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

Seven general practitioners used various methods to identify patients in their practices whom they had inherited and whose medication they regarded as inappropriate in the light of current knowledge. Information was collected in each case about the drug concerned, the patient, the original prescriber, and the reason for continued prescribing. Each patient was also interviewed. Altogether, 25 different drugs were prescribed for 40 patients: in 16 the inappropriate drug was one acting on the brain, in 13 an antihypertensive, in seven it was given for heart disease and in three, for asthma. The influence of the original prescriber, and the patient's dependence on the drug, helped to explain its continued use. Almost half the patients said that they might consider changing their medication. The study underlines the importance of reviewing long-term medication and offers a method of scrutinizing repeat prescribing in general practice. Community pharmacists could help in this process.
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PMID:Continued prescribing of inappropriate drugs in general practice. 855 83

Pregnancy increases the risk for respiratory failure from to numerous pulmonary diseases. Adult respiratory distress syndrome, aspiration, venous air embolism, asthma, thromboembolism, and heart disease are etiologies shared by non-pregnant women. However, their management is complicated by complex physiologic changes during pregnancy. Amniotic fluid embolism and tocolytic-induced pulmonary edema are unique to pregnancy and must be added to the list of causes of respiratory failure. Diagnostics and supportive care is difficult and must be directed with the mother and the fetus in mind. This dictates a thorough understanding of maternal physiology, and the safety of drug use during pregnancy.
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PMID:Acute respiratory failure in pregnancy. 863 95

Environmental tobacco smoke is a complex mixture of many chemical substances. The term passive smoking is used when a person breathes in air contaminated by tobacco smoke. Active and passive smoking expose an individual to the same substances, but the relative concentrations of the various substances differ. Thus, under conditions where individuals are exposed to an amount of nicotine corresponding to their smoking 1/2 a cigarette, they will be exposed to an amount of nitrosodimethylamine corresponding to their smoking about five cigarettes. Exposure of children to environmental tobacco smoke is associated with increased risk of lower respiratory tract infections, middle ear infections and asthma. Accumulating evidence points to passive smoking as a risk factor for the sudden infant death syndrome. Long term exposure to environmental tobacco smoke increases risk of lung cancer and heart disease. It is estimated that in Norway, 50 non-smokers die of lung cancer and 300-500 of heart disease annually, as a result of long term exposure to environmental tobacco smoke.
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PMID:[Health damages from passive smoking]. 865 89

Data were analyzed on 290 children admitted consecutively to the pediatric intensive care unit (PICU) of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, in 1993 to examine the frequency, severity, risk factors, and mortality of hypokalemia (3.5 mEq/l serum potassium) and the efficacy of treatment. 43 (14.8%) children had 54 episodes of hypokalemia. Most (68.6%) episodes were moderate. Predisposing factors were the nature of primary disease (renal disease 19%, septicemia 19%, acute diarrhea 14%, and heart disease with congestive failure and meningoencephalitis 12% each), malnutrition (weight for age 80% in 72%), and treatment with drugs (diuretics 20%, beta-agonists 13%, and corticosteroids 11%). Diagnoses most common in hypokalemia cases were acute renal failure (25%), septicemia (22.8%), and acute severe bronchial asthma (20%). The most important predisposing factor for hypokalemia prior to hospitalization was poor oral intake (i.e., inability to replace adequate potassium) (27%). All 43 children received 4-6 mEq potassium/100 ml of intravenous fluids. Clinicians administered an infusion of 0.3 mEq potassium/kg/hour to 7 children (9 episodes) who had ECG changes of hypokalemia until the ECG became normal. Potassium levels returned to normal in all 9 episodes requiring rapid correction and in 40 of 45 episodes requiring slow correction. PICU patients with hypokalemia were more likely to die than PICU patients with no hypokalemia (25.6% vs. 10.9%; p 0.05; odds ratio = 2.34). Hypokalemia patients who received slow correction therapy were more likely to die than those who received rapid correction therapy (31% vs 0; p 0.05). Mortality was lower in PICU patients whose hypokalemia was corrected than in PICU patients whose hypokalemia was not corrected (13.5% vs. 100%; p 0.05). Based on these findings, regular monitoring and rapid correction are recommended to improve the outcome of hypokalemia.
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PMID:Hypokalemia in a pediatric intensive care unit. 877 44

