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

Approximately 14 million persons worldwide are estimated to be infected with HIV-1. As more effective therapies have produced longer survival times for HIV-infected patients, new complications of late-stage HIV infection including HIV-related heart disease have emerged. The most common and life-threatening cardiovascular complication of HIV infection is the development of primary heart muscle disease associated with severe global left ventricular dysfunction (also termed cardiomyopathy). Other less common forms of symptomatic heart disease in HIV-1-infected patients are pericardial effusion with cardiac tamponade, high-grade arrhythmia with sudden cardiac death, and systemic embolization caused by nonbacterial thrombotic endocarditis or infective carditis. The demographic and clinical characteristics of HIV-infected patients who develop cardiomyopathy as well as potential enhancing risk factors are as yet poorly characterized. This review briefly describes the various presentations and potential causes of symptomatic HIV-related heart disease and discusses the challenge facing clinicians who evaluate HIV-infected patients presenting with serious cardiac manifestations of their disease.
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PMID:Cardiomyopathy and other symptomatic heart diseases associated with HIV infection. 883 75

Syncope is a frequent clinical event. It is mainly caused by a suddenly reduced cerebral blood flow. There are two reasons for sudden cerebral underperfusion: cardiogenic - associated with cardiac disorders and neurocardiogenic - resulting from a sudden fall of arterial blood pressure due to impaired autoregulation of the circulation. Cardiogenic syncopes prevail in cardiac diseases associated with impaired blood flow and cardiac arrhythmias. They develop in aortic stenosis, hypertrophic cardiomyopathy, atrial myxoma, myocardial infarction, pulmonary embolism, cardiac tamponade. Cardiac arrhythmias associated with syncope include ventricular tachycardia, supraventricular tachycardia in the preexcitation syndrome, sinus bradycardia, II degrees and III degrees atrioventricular block, atrial fibrillation with rapid ventricular response. The prognostic value and pathomechanisms loss of consciousness in these disease states have been discussed. Neurocardiogenic syncopes include vasovagal syncope, carotid sinus syndrome, orthostatic hypotension, event-induced syncope. It is frequently difficult to establish the reason for syncope. Physical examination and a history should be taken first followed by noninvasive studies such as standard ECG, exercise testing, carotid sinus compression, Holter monitoring, tilt testing, signal-averaged ECG. Noninvasive diagnosis helps establish the cause of syncope in 53-62% of cases and is indispensable before proceeding to electrophysiological testing. Such testing should be limited to patients with organic heart disease, in whom previous examinations did not reveal the etiology of loss of consciousness.
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PMID:[Syncope as a cardiologic problem]. 892 55

The blood flow in the hepatic veins can normally be studied easily by Doppler ultrasound. The pattern of blood flow in normal individuals is described, and its relation to the cardiac cycle and changing pressure in the right atrium. The blood flow shows variations in healthy persons, and may change in cases of heart disease and hepatic disease. Conditions such as atrial fibrillation, tricuspid regurgitation, abnormal relaxation, restrictive cardiomyopathy, constrictive pericarditis and cardiac tamponade are reflected in the hepatic veins, and the pattern of blood flow may help in diagnosis, and in grading the pathology. In cirrhosis and portal hypertension the heart-synchronous variation in velocity is reduced. This is due to increased resistance to blood flow across the liver and the pressure gradient becoming larger than the variations in pressure in the right atrium.
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PMID:[Doppler ultrasound of blood flow in the hepatic veins]. 918 59

A case of metastatic colonic adenocarcinoma invading the left atrium is reported in a patient with clinical signs of cardiac tamponade. The intracavitary extension of the tumour was clearly demonstrated by contrast enhanced CT. As CT plays an important role in the evaluation of patients with intrathoracic masses, intravenous contrast medium is recommended in those cases with associated clinical symptoms of heart disease or pericardial effusion. Its use may establish the diagnosis of cardiac involvement.
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PMID:Lung metastasis invading the left atrium--CT diagnosis. 1070 80

The authors report a case of aortic dissection and cardiac tamponade in a 29-year-old man after ingestion of ecstasy (methylenedioxymethamphetamine, MDMA) at a "rave" party. There was no history of hypertension, myxoid heart disease, or other risk factors for aortic dissection in the deceased, although a minor degree of cystic medial necrosis was noted on histologic examination of the aorta. Autopsy toxicology revealed low residual levels of MDMA in the blood about 48 hours after ingestion of the drug. This case report describes a probable association between MDMA ingestion and aortic dissection in a previously well young adult. The likely mechanisms are discussed, and the difficulties in diagnosing this complication are highlighted.
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PMID:Aortic dissection after ingestion of "ecstasy" (MDMA). 1099 Feb 89

