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

A thorough cardiovascular evaluation is necessary to detect potentially lethal abnormalities that may predispose children and adolescents to sports-related sudden death. Hypertrophic cardiomyopathy and anomalous origin of the left coronary artery from the right sinus of Valsalva are the two most common cardiac abnormalities associated with sudden death during childhood. Other conditions potentially associated with sudden death are Marfan's syndrome, aortic valve stenosis, primary pulmonary hypertension, and arrhythmias. A detailed medical evaluation is indicated for subjects who have a history of nonvasodepressor syncope, exercise-related syncope or presyncope, angina pectoris, or known congenital or acquired heart disease. In addition, a family history of premature sudden unexpected syncope or death, hypertrophic cardiomyopathy, premature atherosclerotic heart disease, severe arrhythmias, or Marfan's syndrome or premature aortic aneurysms is an indication for a thorough cardiovascular evaluation before participation in sports.
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PMID:Cardiovascular evaluation of the child and adolescent before participation in sports. 406 61

An analysis of 555 consecutive cases of congenital heart disease in Ceylon has shown that for the whole series interatrial septal defect is the commonest cardiac lesion; next is interventricular septal defect, followed by persistent ductus arteriosus. Interventricular and interatrial septal defects are equally common among all the patients below 16 years of age, but interventricular septal defects are commonest among those below 11 years. Persistent truncus arteriosus is unusually common, while coarctation of the aorta and congenital aortic stenosis are rare, as compared with series reported from other places.
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PMID:Congenital heart disease in Ceylon. 542 73

After an initial pilot study in five patients, the effect of flecainide on chronic ventricular arrhythmias was tested during 48-hour oral administration of 250 mg twice a day in nine further patients with previously drug-resistant chronic, stable ventricular arrhythmias. Mean age was 45.9 +/- 14.9 years; seven patients were male. Three patients had coronary artery disease, whereas the diagnoses in the remaining patients were congestive cardiomyopathy, aortic stenosis or no apparent heart disease. Continuous Holter monitoring with quantitative evaluation was performed in all patients for 24 hours before and during a two days' period of treatment. The mean number of ventricular ectopic beats decreased from 20.3 +/- 6.4 beats/min during hour six of treatment and further to 3.1 +/- 7.7 beats/min during hour 25 to 48 after onset of treatment. In either of nine patients, the mean decrease in ventricular ectopic rate was 97.5%. In only one patient, therapy was ineffective, Ventricular couplets were completely suppressed in six of eight cases. Looking at the spontaneous variability of ventricular ectopic beats during the control period, eight of nine patients showed a decrease which considerably exceeded the statistically necessary one. Headache of moderate degree was reported in one case in the pilot study. Therapy had to be stopped after the first dose because of QRS widening in another patient. In conclusion, this short-term study suggests that flecainide may be an effective drug for the management of ventricular arrhythmias.
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PMID:[Effect of flecainide on chronic ventricular arrhythmias (author's transl)]. 617 28

Of 880 patients who attended the paediatric cardiology unit, University College Hospital, Ibadan, during a ten-year period, 635 (72.2%) had congenital cardiac malformations. Ventricular septal defects were the commonest lesions (35% of the 635 cases), followed by patent ductus arteriosus (22%), Fallot's tetralogy (10%), pulmonary stenosis (9%) and atrial septal defects (7.5%). Coarctation of the aorta was uncommon (2%) and aortic stenosis rare (0.6%). The overall sex incidence was even. Aetiological factors were ascertained in 72 cases (11%). In 60% of these cases intra-uterine rubella was responsible and in 18% perinatal asphyxia. In most patients the cardiac malformation was detected late; consequently complications, such as heart failure, pulmonary hypertension, and polycythaemia were common, even in new patients. Sixty-seven patients (11%) died in hospital, mostly from surgical intervention, heart failure, hypoxaemia, bronchopneumonia and associated extracardiac defects. It is suspected that hypocalcaemia, resulting from vitamin D deficiency may be a cause of the observed low prevalence of obstructive aortic lesions. We suggest that cardiac evaluation be performed at birth in postnatal clinics and in immunization centres, in order to facilitate early detection and treatment of congenital heart disease.
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PMID:Congenital heart disease in Nigeria: a ten-year experience at UCH, Ibadan. 618 56

