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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Specialised antenatal echocardiographic screening has allowed 1049 consecutive examinations in 992 patients resident in the Aquitaine region over a period of nine years. The most frequently encountered indications are expertise (suspicion of cardiopathy during initial screening) and family history. Expertise allows a higher detection rate (46.5%) compared to the other indications. We have screened 150 cardiopathies in utero and among them 143 were able to followed up after delivery. We have noticed a much greater severity of the anomalies compared to those encountered in paediatric cardiology. An associated chromosomal anomaly was noticed in 9% of cases and more frequently for atrio-ventricular communication and conotruncal cardiopathies. The rate of abortion was 35%, and the mortality for the surviving pregnancies was elevated (35%). Pharmacological treatment was instituted in 95% of cases of sustained supraventricular tachycardia with 81% successful. Diagnosis errors concerned benign cardiopathies above all and did not change the management of the pregnancy. The sensitivity of fetal echocardiography was 93.1% and its specificity 99.1%. This study shows the viability of fetal cardiac echography for the detection of the majority of congenital cardiopathies in a population at risk and in the management of fetal cardiac rhythm disorders. Nevertheless it remains a specialised examination for which the performance depends much on the initial screening performed by gynaecologists. Although the mortality rate of the screened children is elevated, indicating the frequent parental choice of abortion and the complexities of the cardiopathies, antenatal diagnosis has allowed optimisation of the neonatal management for certain curable cardiopathies.
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PMID:[Value of fetal echocardiography in screening for congenital heart diseases. Report of 1,049 consecutive examinations]. 1208 45

This article describes the urgent need for modern family planning (FP) services and supplies in the Soviet Union, and presents the nation's high induced abortion rate as one of its most serious medical and social problems. With more than 6 million legal abortions per year, and another estimated 6 million performed illegally, the problem of induced abortion is placed on par with heart disease and cancer in the Soviet Union. Induced abortion is the primary method of birth control, responsible for terminating 2 out of 3 pregnancies. Many abortion seekers, especially those employing illegal services, suffer complications resulting in loss of ability to work or even death. The maternal mortality rate for 1988 was 43.0/10,000. Efforts to decrease the level of abortion have increased during reconstruction, and have been witness to a decline in the number of abortions by 866,000 over the period 1985-1988. Contributory factors behind this decline, as well as the decrease of the abortion ratio, are an increased contraceptive prevalence level totalling 13.7% of reproductive-age women, stabilization of the birth rate at a low level, a smaller proportion of reproductive-age women in the population, and rate reporting changes. Nonetheless, inadequate family planning services prevail in the Soviet Union. Instead of focusing upon abortion and contraception, services focus upon diagnosing and treating infertility, and offer neither FP information nor services for premarital youths. Moreover, contraceptive supplies suffer serious, ongoing shortages. Research is needed on the social, demographic, medical, and biological aspects of reproductive behavior in the Soviet Union. Regional differences, abortion law, public opinion on illegitimate pregnancy, abortion methods, health personnel training, and maternal and child health are also discussed.
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PMID:Looking at abortion and contraception. 1228 99

All couples are entitled to contraception but it is an obligation for female heart patients whose pregnancies must be carefully planned and any dangerous or even incompatible pregnancy which would have to be terminated by therapeutic abortion must be prevented altogether. An effective and perfectly safe method is indispensable for such a high risk group. Tubal ligation, where partial reversibility may attenuate the psychological impact of permanent sterility might be considered after carefully weighing the numerous factors. Local contraception can only be justified to the extent that all methods are contraindicated. Use of an IUD entails the risk of bleeding if an anticoagulant is administered and infection in the case of exposed heart disease. Hormonal contraception with combined pills is always risky and low-dose pills have not been shown to be less harmful than regular ones from the cardiovascular point of view. From this standpoint, continuous progestogen-only minipills seem to be the safest method to be suggested as 1st choice. (author's modified)
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PMID:[Contraception in female heart patients]. 1231 22

