Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The sensitivity of myocardial perfusion imaging (MPI) using thallium-201 injected both at rest and during peak exercise was compared to simultaneously recorded 12 lead electrocardiography (ECG) for the detection of transient ischemia in 20 normal subjects and 63 patients with coronary artery disease (CAD). No significant perfusion defects or ECG changes were seen on either the rest or exercise studies in any of the normal subjects. Fifty-six percent of patients with CAD developed new perfusion defects with exercise compared to 38% who developed ischemic ST-segment depression (P less than 0.02). However, when chest pain and/or ST depression were considered indices of ischemia, the sensitivity of exercise testing and thallium-201 MPI was similar. The increased sensitivity of MPI compared to ST-segment depression on the ECG was due to patients with baseline ECG abnormalities and those who failed to achieve 85% of predicted maximum heart rate with exercise. Analysis of the exercise results according to the extent of coronary artery disease revealed a progressive increase in both positive ECGs and MPI with the number of vessels involved. In patients with single vessel disease the MPI was more sensitive than the ECG (P less than 0.02). The combination of the rest and exercise ECG, MPI and chest pain during exercise failed to identify 11% of patients with CAD. Exercise thallium-201 MPI is a useful adjunct to conventional exercise testing particularly when evaluating patients with abnormal resting ECGs, those who develop ventricular conduction defects of arrhythmias during exercise, and those who fail to achieve their predicted heart rate because of fatigue or breathlessness.
 ...
PMID:Thallium-201 myocardial perfusion imaging at rest and during exercise. Comparative sensitivity to electrocardiography in coronary artery disease. 83 Feb 22

This study evaluates propranolol's effect on symptoms, arrhythmias, and exercise tolerance in 16 patients with mitral valve prolapse. Three patients (19 per cent) experienced symptomatic deterioration with propranolol therapy, seven (44 per cent) were unchanged, and six (37 per cent) noted an over-all symptomatic improvement, primarily due to a reduction in palpitation. Symptomatic improvement continues in these six patients an average of 12.5 months after beginning propranolol therapy. Treatment with propranolol alleviated chest pain in only two of eight patients and it did not improve the ability to perform treadmill exercise. Fatigue did not improve, and in three patients appeared for the first time during propranolol therapy. Premature ventricular contractions were reduced by at least 75 per cent in five of nin patients (56 per cent), and paroxysmal ventricular tachycardia was eliminated in three of four patients. We conclude that propranolol is not uniformly effective in patients with mitral vale prolapse. A trial of propranolol may be instituted fro patients with mitral valve prolapse who have severe symptoms and/or arrhythmias, but the drug should only be continued in those who demonstrate clinical and/or antiarrhythmic response.
 ...
PMID:Propranolol for patients with mitral valve prolapse. 84 37

Significant pericardial disease can exist without overt manifestations. Occult constrictive pericardial disease (OCPD) is identified by normal baseline hemodynamics and normal left ventricular systolic function with a characteristic response to rapid volume infusion. Following the intravenous administration of 1000 ml of normal saline over six to eight minutes, striking elevations of filling pressures are seen; however, diagnosis depends specifically upon a) the development of typical pressure pulse morphology of constriction, b) loss or reversal or respiratory variation of right atrial pressure, and c) precise diastolic equilibration of intracardiac pressures. Nineteen patients with OCPD have been identified in a five year period. Unexplained fatigue, dyspnea and chest pain was the uniform pattern of presentation. Eleven have undergone pericardiectomy resulting in a dramatic symptomatic improvement in all. Each demonstrated gross and/or microscopic evidence of pericardial disease. Recatheterization with volume infusion in five patients following pericardiectomy has revealed return to normal or near normal hemodynamics. This study describes the method for diagnosis of OCPD and recommends pericardiectomy for the management of disabling symptoms.
 ...
PMID:Occult constrictive pericardial disease. Diagnosis by rapid volume expansion and correction by pericardiectomy. 92 61

A case of symptomatic congenital pericardial defect with herniation of the left atrial appendage is reported. The patient had experienced increasing fatigue, chest pain, shortness of breath, and slight cyanosis. A partial pericardiectomy through a median sternotomy was performed and the patient made an uneventful recovery.
 ...
PMID:Congenital partial pericardial defect: surgical correction by partial pericardiectomy through a median sternotomy. 94 55