Accurate assessment of ventricular muscle contractile function in patients with heart disease is impaired by alterations in afterload, preload and wall thickness which often accompany the disease. The relationship between pressure and volume at end systole is considered to provide a contractile index which is independent of preload and which accounts for afterload. Use of the index prerequisites determinations of the left ventricular end systolic pressure, wall thickness as well as the dimensions or volumes, respectively, which may be assessed with either invasive or noninvasive methods. In patients with aortic stenosis and congestive heart failure, there was a significantly reduced slope (0.9 +/- 0.5) of the end systolic stress-volume relationship as compared with healthy subjects (5.8 +/- 1.3) or patients with aortic stenosis without congestive heart failure (3.9 +/- 1.3), while the ejection fraction showed no significant differences. In patients with mitral regurgitation with no or only minimal symptoms postoperatively, preoperatively the end systolic index (ESS/ESVI) was higher (3.3 +/- 0.4) than in patients with marked symptoms postoperatively or those who died perioperatively (2.2 +/- 0.2) and the values of both patient groups were lower than those of normals. In contrast, the values for ejection fraction among the normals and both groups of patients showed substantial overlap. In patients with aortic insufficiency and congestive heart failure, as opposed to patients with aortic insufficiency and only slight symptoms, there was a significantly compromised ejection fraction as well as diminished end systolic index (ESS/ESVI). Patients with hypertension accompanied by congestive heart failure had a significantly diminished slope of the relationship between end systolic left ventricular stress and volume while the values for hypertensive patients without congestive heart failure were within normal limits; in both groups of patients, the ejection fraction was normal. In patients with mitral stenosis, the end systolic index at 5.28 +/- 0.53 did not differ significantly from that of healthy subjects at 4.87 +/- 0.53, while the velocity of circumferential fiber shortening was diminished. Patients with large atrial septal defects and symptoms of congestive heart failure did not differ with respect to end systolic index or ejection fraction as compared with atrial septum defect patients without symptoms. In children with aortic stenosis and high pressure gradients, there was an increased ejection fraction together with a normal end systolic index.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Assessment of systolic ventricular muscle function in man: the end systolic index. 623 85

Forty-nine cases of Wolff-Parkinson-White syndrome (WPW) were diagnosed out of 10 750 patients with cardiac disease (0.45 p. 100), 24 cases out of 3 761 congenital malformations and 25 cases in the 6 989 patients with acquired heart disease. Right ventricular pre-excitation was recorded in 31 cases; 13 in the lateral zone, 12 in the posterior paraseptal zone and 6 in the anterior paraseptal zone. Left ventricular pre-excitation was recorded in 18 cases: 8 in the lateral zone, 5 in the anterior paraseptal and 5 in the posterior paraseptal zones. WPW and congenital heart disease: Out of 20 cases of Ebstein's anomaly, 5 cases of WPW were observed: 4 right posterior and 1 right lateral pre-excitations. Out of 218 cases of hypertrophic obstructive cardiomyopathy, 7 cases of WPW were observed, 4 of which were congenital. Three cases of WPW were recorded in 699 patients with ventricular septal defects. Out of 1 348 cases of atrial septal defect, 5 cases of pre-excitation were recorded, including 3 right posterior pre-excitations associated with an ostium primum defect. Pre-excitation was also observed in isolated cases of corrected transposition of the great arteries, supravalvular aortic stenosis, aortic incompetence and patent ductus arteriosus. Pre-excitation and acquired heart disease: Five cases of pre-excitation were recorded out of 305 cases of dilated cardiomyopathy (1.62 p. 100). Eleven cases of pre-excitation were recorded in a total of 3 471 cases of valvular heart disease (0.31 p. 100): 9 in rheumatic valve disease and 2 in mitral valve prolapse. Nine cases of pre-excitation were observed in 2 850 cases of coronary artery disease. Intermittent Wolff-Parkinson-White syndrome: Ventricular pre-excitation masks the ECG changes of complete right bundle branch block in Ebstein's anomaly, complete left bundle branch block in aortic incompetence and dilated cardiomyopathy, and the in-complete right bundle branch block often seen in mitral valve prolapse. The characteristic appearances of WPW depend on the zone of pre-excitation. Right ventricular hypertrophy observed in ventricular septal defect with pulmonary stenosis and mitral stenosis may be masked by right lateral pre-excitation. Changes of inferior wall myocardial infarction may be masked by left anterior wall pre-excitation. On the other hand, the effects of WPW on left ventricular hypertrophy are variable, high amplitudes of the resultant forces seeming to depend on late and isolated activation of one of the left ventricular walls.
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PMID:[Wolff-Parkinson-White syndrome and cardiopathies]. 624 Feb 36

