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

Improvements in surgical and medical treatment have led to improved survival of infants with congenital heart disease. Coincident with this improved survival has been an increase in the number of patients with congenital heart disease and arrhythmia. Arrhythmias in this population can be life threatening but are more commonly life altering, creating considerable patient distress--both from the symptoms of the arrhythmia and from fear of paroxysmal events. Arrhythmia in the setting of congenital heart disease can result from hemodynamic compromise and can in turn result in more hemodynamic compromise, creating a cycle of clinical deterioration. Aggressive treatment of arrhythmia and aggressive evaluation for surgically correctable hemodynamic burdens is therefore warranted. Treatment options for arrhythmia in patients with congenital heart disease include pharmacologic therapy, catheter intervention, implantable device therapy, and surgical intervention. Pharmacologic therapy is currently the primary mode of treatment of arrhythmia in this setting; however, data from large trials of patients with ischemic or dilated cardiomyopathy suggest that many antiarrhythmic agents may increase overall mortality rates in certain patient groups. In addition, pharmacologic therapy is associated with significant short- and long-term side effects, relatively low success rates, and problems with compliance. For these reasons and because of recent advances in catheter and device therapy, nonpharmacologic therapy should be considered in lieu of medication, whenever possible.
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PMID:Arrhythmias in Congenital Heart Disease. 1109 4

Childhood stoke is increasingly recognized, but studies remain largely descriptive. Important differences from adult stroke include the following: (1) frequently delayed or missed diagnosis, (2) heterogenous and overlapping risk factors, and (3) developmental differences in the cerebrovascular, neurologic, and coagulation systems. These aspects limit the extrapolation of the results of adult stroke research and present challenges in caring for children with stroke. The incidence of childhood ischemic stroke exceeds 3.3 in 100,000 children per year, more than double the estimates from past decades. The increased incidence reflects, in part, increased survival in previously fatal conditions predisposing to stroke, including congenital heart disease, sickle cell anemia, and leukemia. Risk factors for stroke are recognized in more than 75% of children. Common risk factors include congenital heart disease and sickle cell disease. Progressive arteriopathies, including vasculitis and moyamoya syndrome, are rare in children with stroke; however, transient arteriopathies including post-varicella angiopathy are increasingly recognized. Prothrombotic abnormalities are frequently present but of unclear significance. Adverse outcomes after childhood stroke, including death in 10%, recurrence in 20%, and neurologic deficits in two thirds of survivors could be reduced with available stroke treatments. Aggressive prehospital emergency care and transfer could improve access to hyperacute stroke therapies including tPA. Currently, the diagnosis is delayed by more than 24 hours from onset in most children. As in adults, tPA will likely produce unacceptable rates of intracerebral hemmorrhage unless given within 3 hours of stroke symptom onset. The appropriate choices for in hospital treatment and secondary preventative strategies, including aspirin and anticoagulants, are controversial. Empiric recommendations are published; however, age-appropriate clinical trials are urgently needed. The large multinational networks of investigators necessary for designing and conducting these future trials are now being formed.
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PMID:Stroke in children: recognition, treatment, and future directions. 1120 20

This study was designed to determine how internal behaviors of children with congenital heart disease were handled by their mothers. The study group included the mothers of 96 children randomly selected (ages ranging from 4 to 11 years) who were being monitored at the Institute of Cardiology. A 21-item questionnaire was administered to obtain information about the mother and the child. Internal subsets of the Child Behavior Check List (CBCL)/4-18 were performed, including withdrawn aggressive behaviors, somatic complaints, and anxiety/depression tests. The results showed that factors influencing withdrawn aggressive behavior were low parent education (p =.000), poor economic status of the family (p =.02), and aggravation of the hemodynamic status of the disease (p =.003). The factors influencing somatic complaints were low parent education (p =.000) and severity of the hemodynamic status of the disease (p =.02). An increase in the number of children in the family seemed to have an effect on anxiety/depression levels (p =.009).
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PMID:Evaluation of internal behaviors of children with congenital heart disease. 1174 Jul 94

