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

Nineteen patients survived a cardiac arrest not associated with an acute myocardial infarction, and had a normal electrophysiologic study with no inducible ventricular tachycardia despite programmed stimulation with one to three extrastimuli at two or more ventricular sites. Among 14 patients who had obstructive coronary artery disease, cardiac arrest occurred during exertion or an episode of angina pectoris in 11; 24 hour ambulatory electrocardiographic recordings demonstrated infrequent or no premature ventricular complexes in 10 and an ischemic response occurred during stage I or II (Bruce protocol) in 6 of 9 patients who underwent exercise testing. Treatment of these patients consisted of myocardial revascularization (eight patients) or antianginal medications (six patients). Only three patients were also treated with an antiarrhythmic drug. Over a follow-up period of 26 +/- 15 months (mean +/- standard deviation), only one patient died suddenly. Two patients who had coronary artery spasm were treated with coronary vasodilator medications and had no recurrence of cardiac arrest over 7 and 36 months of follow-up, respectively. Three patients who had cardiomyopathy or no identifiable structural heart disease were treated with nadolol or amiodarone and had no recurrence of cardiac arrest over 3 to 27 months of follow-up. Among patients who survive a cardiac arrest and have a normal electrophysiologic study, those with obstructive coronary artery disease or coronary artery spasm generally have an excellent prognosis with treatment directed primarily at the underlying heart disease. The clinical features of these patients suggest that cardiac arrest was related to ischemia rather than a primary arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical features and prognosis of patients with out of hospital cardiac arrest and a normal electrophysiologic study. 673 52

The observed normal ranges of age- and weight-adjusted maximal oxygen uptake and age-adjusted maximal heart rate during upright exercise using the Bruce protocol are shown for 104 asymptomatic women. Cardiac output was measured during upright exercise in 11 normal women with the use of the direct Fick method. On the basis of the relation between oxygen uptake and cardiac output in these 11 women, the cardiac output and stroke volume were estimated by regression in the 104 women to provide normal ranges of age-adjusted values for cardiac output and stroke volume. The potential usefulness of these age-adjusted normal ranges is illustrated by analysis of 21 observations of maximal cardiac output in 16 women with heart disease.
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PMID:Approximate normal standards of maximal cardiac output during upright exercise in women. 722 55

Although exercise testing has been advocated to unmask proarrhythmic potentials in patients receiving flecainide acetate, the effects of this drug on exercise parameters in individuals without structural heart disease have not been reported. This study was undertaken to assess the effects of flecainide on hemodynamics and electrocardiographic changes during exercise testing in 24 patients with paroxysmal supraventricular tachyarrhythmias, who had normal cardiac structure and sinus node function. Paired treadmill exercise tests using the Bruce protocol were performed after 1 week of treatment with flecainide (200 mg/day) or placebo in a double-blind, randomized design. Exercise testing was terminated because of either fatigue or dyspnea in all subjects. Although resting heart rate was unaffected, flecainide reduced the exercise heart rate (expressed as a percentage of age-predicted maximum) compared with placebo (84 +/- 12% vs. 92 +/- 9%, p < 0.001). Neither resting and exercise systolic blood pressure nor exercise duration were affected. PR interval shortening with exercise was not affected by flecainide, whereas QRS was prolonged compared with placebo (20 +/- 9% vs. 0 +/- 8%, p < 0.01). Compared with placebo, flecainide significantly shortened QTc (-7 +/- 12% vs. 0 +/- 8%, p < 0.05) and JTc (-34 +/- 11% vs. -21 +/- 11%, p < 0.01) intervals during exercise. During exercise, flecainide produced significant depression in the sinus node automaticity and manifested use-dependent slowing of ventricular conduction and acceleration in ventricular repolarization.
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PMID:Effects of flecainide on exercise hemodynamics and electrocardiography in patients without structural heart disease. 774 84

After undergoing the Fontan procedure for congenital heart disease, 16 young patients performed a maximal treadmill test according to the Bruce protocol. The peak velocity of the blood flow in the ascending aorta, stroke index, and cardiac index were measured by continuous-wave Doppler echocardiography at rest and at each stage of the test. The results were compared with those from 18 normal children. The body surface area was similar in the two groups. The endurance time was 37% shorter in the Fontan group than in the control group. From the beginning of exercise until the sixth minute, the increase in stroke index was lower in the Fontan group (NS). After that point, the stroke index was maintained at a high level in the control group but decreased toward its original level in the Fontan group. The response of cardiac index to exercise in the two groups was comparable until the sixth minute, after which the Fontan group failed to maintain an ascending curve. All the hemodynamic values were significantly higher in the control group at maximal exercise; at this point the cardiac index had increased 79% in the Fontan group and 170% in the control group. The subnormal response of the stroke volume at submaximal exercise and the subsequent decrease at maximal exercise following the Fontan procedure are important hemodynamic findings.
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PMID:Maximal hemodynamic response after the Fontan procedure: Doppler evaluation during the treadmill test. 799 34

We have previously reported that plasma endothelin-1 (ET-1) levels were significantly increased after exercise in healthy athletes. In the present study, venous plasma ET-1 levels were measured to investigate whether the role of ET-1 during exercise differs between healthy athletes and patients with congenital heart disease. Seven patients (mean age 13 years) performed symptom-limited treadmill exercise (Bruce protocol). All patients were in class I of the NYHA functional classification. The mean end-exercise O2 utilization was 32 ml/min/kg (166% of ventilatory threshold). Blood sampling was carried out in the seated position. The plasma ET-1 level was 1.21 pg/ml before exercise and did not alter immediately after or 30 min after exercise. The plasma level of norepinephrine was markedly elevated immediately after exercise and returned to the basal level 30 min after exercise. The present study demonstrated that exercise failed to alter plasma ET-1 levels in patients with congenital heart disease.
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PMID:Plasma endothelin-1 levels after exercise in patients with congenital heart disease. 858 55