The hypoplastic left heart syndrome is a malformative complex which unfortunately can not be treated surgically. This cardiopathy is the result of a serious embryogenic error and takes into consideration the different anatomic varieties described here. Borderline cases are also noted especially isthmic coarctation of the aorta or aortic stenosis in the neonatal period. Though several years ago, the diagnosis of the hypoplastic left heart syndrome was made only on pathology, it is now possible to make this diagnosis using clinical, laboratory and radiologic examinations. However, they are cases that remain difficult to label precisely, especially in minor forms and we feel that these deserve hemodynamic investigations.
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PMID:Radiologic patterns of the hypoplastic left heart syndrome. 644 6

Increased myocardial blood flow occurs in ventricular hypertrophy, but flow per 100 grams of myocardium remains normal. The increase in flow may be obtained at the expense of the existing coronary vascular reserve or by an increase in the vascular bed. The coronary vascular reserve was studied by analyzing the hyperemic reaction to selective injection of contrast agent into the coronary arteries in 25 patients: a control group (9 patients) with chest pain syndrome, normal coronary arteries and a normal left ventricle (Group I) and 16 patients with aortic stenosis, left ventricular hypertrophy and normal coronary arteries (Group II). The hyperemic response in Groups I and II was 73.3 +/- 2.2 and 65.8 +/- 9.1 percent, respectively (difference not significant). Group II was subdivided into two groups: Group IIA had five patients with a left ventricular mass of less than 200 g (mean 158.8 +/- 25.9); this group had a hyperemic response of 102.3 +/- 9.9 percent. Group IIB had 11 patients with a left ventricular mass of more than 200 g (mean 308.9 +/- 22.5) and a hyperemic response of 49.27 +/- 10.42 percent. The hyperemic response was correlated with the diastolic left ventricular-aortic gradient (r = +0.64, p less than 0.001), left ventricular mass (r = -0.51, p less than 0.01) and aortic diastolic pressure (r = +0.636, p less than 0.001). Group I had a left ventricular mass similar to that of Group IIA (124.9 +/- 9 and 158.8 +/- 26 g, respectively) but a lower hyperemic response (73.3 +/- 2 and 102.3 +/- 10 percent, respectively). These data suggest that severe left ventricular hypertrophy is associated with a reduction in coronary vascular reserve; it is speculated that this decrease in the vascular reserve capacity may be related to the ischemic component of hypertrophic heart disease.
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PMID:Coronary flow studies in patients with left ventricular hypertrophy of the hypertensive type. Evidence for an impaired coronary vascular reserve. 645 Nov 67

The diagnoses and age at presentation of 1665 infants with symptomatic heart disease, who were admitted to the Brompton Hospital, London, during the period 1973-82 were reviewed. The frequency of certain conditions had changed during the period of the study. Complete transposition of the great arteries and critical aortic stenosis had become less common, whereas the frequency of right ventricular outflow tract obstruction, and of critical pulmonary stenosis in particular, had increased. Several conditions, including coarctation of the aorta, hearts with univentricular-atrioventricular connexion, and double outlet ventricle, formed a higher proportion of cases in the present series than in the New England Regional Infant Cardiac Program study, whereas the proportion of cases of atrial septal defect, hypoplastic left heart syndrome, and pulmonary atresia with intact septum was smaller. Most of the cyanotic infants presented during the first 14 days of life at the time of ductal closure. As expected this was also true of other duct dependent circulatory disorders such as aortic coarctation and interrupted aortic arch. Acyanotic infants with potentially large left to right shunts tended to present during the second month of life, when the pulmonary vascular resistance fell. This study emphasises that most symptomatic infants with heart disease present during the first two months of life. As a consequence the provision of expert neonatal and infant medical services is an integral part of any paediatric cardiac service.
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PMID:The presentation of symptomatic heart disease in infancy based on 10 years' experience (1973-82). Implications for the provision of services. 646 10

Successful management of congenital heart disease requires complete anatomic definition and timely surgical intervention. Preoperative anatomic detail is enhanced by coordination of different imaging disciplines. Precatheterization cardiac ultrasound avoids unnecessary catheter manipulation, excess radiation and reduces contrast volume. Detailed noninvasive imaging, coupled with an understanding of the natural history and surgical alternatives, obviate the need for preoperative cardiac catheterization in selected lesions. Cardiovascular anomalies which, in a well defined set of circumstances, may be exclusively managed by two-dimensional echocardiography include sinus venosus and secundum type interatrial septal defects, severe aortic stenosis in infancy, and hypoplastic left heart syndrome. The "well defined set of circumstances" are particular to each lesion and must include the patient's history, physical examination, electrocardiogram, and chest X-ray. Definitive management of a cardiovascular anomaly entails consideration of the relative superiority and cost benefit advantages of the different imaging disciplines.
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PMID:Two-dimensional echocardiography and its influence on cardiac catheterization. 646 59


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