substances such as bradykinin and prostaglandins, there is an exaggerated response of the ventricular receptors. Because these receptors cause a reflex depression of the cardiovascular system and, in particular, induce renal vasodilation, they may protect the heart and kidney by lessening myocardial oxygen requirements and by increasing renal blood flow. In the situation of heart failure both atrial and ventricular receptors are reset and therefore provide for an exaggerated neurohumoral discharge. Finally, patients with aortic stenosis may demonstrate a paradoxical vasodilation and syncope during exercise when there likely is excessive stimulation of left ventricular receptors by the high transmural pressure.
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PMID:Cardiac receptors: their function in health and disease. 638 3

This study comprised 165 cases of coronary artery spasm (147 men and 18 women) with an average age of 49,2 years (range 27 to 73 years). Smoking was a particularly significant risk factor. Symptoms were usually of recent onset (80%) and dominated by attacks of angina pectoris either at rest alone or associated with angina of effort. 14% of cases of spasm were observed during acute myocardial infarction. Some cases presented with syncope due to cardiac arrhytmias. The basal electrocardiogramme was normal in 53% of cases. Exercise stress testing may be normal (30/65 cases) or positive (ST depression recorded in 26/65 cases). In 5 cases, ST elevation was observed. Left ventricular function was usually normal: 115 patients (70%) had organic atherosclerotic lesions, with 1, 2 and 3 vessel disease in 40%, 18% and 22% respectively. Spasm was spontaneous in 24,2% of cases but most commonly provoked by ergometrine. Criteria of spasm only applied to focal spasm and exclused catheter--induced spasm. The most common site of spasm was the right coronary artery (50,3% of cases), followed by the left anterior descending (31% of cases) and left circumflex (10,3% of cases). The outcome of these 165 cases depended on the therapeutic options (surgical treatment in 48 cases). The medium term results were generally good with a low mortality rate and follow up showed that the calcium antagonists provided effective prophylaxis against recurrence of spasm.
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PMID:[Coronary artery spasm. Apropos of 165 cases]. 641 13

Although exercise-induced ventricular tachycardia (VT), whether sustained or nonsustained, is usually associated with significant organic heart disease, its prevalence, associated characteristics and prognostic significance in an asymptomatic, unreferred community-dwelling population are unknown. Therefore, the prevalence of VT associated with maximal treadmill exercise was assessed in 597 male and 325 female volunteers, aged 21 to 96 years (mean +/- standard deviation 54 +/- 16), from the Baltimore Longitudinal Study on Aging who were without apparent heart disease. Ten subjects, 7 men and 3 women, with exercise-induced VT were identified, representing 1.1% of those tested; only 1 was younger than 65 years. All episodes of VT were asymptomatic and nonsustained. In 9 of 10 subjects, VT developed at or near peak exercise. The longest run of VT was 6 beats; multiple runs of VT were present in 4 subjects. Two subjects had exercise-induced ST-segment depression, but subsequent exercise thallium scintigraphic results were negative in each. Compared with a group of age- and sex-matched control subjects, those with asymptomatic, nonsustained VT displayed no difference in exercise duration, maximal heart rate, or the prevalence of coronary risk factors or exercise-induced ischemia as measured by electrocardiography and thallium scintigraphy. Over a mean follow-up period of 2 years, no subject has developed symptoms of heart disease or experienced syncope or sudden death. Thus, exercise-induced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not portend increased cardiovascular morbidity or mortality rates over a 2-year period of observation.
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PMID:Prevalence and prognosis of exercise-induced nonsustained ventricular tachycardia in apparently healthy volunteers. 648 25

In order to evaluate the relative role of the automatic nervus system and of the intrinsic electrophysiologic properties on the sinus node function, we measured the corrected sinus node recovery time before and after autonomic nervous system blockade in 24 patients. Fourteen had a sick sinus syndrome, five had a carotid sinus syncope, two had syncope of unknown origin associated with bradycardia. Beta blockade was obtained by infusing metoprolol intravenously at a dosage of 0.2 mg/kg; complete automatic blockade was achieved by further i.v. administration of atropine at a dosage of 0.04 mg/kg. After beta blockade, the corrected sinus node recovery time increased in patients with sick sinus syndrome and intrinsic slow heart rate, whereas it decreased in patients with carotid sinus syncope or with syncope and bradycardia. In patients with sick sinus syndrome and normal intrinsic heart rate the response was variable. A positive direct correlation was found between the changes of the corrected sinus node recovery time induced by beta blockade and those induced by autonomic blockade; that is, both either prolonged or shortened the corrected sinus node recovery time. The changes of the corrected sinus node recovery time after beta blockade alone were inversely correlated with the intrinsic heart rate. We conclude that patients with intrinsic depression of the sinus node have an increased sympathetic tone.
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PMID:[Influence of beta block and autonomic nerve block on the recovery time of the sinus node in sick sinus syndrome and carotid sinus syndrome]. 651 82