Children with chronic cyanotic heart disease often develop systemic-to-pulmonary artery collateral vessels that can be deleterious at the time of a Fontan procedure because of excessive pulmonary blood flow with resultant ventricular volume overload. We therefore occlude all significant collateral arteries during preoperative cardiac catheterization. From June 1993 to September 2001, 137 children ranging from 1.5 to 18.3 years old (median, 2.4 years), underwent a fenestrated lateral tunnel Fontan procedure. Of these, 130 (95%) had a previous bidirectional Glenn anastomosis, including 43 (31%) with a Norwood procedure. Preoperatively, 52 children (38%) required occlusion of collateral vessels. Two of five perioperative deaths (operative survival, 96%) resulted from excessive pulmonary blood flow; one from unrecognized collateral arteries and one from uncontrollable collateral arteries. Postoperatively, 29 children (22%) required coil occlusion of collateral vessels for elevated pulmonary artery pressures, heart failure, or prolonged chest tube drainage. At follow-up of 1.5 months to 8.3 years (mean, 4.1 years), there have been four late deaths (two from pneumonia, two secondary to heart failure); nine patients underwent cardiac transplantation for refractory heart failure. Ten of 11 patients with ventricular failure required occlusion of significant collateral vessels postoperatively. Hemodynamically significant collateral arteries are common in Fontan candidates. Aggressive control can result in good early and medium-term survival. After the Fontan operation, the presence of significant collateral vessels may be a marker for eventual cardiac failure; 11 of the 29 patients who required postoperative coil placement went on to transplantation or died of heart failure.
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PMID:Management of aortopulmonary collateral arteries in Fontan patients: occlusion improves clinical outcome. 1199 64

The aim of this review of the landmark HMG-CoA reductase inhibitors (statins) studies is to enable the clinician to draw practical lessons from these trials. The Scandinavian Simvastatin Survival Study (4S) established the importance of treating the hypercholesterolemic patient with established cardiovascular heart disease. The West of Scotland Coronary Prevention Study (WOSCOPS) showed the benefit of treating healthy hypercholesterolemic men who were nevertheless at high risk of developing cardiovascular heart disease in the future. The Cholesterol and Recurrent Events (CARE) study, a secondary prevention trial, proved the benefit of treating patients with myocardial ischemia and cholesterol levels within normal limits. This conclusion was confirmed by the Long-term Intervention With Pravastatin in Ischemic Disease (LIPID) study, another secondary prevention study that enrolled patients with a wide range of cholesterol levels (4-7 mmol/dL), into which the large majority of patients would belong. The importance of treating patients with established ischemic heart disease (IHD), and those at high risk of developing cardiovascular heart disease, regardless of cholesterol level, was being realized. The Air Force/Texas Coronary Artery Prevention Study (AFCAPS/TexCAPS) then showed that treatment can reduce adverse cardiovascular events even in the primary prevention of patients with normal cholesterol levels. The Myocardial Ischemia Reduction With Aggressive Cholesterol Lowering (MIRACL) trial showed that hypocholesterolemic therapy is useful in the setting of an acute coronary syndrome, while the Atorvastatin Versus Revascularisation Treatment (AVERT) study showed that aggressive statin therapy is as good as angioplasty in reducing ischemic cardiac events in patients with stable angina pectoris. Finally, the Heart Protection Study (HPS) randomized more than 20,000 patients, and the value of statins in reducing adverse cardiovascular events in the high-risk patient, including the elderly, women, and even in those with low cholesterol levels, is beyond doubt. The emphasis is now on the risk level for developing cardiovascular events, and treatment should target the high-risk group and not be dependent on the actual cholesterol level of the patient. It is interesting to compare the large amount of data on the value and safety of the statins with the much more limited and less convincing data on antioxidant vitamins.
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PMID:Protecting the heart: a practical review of the statin studies. 1281 99

Psoriasis is associated with significant psychosocial morbidity and a decrease in health-related quality of life. It is important to view psoriasis as a serious disease and resist the tendency to underestimate its impact on overall patient well-being. The disability experienced by psoriasis sufferers is comparable to that of patients with other chronic illnesses such as heart disease, diabetes, cancer, and depression. Aggressive intervention is warranted in order to improve patient quality of life and decrease the potential for psychosocial sequelae. Health-related quality of life measures are becoming a necessary adjunct to traditional clinical assessments in the evaluation and treatment of psoriasis patients by the individual clinician. They also provide valuable information to government agencies and third party payers in the determination of resource allocation and reimbursement.
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PMID:Quality of life issues in psoriasis. 1289 27