118 patients with lung cancer who underwent treadmill exercise electrography (ECG) as part of their preoperative evaluation, were investigated for postoperative events. On the treadmill exercise ECG 27 patients were positive and 91 were negative. The more elderly patients tended to reveal ischemic findings in treadmill exercise ECG. Of the 71 patients with normal of result by ECG at rest, 15 patients (21.1%) had postoperative ischemic change on ECG. As a result, it was considered that this examination was insufficient to detect latent ischemic heart disease. The patients who had a discontinued at stage 2 or less of the Bruce protocol and had a negative result by treadmill exercise ECG, were classified as insufficient group and separated from the others. (27/118 patients). This group consisted of advanced age (p < 0.05) who tended to experience postoperative events. In the sufficient group, patients showed ischemic events predominantly on ECG at postoperative period (p < 0.01). We concluded that as preoperative screening of heart disease prior to lung cancer surgery ECG at rest was not adequate while treadmill exercise ECG was useful.
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PMID:[Preoperative evaluation of cardiac disease for patients with lung cancer: usefulness of treadmill exercise electrocardiogram]. 1003 70

Atherosclerosis is a general health problem that not only affects the coronary arteries but also (in men) the penile arteries, thus contributing to organic causes of erectile dysfunction (ED) in heart disease patients. These organic causes are intertwined with psychological and pharmacological causes because medication prescribed for heart disease patients may also cause ED. The incidence of ED after myocardial infarction ranges from 38 to 78%. As sexual intercourse involves physical exertion, the medical history, ventricular function determined through echocardiography, and stress testing are used to classify patients into various groups where coital activity represents a greater or lesser cardiovascular risk. The energy requirements for intercourse are not high, ranging from 3.7 metabolic equivalents (METs) of energy expenditure at resting state during the preorgasmic phase to 5 METs during orgasm. The Bruce protocol for exercise stress testing is a six-stage protocol with changes in the slope and speed of the treadmill. As a general rule, a patient who completes the first two stages of the Bruce protocol has a functional capacity greater than 7 METs, which is considered sufficient for sexual intercourse. The physician or cardiologist concerned should institute first-line treatment with oral drugs according to the indications listed below. If sexual activity is not contraindicated, the treatment of choice for ED in heart disease patients is oral therapy with sildenafil, except in those cases in which its use is contraindicated. Specific recommendations are discussed.
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PMID:Erectile dysfunction in heart disease patients. 1549 52

The Duke Treadmill Score (DTS) has been shown to predict mortality in women who have symptomatic heart disease, but its ability to do so in asymptomatic women is unknown, as is its comparative advantage to exercise capacity. We investigated whether a decreased DTS is associated with increased mortality in a prospective cohort of 5,636 asymptomatic women. A symptom-limited exercise treadmill test using Bruce's protocol was performed at baseline. DTS was calculated using exercise time, exercise-induced angina, and ST-segment depression. Exercise capacity was measured in METs. Deaths and cause of death were identified from 1992 to 2000. After adjusting for the Framingham Risk Score, the risk of death decreased by 9% for each unit increase in DTS and by 17% for every 1-MET increase (p <0.001). Those who had a DTS <5 (moderate or high risk) had hazard ratios for death and cardiac death that were 2.2 and 2.5 times greater, respectively, than did those who had a DTS > or =5 (low risk), after adjusting for Framingham Risk Score (p <0.001). Receiver-operating characteristic curves for the DTS model and the exercise capacity model were not significantly different. In conclusion, we have demonstrated that, although the DTS is an independent predictor of mortality and cardiac mortality in asymptomatic women, it does not appear to be a better predictor than exercise capacity alone. The role of ST-segment changes and symptoms with stress testing in asymptomatic women does not provide additional prognostic information.
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PMID:Prognostic value of the duke treadmill score in asymptomatic women. 1605 60

Exercise testing in pediatric patients differs in many aspects from the tests performed in adults. Diseases that are associated with myocardial ischemia are very rare in children. Their cardiovascular response to exercise presents different characteristics, particularly maximal heart rate and blood pressure response, which are essential in interpreting hemodynamic data. The main indications for exercise testing in children are evaluation of exercise capacity and identification of exercise-induced arrhythmias. There are many testing protocols, but the Bruce protocol is widely used in many pediatric cardiac centers. In this article the authors describe the main indications for exercise testing in children with congenital heart disease, the contraindications for exercise testing and the indications for terminating an exercise test.
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PMID:Exercise testing in pediatric cardiology. 1612 79

Endocarditis is a rare and serious complication of brucellosis and is the main cause of death in this pathology. Diagnosis requires a high level of suspicion and is based on the association of epidemiological, clinical and serological elements. Echocardiography plays a crucial role in early diagnosis, as well as in identifying predisposing heart disease and local complications typical of this pathology. Treatment is not consensual; most authors recommend an early surgical approach, due to the degree of tissue destruction caused by Brucella and the high rate of recurrence. Nevertheless, other authors stress the need for prognostic stratification of each case and support conservative treatment in low-risk cases. This article describes the case of a patient with brucella endocarditis that was treated medically and reviews the relevant literature.
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PMID:Brucella endocarditis--case report and literature review. 1917 31


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