The midsystolic click-late systolic murmur syndrome is a complex entity with variable manifestations that involves a primary process causing myxomatous degeneration of the mitral valve leaflet(s) and subsequent systolic mitral valve leaflet prolapse. Other cardiac diseases may cause mitral valve prolapse and regurgitation associated with a midsystolic click that mimics this primary syndrome. The prolapsing mitral valve leaflet(s) syndrome occasionally may be familial. Most patients are asymptomatic but some complain of chest pain, palpitation, dyspnea or fatigue. Prolapsing mitral valve leaflet(s) can be distinguished from other causes of systolic clicks and mitral regurgitation murmurs by the characteristic movement of the clikmurmur complex in systole with various hemodynamic interventions. The clinical diagnosis usually can be confirmed by echocardiography, which demonstrates the abnormally prolapsdrome usually is minimal but can be progressive and lead to the need for prosthetic valve replacement. Most symptomatic patients can be managed medically but some require cardiac catheterization to evaluate the possibility of coexistent coronary artery disease, to assess the degree of mitral regurgitation and to evaluate other associated cardiac lesions. All patients with this syndrome should receive antibiotic prophylaxis prior to any surgical or dental procedures. Those patients suspected of having arrhythmias should be evaluated by continuous ambulatory ECG monitoring and dangerous arrhythmias probably should be treated. The prognosis usually is excellent, but sudden death and rapidly progressive mitral regurgitation due to ruptured chordae tendineae have been reported. Although more than a decade has elapsed since the midsystolic click-late systolic murmur syndrome was first recognized, much remains to be learned about this common but complex clinical entity.
 ...
PMID:The systolic click-murmur syndrome: clinical recognition and management. 101 8

Six patients in functional class II and 11 in functional class III underwent graded treadmill exercise, with severe fatigue as their limiting symptom. During exercise, none of the patients developed chest pain, or significant arrhythmia. Our data suggest that at a treadmill workload of 2 mph and 7 per cent slope, with an oxygen consumption four times that at rest, measurement of the pulmonary arterial oxygen saturation permits clear separation of functional class II from functional class III. Although there was a significant difference in the heart rate response, mean pulmonary arterial pressure, and percentage change in pulmonary arterial end-diastolic pressure, considerable overlap occurred. The use of pulmonary arterial oxygen saturation may prove to be of value in instances in which the functional cardiac status is not reasonably clear from the clinical interview or routine exercise testing. It requires less than maximal effort on the part of the patient, and provides an objective end point to distinguish between two important groups of patients.
 ...
PMID:Pulmonary arterial oxygen saturation during treadmill exercise. A discriminative index of functional class. 117 68

The psychosomatic approach requires of the practitioner broad knowledge and skills relevant to the psychosocial, metabolic and physical responses of patients. The approach, being holistic, becomes appropriate in many different clinical situations (and should not be restricted to a few so-called psychosomatic diseases). Wise physicians and perceptive laymen have recognized the validity of an holosomatic approach for over 4000 years. Although the prevalence and incidence of psychosomatic disturbances are difficult to estimate (and probably underestimated in many surveys), data support the statement that family physicians should employ a psychosomatic approach in at least 15 per cent of cases. The general internist will probably encounter primarily psychosomatic disturbances in about 30 per cent of his patients; for example, many common presenting symptoms such as fatigue and chest pain arise in a setting of psychological stress. Apart from a sound knowledge of the genesis and manifestations of metabolic and structural changes, the physician must be familiar with the causes and symptoms of psychological disorders. Skillful interviewing and histroy-taking provide the data necessary to analyze and unravel psychosomatic interplay. Psychotherapeutic interviews often enable both the patient and the physician to understand the clinical problem: this understanding appears to aid recovery.
 ...
PMID:The psychosomatic approach in the practice of medicine. 122 38