Two sisters with Ehlers-Danlos syndrome, inherited as an autosomal recessive trait, and congenital heart disease are herein reported. One was a 20-year-old woman with Ehlers-Danlos syndrome and multiple aphthous stomatitis, bronchial asthma, an emphysematous lung, a ventricular septal defect and a bilateral inguinal hernia due to hyperextensibility and joint hypermobility. The other was a 17-year-old girl with the same syndrome and an atrial septal defect, a ventricular septal defect and patent ductus arteriosus. The combination of Ehlers-Danlos syndrome and congenital heart anomalies in these siblings suggest a common genetic defect to be the cause of these diseases.
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PMID:Ehlers-Danlos syndrome and congenital heart anomalies. 878 53

Pediatric cardiac emergencies require very specific treatment in the emergency room setting. Considering the possibility of a cardiac problem as the cause for the presenting symptoms is the initial step in successful management. Many patients present with what is initially considered a primary pulmonary disorder such as pneumonia, asthma, or bronchiolitis. Airway stabilization and ventilatory support, if needed, remain the first steps in stabilizing the patient. Many neonates with acutely decompensating heart disease may require the patency of the ductus arteriosus for survival. Prostaglandin E given as continuous infusion is the treatment of choice. Congestive heart failure can present at any age. In older patients, it is often due to myocarditis and is characterized by low cardiac output. Supportive measures, fluid restriction, and inotropic support are the basic concepts for initial treatment. Supraventricular tachycardia is a frequent arrhythmia, especially in young children. If the patient is unstable, immediate intravenous administration of adenosine or synchronized cardioversion are the initial interventions. In stable patients, vagal maneuvers may be attempted to abort the arrhythmia.
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PMID:Cardiac emergencies in children. 879 20

Bronchial casts are characterized by the formation of obstructive airway plugs that may be large enough to fill the branching pattern of an entire lung. The condition is rare but can occur at any age. Casts may be secondary to underlying diseases such as asthma and cystic fibrosis, but there are often no predisposing factors. There is no accepted classification system for bronchial casts; but only a confusion of descriptive terms such as mucoid impaction, fibrinous bronchitis, and pseudomembranous bronchitis. Based on a review of nine well-documented cases and the available literature, we have separated bronchial casts into two well-defined groups: Type 1 (inflammatory), consisting of casts composed mainly of fibrin with a dense eosinophilic inflammatory infiltrate; and Type 2 (acellular), consisting of casts composed mainly of mucin with little or no cellular infiltrate and occurring only in children with congenital cyanotic heart disease. Acute mortality was high in both groups. Survivors of Type 1 casts seem to be well controlled with inhaled steroids. Optimal therapy for patients with Type 2 casts is not clear; the prognosis probably depends on underlying cardiac status. We hope that this simple classification will provide a framework for further study of this obscure condition.
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PMID:Bronchial casts in children: a proposed classification based on nine cases and a review of the literature. 900 37

This report presents an update of the prevalence of selected chronic conditions in the United States. Its purpose is to provide prevalence data by age, sex and age, race and age, family income, and geographic region for major chronic condition systems. It further assesses the percent of selected conditions that cause activity limitation, the percent for which a physician was consulted, and the percent that caused hospitalization. Conditions with the highest prevalence and those causing the most disability days are also analyzed. Trends in prevalence rates for the conditions with highest prevalence are examined as well. Information for this report is based on data collected during the National Health Interview Survey (NHIS) for the years 1990, 1991, and 1992. This is a continuing nationwide survey of households for which a probability sample of the civilian noninstitutionalized population of the United States is interviewed by the U.S. Bureau of the Census regarding the health and other characteristics of each member of the household. The sample for the years 1990-92 was composed of 142,638 households containing 368,075 persons. Each household was administered one of six of the chronic conditions system lists. Deformities or orthopedic impairments was the most frequent chronic condition reported with almost 35 million conditions. Other conditions high in prevalence were chronic sinusitis, arthritis, and high blood pressure with annual averages of 33.7, 31.8, and 27.6 million conditions, respectively. Mental retardation and multiple sclerosis caused the highest percents of activity limitation among persons afflicted, 87.5 percent and 69.4 percent, respectively. Deformities and other orthopedic impairments, arthritis, and heart disease caused the highest numbers of restricted activity days and bed disability days per year, whereas, malignant neoplasms of the lung, bronchus, and other respiratory sites, caused the highest number of restricted activity days per year, per condition reported, 96.1 days. In little more than a decade, the prevalence rate from asthma has increased almost 50 percent and the rate from chronic bronchitis has increased 46 percent.
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PMID:Prevalence of selected chronic conditions: United States, 1990-1992. 904 23

