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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Without treatment, about 60% of atrial arrhythmia patients suffer a relapse within 3 months and 70% within one year. Antiarrhythmic treatment intended to reduce this percentage is therefore justified, on condition that it is well tolerated. Several preliminary questions have to be settled before this medical prophylaxis: 1) Justification of antiarrhythmic treatment (sometimes pointless to deal with very occasional episodes); 2) Treatment of the underlying heart disease (valve disease, cardiothyrotoxicosis, etc.) or promoting factors (potassium depletion etc.); 3) Accurate assessment of any associated conduction abnormalities, which may constitute a contraindication to antiarrhythmic treatment (WPW syndrome in the case of verapamil and the digitalis-like drugs) or require additional treatment (pacemaker); 4) Definition of the mechanism (vagal or sympathotonic) inducing arrhythmia; 5) Evaluation of the hemodynamic parameters of the underlying heart disease (size of the atria, ventricular function, coronary or valvular lesions) which may limit the efficacy of the treatment. Once these parameters have been identified, the primary treatment should be type la or lb antiarrhythmics, which have been shown to be effective, despite the fact that they are not without arrhythmic risks (the Ib antiarrhythmics are less effective and have a poor safety profile). The beta-blockers have preferential indications (hypersympatheticotonia, hyperthyroidism, hypertrophic myocardiopathy, mitral prolapse, angina etc.) and can be replaced by verapamil or bepridil if there are non-cardiac contraindications (ulcers, asthma, diabetes). Amiodarone is extremely effective, but its poor extracardiac safety restricts its long-term use. Complementary treatments (digitalis-like, anticoagulants or anti-PAF and cardiostimulant drugs) should be added if necessary. Recurrences (to be confirmed by ECG or Holter) should lead to rigorous confirmation of therapeutic compliance and observance of simple hygienic and dietary measures (no excessive exertion, elimination of stimulants etc.). With strict clinical and ECG monitoring, it would then be possible either to increase the dose levels (accompanied by plasma determinations if possible) or to switch to a treatment with more effective, but more aggressive drugs (amiodarone, flecainide) or to use drug associations (la and lb, la and II etc.). Repeated failure of such attempts should lead to a non-medical approach to treatment.
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PMID:[Preventive drug therapy of recurrence of atrial fibrillation]. 129 92

Most ischemic heart disease in associated with severe coronary atherosclerosis. A small subset of patients, however, had angina pectoris despite angiographically normal coronary arteries and absence of inducible coronary spasm. Coronary microcirculation (i.e. arteries too small to be visualized by current angiographic techniques) has been identified as the weak point of these patients. Small coronary vessel involvement may be due to organic conditions (such as diabetes, vasculitis, systemic collagen-vascular diseases, infectious processes) that act through coronary thrombosis or embolism and related alteration in coronary vasomotion; alternatively, the vascular abnormality appears to be entirely functional (no ultrastructural myocardial changes) such as the case of hypertension, hypertrophic cardiomyopathy and syndrome X. Whatever the cause(s) and mechanism(s) of the small coronary artery involvement, this leads to myocardial ischemia and to the related complications as in classic atherosclerotic heart disease. Syndrome X is characterized by effort-induced angina pectoris, ST-segment changes during exercise testing, negative ergonovine test and reduced coronary reserve. A pre-arteriolar hypersensitivity to vasoconstrictor influences (elicited by cold pressor test or ergonovine) and a reduced vasodilator capacity (unmasked by metabolic and pharmacological studies) have been proposed as potential pathogenetic substrate. This dynamic alteration in vasomotion would answer for both symptoms and signs of myocardial ischemia, that, however, appear to be contemporarily elicitable in a minority of patients. Treatment with beta-blockers and calcium-antagonists has been found to be effective. The long-term follow-up shows favorable outcome with a high survival rate and a low incidence of cardiovascular events.
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PMID:[Angina due to microvascular pathology]. 184 63