In a 14-month period mitral leaflet prolapse was diagnosed in 85 patients by echocardiography or cineangiography. Chest pain alone was the presenting complaint in 30 patients and linked with palpitation, dyspnoea, or syncope in 9. Eleven presented with major neurological disturbances (9 had transient ischaemic attacks), 10 with palpitation, 4 with undue and persistent fatigue, 2 with dyspnoea, and 2 with dizziness. Seventeen were referred not because of symptoms but because of clicks and murmurs. Overall, chest pain affected 61 patients and unless associated with coronary artery disease was not anginal. Palpitation was admitted by 42 patients; dizziness, lightheadedness, or paraesthesiae by 15, and syncope by 12. Systolic auscultatory abnormalities were noted in 69: 25 had single clicks, 3 had multiple clicks, 19 had both click(s) and murmur, and 22 had a murmur alone. Electrocardiography revealed ST segments flat for greater than 0-10 s in 21, prolonged QTc in 18, and T wave flattening or inversion in inferior limb and lateral chest leads in 14. The exercise stress test was abnormal in 13 of 27 patients. Mitral valve echograms showed definite mitral leaflet prolapse in 61, 'possible' prolapse in 14, and were normal in 8 patients with angiographic proof of mitral leaflet prolapse. Cardiac catheterization with left ventriculography showed prolapse of posterior mitral leaflet in 36, of both leaflets in 2, and left ventricular wall motion abnormalities in 16 cases. Selective coronary arteriography in 31 cases showed major vessel narrowing of larger than or equal to 80 per cent lumen diameter in 4, all with angina. This consecutive series indicates that the physical event of mitral leaflet prolapse is more common than hitherto appreciated, is priminently associated with non-anginal chest pain, palpitation, and neurological disturbances, and in 90 per cent of cases could be shown echocardiographically.
 ...
PMID:Clinical features and investigative findings in presence of mitral leaflet prolapse. Study of 85 consecutive patients. 125 39

This preliminary study represents 10% of the workers in this occupation in Bangalore. The industry is highly commercial in nature and the city of Bangalore; has the largest number of units in Karnataka State. The study provides base line data relating to some morbidity conditions for future comparisons. Low back ache, tiredness, head ache, irritation in the eyes, sleeplessness, joint pains, chest pain, postural giddiness, persistent running nose, abdominal pain, cough and tremors of hands, were some of the common conditions elicited among the workers. Some of the conditions were identified to be possibly related to various processes within the industry. Particularly low back ache and irritation in the eyes (rolling and dipping), tremors of hands (packing). It is very likely that in the final stages when certain chemical ingredients are added which finally give the scent, the chances of pollutants entering either through skin or inhalation is possible. Environmental monitoring has not shown any appreciable dust hazard. The study has helped in identifying some of the areas in the work environment which required improvement. There is a need for social workers, medical personnel and industrial hygienists to explore the possibilities of minimizing possible hazards. A national sampling survey in other parts of the country might also be beneficial.
 ...
PMID:An enquiry into work environmental status and health of workers involved in production of incense sticks in city of Bangalore. 130 84

Based on our experience and the experience of others, the following classification of patients with mitral valve prolapse has been proposed. Mitral valve prolapse - Anatomic includes patients with a wide spectrum of mitral valve abnormalities from mild to severe. Symptoms, physical findings and laboratory abnormalities in these patients are directly related to mitral valve dysfunction and progressive mitral regurgitation. Complications related to abnormal mitral valve include infective endocarditis, thromboembolic events, cardiac arrhythmias, progressive mitral regurgitation, rupture of chordae tendineae and congestive heart failure. Individuals with thick mitral leaflets and mitral systolic murmur are at higher risk of developing complications. The term mitral valve prolapse syndrome refers to the occurrence of symptoms such as palpitation, chest pain, fatigue, poor exercise tolerance, dyspnea, orthostatic phenomena and syncope or presyncope in patients with mitral valve prolapse which cannot be explained on the basis of mitral valve abnormality alone. The pathogenesis of these symptoms in patients with mitral valve prolapse syndrome appears to be related to metabolic neuroendocrine abnormalities. Preventing infective endocarditis is a major consideration in patients with mitral valve prolapse. Significant mitral regurgitation with the development of congestive heart failure often requires mitral valve surgery. The most important therapeutic approach in patients with mitral valve prolapse syndrome is to explain the mechanisms of symptoms and to reassure the patient.
 ...
PMID:Mitral valve prolapse: etiology, clinical presentation and neuroendocrine function. 134 25


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>