During 1981-1986, 86 maternal deaths transpired at the obstetrics department of the Jawaharlal Institute of Postgraduate Medical Education and Research in Pondicherry, India. The maternal mortality rate stood at 5.8/1000 births. 31.4% were primigravidae. The percentage of maternal deaths characterized as gravidae 2-4, 5, and multigravidae was 42.9%, 9.3%, and 16.4%, respectively. The leading causes of death were sepsis (41.9%), especially septic abortion (30.2%); eclampsia-severe preeclampsia (10.5%); ruptured uterus (9.3%); and hemorrhage and prolonged labor (8.1% each). Direct obstetric causes of death accounted for 81.4% of all maternal deaths. Indirect obstetric causes of death were hepatitis (5.8%), heart disease (4.7%), and severe anemia (2.3%). Most of the women who died were illiterate (97.6%), poor (98.8%), and had received no prenatal care (94.2%). 47.7% traveled more than 60 km to the hospital. Quacks or untrained traditional birth attendants had excessively interfered with about 33% before they reached the hospital, especially the septic induced abortion, obstructed labor, and ruptured uterus cases. Among the 48 women who delivered before dying, there were 24 live births (5 of whom died during the early neonatal period) and 24 still births. These findings indicate a need for a cooperative effort to improve and expand maternal and child health care in the community.
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PMID:Determinants of maternal mortality: a hospital based study from south India. 1231 6

The motivations which led to creation of a family planning specialty within social medicine are discussed and currently available contraceptive methods are reviewed. Among considerations which lead to family planning are the universal worry about uncontrolled population growth and limited resources, especially in the 3rd World: the earth's population is expected to reach 6.5 billion in the year 2000, but already 2.2 billion persons lack adequate resources. Health education and family planning are needed to promote safe conditions for pregnancy and to avoid pregnancy in cases of genetic deficiency. Family planning is a purely medical problem when the woman has a medical problem that would be life threatening to her or her child in case of pregnancy. Illnesses that may be aggravated by pregnancy include cardiopathy, diabetes, nephropathies, thyroid disease, and tuberculosis. Family planning involves provision of information and counseling for patients suffering such disorders as well as for patients who are infertile. Among psychosocial indications for family planning are 2 major problems of modern society: the quality of life and abortion. Family planning has given women the possibility of becoming sexual companions, but the fact that they and not men must submit themselves to contraceptive methods is a negative psychological factor for the stability of the couple. A great change has occurred in Spanish society, in that marriage used to be the only legitimate context for sexual activity and, for Catholics, the only legitimate sexual activity was that oriented toward procreation. Promiscuity, pornography, and sexual liberties and abuses promote undesired pregnancies and abortions. In addition, premarital and extramarital sexual relations have become more frequent. Some 300,000 abortions occur annually in Spain, but abortion can never be a valued family planning method because of its associated morbidity and mortality, and high costs of hospitalization in cases of complications. There is no better prophylactic for abortion than state supported family planning and coeducation as the maximum exponent of respect between the sexes. Contraception has been legal in Spain for about a dozen years, although various methods were in use prior to that time. The choice of a contraceptive method depends largely on motivation and the couple's marital status, number of children living and desired, unconscious psychological motivations, and other factors. The most common methods in Spain in 1982 in order of frequency were coitus interruptus, combined oral contraceptive, barrier methods, IUDs, Ogino-Knaus, temperature rhythm, injectables, female sterilization, and male sterilization.
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PMID:[Medical and social considerations of family planning]. 1233

Selenium is an essential trace element. It is, however toxic at concentration little above which is required for health. Selenium is incorporated into proteins as selenocysteine, the 21(st) amino acid. Selenoproteins are found in bacteria, archaea and eukaryotes. Biochemical and physicochemical properties of selenium result in the unique redox characteristics of selenocysteine and its use in antioxidant enzymes. In this context of a redox reaction is the reduction of reactive oxygen metabolites by glutathione peroxidases, helping to maintain membrane integrity, reduces the oxidative damage to lipids, lipoproteins, and DNA. Selenium has structural and enzymatic roles. Selenium influences a number of endocrine processes, most notably, those involved in thyroid hormone synthesis and metabolism. Se is needed for the proper functioning of the immune system, a role in viral suppression, AIDS, and also is implicated in delaying the aging process. Its deficiency has been linked to a number of disorders such as heart disease, diabetes, and diseases of the liver, and it is required for sperm motility and may reduce the risk of miscarriage. Se supplementation has recently moved from the realm of correcting nutritional deficiencies to one of pharmacological intervention, especially in the clinical domain of cancer chemoprevention. During the last few years, a tremendous effort has been directed toward the synthesis of stable organoselenium compounds that could be used as antioxidants, enzyme modulators, antitumor, antimicrobials, antihypertensive agents, antivirals and cytokine inducers. The biochemistry and pharmacology of selenium-based compounds are subjects of intense current interest, especially from the point of view of public heath. The purpose of this review is to discuss the recent pharmacological applications of organoselenium compounds as therapeutic agents in the treatment of several diseases.
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PMID:Organoselenium compounds as potential therapeutic and chemopreventive agents: a review. 1518 May 70