The clinical course of 59 patients with coronary artery spasm and no fixed severe coronary obstruction was analyzed for an average of 5.9 years. The study group consisted of 27 men and 32 women. Angina at rest was the predominant symptom in 93% of the patients. Myocardial infarction occurred in 19% and syncope during angina in 27%. During spontaneous anginal episodes, 64% of the patients showed ST segment elevation, 17% ST segment depression and 15% no electrocardiographic changes. Major arrhythmias during angina occurred in 24% of the patients. Permanent pacemakers were required in 10% of the patients. Stress tests were positive in 32% of the patients. Long-acting nitrate therapy controlled symptoms in only 31%, and calcium antagonist agents controlled symptoms in 83% of the patients unresponsive to nitrates. Spontaneous remission of angina for at least 1 month while receiving no medical treatment occurred in 39% of the patients. Fifteen percent of patients had an indefinite remission with no recurrence of symptoms for at least 2 years. There were no cardiac deaths. The natural history of medically treated patients with pure coronary spasm is characterized by recurrent angina at rest, frequent spontaneous remission, a poor response to long-acting nitrate therapy and a good response to calcium antagonists. Although myocardial infarction and major arrhythmias are common, cardiac mortality is low in medically treated patients.
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PMID:Natural history of pure coronary artery spasm in patients treated medically. 660 22

The premenstrual symptom complex many women experience in a moderate to severe form can be divided into four subgroups. Because there is more than one syndrome and nervous tension is one of the most common symptoms, the term premenstrual tension syndromes (PMTS) is used. The most common subgroup, PMT-A, consists of premenstrual anxiety, irritability and nervous tension, sometimes expressed in behavior patterns detrimental to self, family and society. Elevated blood estrogen and low progesterone have been observed in this subgroup. Administration of vitamin B6 at doses of 200-800 mg/day reduces blood estrogen, increases progesterone and results in improved symptoms under double-blind conditions. Women in this subgroup consume an excessive amount of dairy products and refined sugar, and progesterone may be of value in them. The second-most-common subgroup, PMT-H, is associated with symptoms of water and salt retention, abdominal bloating, mastalgia and weight gain. The severe form of PMT-H is associated with elevated serum aldosterone. Vitamin B6 at high dosage suppresses aldosterone and results in diuresis and clinical improvement. Vitamin E helps the breast symptoms. Methylxanthines and nicotine should be curtailed and sodium limited to 3 gm/day. PMT-C is characterized by premenstrual craving for sweets, increased appetite and indulgence in eating refined sugar followed by palpitation, fatigue, fainting spells, headache and sometimes the shakes. PMT-C patients have increased carbohydrate tolerance and low red-cell magnesium. Adequate magnesium replacement results in improved glucose tolerance tests and decreased PMT-C symptoms. Deficiency of the prostaglandin PGE1 may also be involved in PMT-C. PMT-D is the least common but most dangerous because suicide is most frequent in this subgroup. The symptoms are depression, withdrawal, insomnia, forgetfulness and confusion. In ten PMT-D patients the mean blood estrogen was lower and the mean blood progesterone higher than normal during the midluteal phase. Elevated adrenal androgens are observed in some hirsute PMT-D patients. Two PMT-D patients with normal blood progesterone and estrogens had high lead levels in hair tissue and chronic lead intoxication. This subgroups needs careful medical attention when the symptoms are severe. Therapy should be individualized according to the results of the evaluation.
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PMID:Nutritional factors in the etiology of the premenstrual tension syndromes. 668 67

The cause of recurrent resting angina one year after aorto-coronary bypass is presented. A 65 year old female with effort and resting angina with syncope had an isolated narrowing of the proximal portion of the left anterior descending artery on coronary angiography. Saphenous vein aorto-coronary bypass and cardiac plexectomy were performed on the 18 . 12 . 78, and an excellent result was obtained in the first postoperative year. Nocturnal angina with syncope recurred on the 31 . 12 . 79 and anterior subendo-cardial ischaemic changes were noted on the post critical electrocardiogramme. On control angiography 10 days later, the bypass graft was shown to be patent. A provocative test with methylergometrine showed spasm of the whole of the revascularised artery without any changes in the other vessels. Attacks of spontaneous angina with ST depression on Holter monitoring continued despite treatment with Nifedipine (6 capsules/day). The substitution of Diltiazem (3 capsules/day) prevented further recurrence with a follow-up of three months. The authors conclude that spontaneous angina after aorto-coronary bypass is not synonymous with graft dysfunction, and suggest that the effects of cardiac denervation in vasospastic angina, where Nifedipine and Diltiazem seem to have different modes of action, need further confirmation.
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PMID:[False failure of an aortocoronary bypass. Spasm of an artery revascularized by 2 saphenous vein graft]. 678 80


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