Bronchodilators used for bronchial asthma reduce respiratory resistance but also increase heart rate to some extent. It is often difficult to use such bronchodilators with elderly patients and patients with heart disease. The object of our study was to investigate whether a specific bradycardic agent, zatebradine, inhibited the heart rate increased by bronchodilators without affecting respiratory resistance. We evaluated the effects of zatebradine on the increases in heart rate and inhibition of the respiratory resistance in response to the bronchodilators, isoproterenol, procaterol (a beta 2-adrenoceptor agonist), 6-(3-dimethylaminopropionyl)-forskolin, NKH 477 (an adenylyl cyclase activator) and aminophylline in the anesthetized and artificially ventilated dog. When zatebradine in doses of 0.05-1.5 mg/kg i.v. decreased heart rate without affecting arterial blood pressure, it dose dependently attenuated the increase in heart rate in response to isoproterenol, procaterol, NKH 477 and aminophylline but did not affect the inhibition by these substances of the increase in respiratory resistance induced by histamine. Propranolol (0.01-0.3 mg/kg i.v.) dose dependently inhibited not only the increase in heart rate but also the inhibition of the respiratory resistance induced by isoproterenol and procaterol. The present results indicate that zatebradine selectively inhibits the increase in heart rate in response to cyclic AMP-dependent bronchodilators without affecting their bronchodilator effects in anesthetized dogs and suggest that zatebradine may be a useful drug for prevention of the tachycardia induced by bronchodilators used for patients with bronchial asthma.
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PMID:Zatebradine inhibits tachycardia induced by bronchodilators without affecting respiratory resistance in dogs. 904 98

Dorzolamide (dorzolamide hydrochloride), the first topical carbonic anhydrase (CA) inhibitor to become available for clinical use, lowers intraocular pressure (IOP) by reducing aqueous humour formation. It is formulated as a 2% eyedrop for use in the management of glaucoma and ocular hypertension. When administered 3 times daily, dorzolamide is effective in lowering IOP in patients with open-angle glaucoma or ocular hypertension. Mean IOP was reduced by approximately 4 to 6 mm Hg at peak (2 hours postdose) and 3 to 4.5 mm Hg at trough (8 hours postdose) in clinical trails. A 1-year comparative study showed that the ocular hypotensive efficacy of dorzolamine 2% 3 times daily was similar to that of betaxolol 0.5% twice daily, but slightly inferior to that of timolol 0.5% twice daily. Dorzolamide has additive ocular hypotensive effects when used in conjunction with topical beta-adrenergic antagonists and was as effective as pilocarpine 2% 4 times daily as adjunctive therapy in patients receiving timolol. Dorzolamide does not appear to produce the acid-base or electrolyte disturbances and severe systemic adverse events associated with oral CA inhibitors, and unlike beta-adrenergic antagonists, it is not contraindicated in patients with asthma, reactive airways disease or heart disease. Furthermore, as CA inhibitors do not cause miosis, they may cause less interference with vision than pilocarpine or epinephrine (adrenaline). The most common adverse effects associated with dorzolamide are bitter taste and transient local burning or stinging. Conjunctivitis was the most common reason for discontinuation of dorzolamide in one large study. Thus, available data suggest that dorzolamide has potential as an alternative therapy option in patients with glaucoma or ocular hypertension who are intolerant of, or unable to receive, ophthalmic beta-adrenergic antagonists and as adjunctive therapy in patients already receiving these agents. Further efficacy and tolerability data are needed to determine the place of dorzolamide in therapy.
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PMID:Dorzolamide. A review of its pharmacology and therapeutic potential in the management of glaucoma and ocular hypertension. 914 58


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