Transient hypertrophic cardiomyopathy has been described in human infants of diabetic mothers. The purpose of this study was twofold: first, to document the features of cardiac hypertrophy in newborns of female rats with streptozotocin-induced diabetes and second, to investigate the natural history of this cardiomyopathy. Marked asymmetrical septal hypertrophy with hypertrophy of myocytes was observed in newborns of diabetic female rats, whether or not the mothers received daily administration of NPH insulin. The abnormal cardiac morphology was no longer apparent 4 weeks after birth. Thus, in this model, the asymmetrical septal hypertrophy was secondary and was not a manifestation of genetically transmitted hypertrophic cardiomyopathy.
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PMID:The cardiomyopathy in infants of streptozotocin-induced diabetic female rats. 207 51

The case is reported of a male infant with hypertrophic cardiomyopathy (HCM), attributed to maternal diabetes, who, contrary to the usually good prognosis of this condition, died at 11 weeks of age. The clinical, echocardiographic, and pathological findings were indistinguishable from familial HCM, except for the lesser degree of myocardial fiber disarray on microscopic examination.
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PMID:Fatal hypertrophic cardiomyopathy in an infant of a diabetic mother. 227 49

The clinical and genetic features of 80 patients with Friedreich's disease from 64 families are described. Diagnostic criteria were: no evidence of dominant inheritance, onset by the age of 20 years, progressive unremitting ataxia of limbs and gait, and absence of knee and ankle jerks. Furthermore, at least one of the following accessory signs was present: dysarthria, extensor plantar response and echocardiographic evidence of hypertrophic cardiomyopathy. Two peaks of onset age were evident at 6-9 and 12-15 years. Analysis of intra-family variation of onset age and absence of clustering of cardiomyopathy and diabetes did not suggest genetic heterogeneity. Peripheral nerve impairment was an early finding and showed slight further progression, whereas involvement of the cerebellar and corticospinal pathways appeared later and mainly accounted for the progressive worsening of the disease.
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PMID:Genetic data and natural history of Friedreich's disease: a study of 80 Italian patients. 227 67

From 1982 to 1986, 1230 sudden death cases were autopsied in Osaka Medical Examiner's Office. Among them, 810 cases were sudden cardiac deaths (SCD) including coronary heart disease (77%), cardiomyopathy (7%), valvular disease (3%). All SCD cases were dead within 24 hours of the appearance of the fatal symptoms, and most of them (72%) were considered instantaneous death. Many of the fatal symptoms began in bed (31%), at bath (17%), at toilet (8%), or at work (8%). Thirty-four percent of them were thought by themselves or by their families to be healthy before the death. Hypertension (38%), coronary heart disease (13%) and diabetes mellitus (11%) were the major past history recorded. Microscopic observation of the hearts of 200 cases autopsied in 1986 showed various cardiac lesions: hypertrophy, atrophy, degenerations of myocytes, cellular and fatty infiltrations of the interstitium. According to their cardiac lesions and degrees of severity of coronary sclerosis, patients who died suddenly were divided into 8 groups as follows: 1. myocardial infarction (41) 2. myocarditis (6) 3. hypertrophic cardiomyopathy (19) 4. chronic ischemia with severe coronary sclerosis (65) 5. chronic ischemia with moderate coronary sclerosis (27) 6. small vessel disease (18) 7. amyloidosis (1) 8. unknown (23). These results suggest that coronary heart disease and hypertension play an important role in SCD.
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PMID:An epidemiologic and histopathological study of sudden cardiac death in Osaka Medical Examiner's Office. 263 29

The clinical spectra of 82 infants of diabetic mothers (IDMs) encountered in the past 15 years are presented. The perinatal mortality rate was 6.1%, The observed morbidities of the 78 live-born IDMs were: large for gestational age, 35.9%; prematurity, 12.8%; small for gestational age, 12.8%; respiratory distress, 17.9%; low Apgar score, 6.4%; nerve injury, 2.6%; hypoglycemia, 10.3%; hyperbilirubinemia, 28.2%; polycythemia, 12.8%; hypocalcemia, 5.1%; hypertrophic cardiomyopathy, 3.8%. Furthermore, 15.9% (13/82) of these infants suffered from congenital malformation, a rate nearly 10 times higher than that of the general neonatal population born in this hospital. In comparing sugar control during organogenesis, the mothers who had malformed infants had significantly higher fasting plasma glucose level than the mothers who had normal infants (P less than 0.05). Since tight control of maternal diabetes is mandatory to reduce the prevalence of mortality and malformation of the IDMs, we suggest that there is an urgent need to improve health education and supervision before and during pregnancy in all diabetic women.
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PMID:Clinical analysis of infants of diabetic mothers. 263 3