Type 2 diabetes is a worldwide epidemic. Cardiovascular diseases remain the major cause of death in patients with diabetes, partly because of the association of diabetes and the metabolic syndrome. In this review, we will discuss the evidence for treatment and prevention of cardiovascular diseases in patients with diabetes. Aggressive treatment of hypertension and dyslipidemia is at the cornerstone in the management of heart disease in those patients. Despite its known benefit on the prevention of the microvascular complications of diabetes, intensive glycemic control may or may not have a significant effect on reducing macrovascular diseases. Finally, lifestyle changes and other cardiovascular therapies aimed at preventing heart disease may also prevent or delay the development of diabetes.
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PMID:Diabetes and heart disease an evidence-driven guide to risk factors management in diabetes. 1294 4

Within the clinical and public health communities, it is often unnoticed that the developing world is experiencing an aging population with its attendant increase in the burden of chronic, noncommunicable diseases. From July 1999 to July 2000, 77% of the world's net gain in elderly persons occurred in developing countries. In Sub-Saharan Africa alone, the number of persons aged 65 years and older is expected to increase by 50% in 2015, from 19.3 million to 28.9 million. This demographic change has profound implications for developing countries that already shoulder a huge burden of communicable diseases, especially the HIV/AIDS epidemic, and continue to be challenged by basic infrastructure needs and economic development. In the 30-year period from 2000 to 2030, the population of elderly persons is projected to double in many Sub-Saharan African countries including the Democratic Republic of Congo, Mozambique, Cameroon, and Ghana. The scale and magnitude of these demographic changes are unprecedented. Since advancing age is the most powerful independent predictor of cardiovascular morbidity and mortality, the impact of these demographic changes on heart disease and stroke will be substantial. Aggressive efforts in promoting healthy aging and the prevention of cardiovascular risk factors will be crucial in preventing an impending cardiovascular epidemic in these countries.
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PMID:Population aging and implications for epidemic cardiovascular disease in Sub-Saharan Africa. 1367 18

This brief report describes an unusual complication of femoral venous access placement. A 17-year-old male underwent cardiopulmonary transplantation for complex congenital heart disease, which was complicated by thrombotic thrombocytopenic purpura, quadrilateral limb gangrene, and stroke. In an effort to urgently obtain a venous access, a right femoral venous catheter was placed into the right groin in the cardiac care unit. The patient subsequently experienced severe hypotension and abdominal distension. Ultrasound and CT scans of the abdomen demonstrated a large retroperitoneal hematoma. Aggressive resuscitation failed to stabilize the patient. Angiography demonstrated an unusual bleeding source from an arterial collateral circulation in the right side of the pelvis, which was then successfully treated with embolization.
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PMID:Retroperitoneal bleeding after inadvertent laceration of an arterial collateral during central venous catheterization; treatment with embolization. 1677 8

Beta-blockers have been used to treat ischemic heart disease, due to negative chronotropic and inotropic properties, thus inducing a decrease in myocardial consumption of oxygen and nutrients, allowing a better balance between nutritional needs and the supply provided by the coronary blood flow. Recent developments in cell biology allowed us to understand that not all beta-blockers are equal, as their intracellular mechanisms of action can be very different. This paper will focus on carvedilol, a non-selective beta-blocker with alfa-blocker properties, currently used to treat hypertension, heart failure and coronary artery disease. Effects of carvedilol on cardiac mitochondria, their relation to its antioxidant properties, and how these can improve cardiomyocyte resistance to aggression and cardiac function will be discussed. We will begin by depicting the effect of carvedilol on mitochondrial parameters, namely oxidative phosphorylation, calcium homeostasis and energy production. Then we will focus on the mitochondrial permeability transition (MPT) and how the antioxidant properties of carvedilol can be used to minimize oxidative stress, a powerful inducer of MPT. Carvedilol will also be highlighted as an enzyme modulator, focusing on its importance to prevent doxorubicin (DOX) cardiotoxicity. The mitochondrial-related mechanism of cardioprotection involving carvedilol will also be addressed, as we will discuss some clinical pieces of evidence showing the importance of mechanisms previously depicted. In conclusion, based upon its molecular mechanisms of action, carvedilol seems to be a unique beta-blocker. These unique characteristics can help us understand the positive impact of carvedilol on the prognosis of patients with heart disease.
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PMID:Carvedilol: just another Beta-blocker or a powerful cardioprotector? 1737 71


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