With the objective of evaluating epidemiologic, clinical and parasitologic aspects of chronic Chagas' disease in patients from the University Hospital of the Federal University of Mato Grosso do Sul, a cross-sectional study was performed with groups of 120 chagasic and non-chagasic patients aged from 16 to 82 years. Epidemiologic aspects were evaluated by means of a questionnaire, cardiopathy by clinical examination, conventional electrocardiogram, radiology and Doppler echocardiograms (only in chagasic patients) and the presence of Trypanosoma cruzi in the blood stream by way of xenodiagnosis and polymerase chain reaction test. The results obtained indicated that the chagasic patients are predominantly alloctones with low-grade schooling, and were exposed to triatomines. The frequency of spontaneous abortion was higher in chagasic women. Chronic chagasic cardiopathy, estimated to occur in 20.2% of the patients, showed 7.5% cardiomegaly, 6.2% aneurysm of the left ventricle, and with a predominance of dyspnea, palpitations and arterial hypertension. Xenodiagnosis was positive for 26.1% of the chagasics and the PCR was positive for 53.7%, and was significantly higher in males and alloctones. An analysis of the results shows that Chagas' disease, in the group studied, presented clinical and parasitologic characteristics demonstrating significant regional differences.
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PMID:[Epidemiological, clinical and parasitological aspects of Chagas' disease in Mato Grosso do Sul State]. 1641 Sep 21

This study was conducted to determine the prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) in primary schoolchildren of Menoufia, Egypt and to study the relationship between these two problems and socioeconomic conditions. A total of 8000 children were screened for cardiac disease in their schools. Children with confirmed RHD and CHD in addition to 200 healthy children (controls) were visited at their homes to assess their social environment and other factors according to a designed questionnaire. We found prevalence rates of 3.4/1000 and 2.6/1000 for the RHD and CHD respectively. The most common cardiac defects were double mitral and pulmonary stenosis in the RHD and CHD groups respectively. Nineteen (39.6%) of the patients were diagnosed for the first time during the study. Penicillin prophylaxis was received by only four (14.8%) of the RHD children and none of the CHD children. The number of other affected siblings, increased multiparity, repeated abortion, and intake of contraceptives by mothers were significantly higher in families of the children with CHD. The proportion of illiterate, unskilled, and heavy smoking fathers was higher in the two patient groups. Family income was lowest in the RHD group, while increased crowding index and low whole social environment were significantly related to both RHD and CHD. Effective programs at the community and health service levels are needed in Menoufia to solve the problem of heart disease in schoolchildren in the immediate future.
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PMID:A clinicoepidemiological study of heart disease in schoolchildren of Menoufia, Egypt. 1758 97

Heart disease during pregnancy necessitating cardiac surgery is potentially increasing maternal and fetal morbidity and mortality. Most patients know about their heart disease long before conception however the relation between the deteriorating cardiac function and the perinatal complications is not emphasized. Best possible results can be achieved by providing preconception counseling for cardiac patients. Consequently, heart-surgery can be performed before pregnancy thereby the maternal risk is lower and fetal loss or induced abortion can be avoided. The pregnant state is not optimal for cardiac surgery as the principal interest of the mother and the fetus is different. Cardiac surgery should be reserved only for saving the patient's life when medical therapy proves insufficient or when conservative management leads to acute heart failure. The multidisciplinary approach, correct risk assessment, diagnosis, operative indication, timing along with appropriate anaesthesia, extracorporeal circulation and alert monitoring of the uterine activity and fetal heart rate patterns make the intervention technically safe. Fetal monitoring is inevitable for prompt correction of operative conditions in case of impending hypoxemia. The perioperative fetal risk can be reduced by applying normothermia, high mean arterial pressure and cardiac index during the intentionally shortest intervention. Cardiac operation with cardiopulmonary bypass during pregnancy has become a relatively safe procedure for the mother but not for the baby.
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PMID:[Pregnancy and cardiac surgery with cardiopulmonary bypass]. 1850 32

Nuchal translucency (NT) measurement between 11-14 weeks of gestation is an'effective method of ultrasound screening for chromosomal fetal anomalies, congenital heart disease, some other structural abnormalities, rare genetic syndromes, skeletal dysplasia and adverse pregnancy outcome (spontaneous abortion and intrauterine fetal demise). The aim of the present study is to assess the prognostic value of increased first trimester NT in fetuses with normal karyotype in relation to pregnancy outcome.
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PMID:[Increased nuchal translucency at 11-14 weeks of gestation in congenital heart disease, genetic syndromes and adverse pregnancy outcome]. 1898 26


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