To determine the frequency and significance of mitral anular calcium (MAC) in hypertrophic cardiomyopathy (HC), 43 clinical and morphologic variables in 200 necropsy cases of HC were examined. Of 100 patients less than 40 years of age, none had MAC. Of the 100 necropsy patients greater than 40 years, 30 (30%) had MAC, 21 (70%) of whom were women. The mean age of the 30 MAC patients was older than that of the 70 non-MAC patients greater than 40 years of age (66 years vs 53 years). The frequency of MAC increased with age. MAC was present in 3 of 31 patients (10%) aged 41 to 50 years; in 6 of 34 patients (18%) aged 51 to 60 years; in 11 of 21 patients (52%) aged 61 to 70 years; and in 10 of 14 patients (71%) aged 71 to 90 years. Compared with the 70 patients greater than 40 years of age without MAC, the 30 patients greater than 40 years of age with MAC had higher average systemic arterial peak systolic pressure (133 mm Hg vs 113 mm Hg); a larger percentage of the MAC patients had calcific deposits in the epicardial coronary arteries (93% vs 41%) and in the aortic valve cusps (33% vs 6%); and a larger percentage of the MAC patients had severe narrowing by atherosclerotic plaques of 1 or more of the 4 major epicardial coronary arteries (47% vs 24%). The frequency of a history of systemic hypertension, diabetes mellitus and total serum cholesterol levels greater than 200 mg/dl in the patients with and without MAC was similar.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Frequency and significance of mitral anular calcium in hypertrophic cardiomyopathy: analysis of 200 necropsy patients. 366 4

We evaluated two groups of diabetic women in pregnancy who differed primarily in the time of initiation of careful diabetes management. Group A (early) were entered in the first trimester (n = 35); group B (late) were entered in the late second or early third trimester (n = 28). Normal women delivering at the same period were used as controls (n = 23). All infants were evaluated by a thorough clinical and echocardiographic examination between 24 and 72 hours of life. Both groups of infants of diabetic mothers had mild increase in mean thickness of ventricular and septal walls compared with those of normal newborn infants, and both had a significant percentage with septal hypertrophy (43% vs 39%). None of the infants in the early group had respiratory symptoms requiring oxygen therapy, compared with 19% in the late group. The early group had significantly fewer infants with elevated right ventricular systolic time interval ratios than did the late group (20% vs 50%); none of the normal infants had elevated ratios. We conclude that careful management of diabetes in pregnancy reduces the severity of hypertrophic cardiomyopathy, although no advantage of early vs late management was obvious. Early management does significantly reduce the number of infants of diabetic mothers who develop respiratory symptoms requiring oxygen therapy.
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PMID:Relationship of prospective diabetes control in pregnancy to neonatal cardiorespiratory function. 388 Aug 22

The clinical characteristics of 107 patients younger than 60 years with mitral anular calcium (MAC) were compared with those of 107 age- and sex-matched control subjects. The patients with MAC included 55 men and 52 women, mean age 51 years. The control group included 55 men and 52 women, mean age 51 years. Patients with MAC had a higher prevalence of cardiomegaly on chest x-ray (p less than 0.0001), left atrial and left ventricular enlargement by echocardiography (p less than 0.0001), precordial murmurs (p less than 0.0001), diabetes mellitus (p less than 0.0001), systemic hypertension (p less than 0.025) and total conduction defects on surface electrocardiograms (p less than 0.0001) compared with the age- and sex-matched control subjects. The mean serum phosphorus and product of serum calcium and phosphorus were higher in patients with MAC (p less than 0.0025) than in the control subjects. The prevalence of coronary heart disease, aortic stenosis and hypertrophic cardiomyopathy and the mean serum cholesterol, triglyceride, total protein, albumin, creatinine, alkaline phosphatase and calcium levels were not significantly different between patients with MAC and the control subjects.
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PMID:Clinical characteristics of patients younger than 60 years with mitral anular calcium: comparison with age- and sex-matched control subjects. 650 99


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