Mechanisms of bleeding common to virtually all patients after heart surgery are platelet dysfunction, enhanced fibrinolysis, dilution of all components of the coagulation system, and the presence of heparin and protamine. The use of warfarin is increasing in patients with heart disease requiring surgery. The replenishment of vitamin K-dependent factors beyond a normal prothrombin time is not assessable, and the dilution associated with cardiopulmonary bypass can reach coagulopathic levels. Optimal preoperative preparation is required and intraoperative therapy initiated when indicated. Individualized heparin and protamine dosing, antifibrinolytic drug administration, minimization of blood loss and dilution, and minimal time on cardiopulmonary bypass are basic adjuncts to meticulous surgical hemostasis. When bleeding is observed in the postoperative period, a sequential assessment of the probable cause leads to initial therapy while laboratory test results are obtained. Ongoing assessment for hemodynamic instability caused by accumulated mediastinal blood is needed while managing the bleeding patient. A chest radiograph and transesophageal echocardiogram can be useful in diagnosing cardiac tamponade.
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PMID:Management of bleeding and coagulopathy after heart surgery. 1115 28

Successful management of pediatric cardiac emergencies requires an accurate diagnosis to institute an appropriate plan of therapy. The diagnosis, however, is not always straightforward, as evidenced by the nonspecific clinical picture that can be presented by congenital heart defects. Entertaining the possibility of a cardiac problem in neonates with pulmonary symptoms unresponsive to standard therapies is crucial for successful management of patients with congenital heart disease. In addition to ventilatory support, prostaglandin E1 infusions or emergency interventional cardiac catheterization is often a life-saving initial measure in patients with acutely decompensated congenital cardiac lesions that require a patent ductus arteriosus for survival. Pericardial tamponade is associated with various acquired and iatrogenic causes. Emergent pericardiocentesis is mandatory when cardiovascular compromise occurs. The goal of anesthetic management is to maintain cardiac output. With the increasing use of central venous catheters in neonatal ICUs and the high mortality rate for central venous catheter-related cardiac tamponade, the diagnosis must be considered in any patient with a central venous catheter in situ who acutely develops unexplained hypotension, bradycardia, and diminished pulses. Arrhythmias also can cause hemodynamic instability in infants and children. Supraventricular tachycardia is by far the most common emergently presenting arrhythmia in the pediatric population. Unstable patients require immediate intravenous adenosine or synchronized cardioversion. Complete heart block is rare, but it can lead to congestive heart failure and occasionally to cardiovascular collapse and sudden death. Emergency treatment of complete heart block includes pharmacologic support and temporary or permanent pacemaker placement as indicated. In infants, congestive heart failure usually is related to congenital heart disease, whereas in older children, it tends to be secondary to an acquired cause. Supportive measures, fluid restriction, and inotropic support are the principles of initial treatment. Prompt recognition and initiation of appropriate therapy in pediatric cardiac emergencies are essential for favorable outcomes.
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PMID:Pediatric cardiac emergencies. 1146 66

The frequency of pericardial involvement in Systemic Sclerosis (SSc) is high on autoptic or echocardiographic studies, but the clinical recognition of pericarditis with or without effusion is rare. We describe a case of a 71-year-old female with no previous history of heart disease, who presented with a large pericardial effusion and tamponade that required pericardial drain. She had suffered from Raynaud's phenomenon since 25 years. Six weeks after hospital discharge she complained of skin hardening on left leg. Pericardial tamponade is a very rare manifestation of SSc and occurs both early or late in the course of the disease, but in our case it preceded the recognition of scleroderma. We have only identified two other cases of pericardial effusion preceding cutaneous involvement in scleroderma.
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PMID:[Cardiac tamponade preceding skin involvement in progressive systemic sclerosis]. 1240 35

Most patients with ventricular tachycardia (VT) associated with structural heart disease should receive an implantable cardioverter-defibrillator as initial therapy. Patients with symptomatic recurrences of tachycardia, including those with multiple defibrillator shocks, are considered for ablation. The vigor with which antiarrhythmic drug therapy is pursued as antecedent therapy to ablation depends on patient factors (eg, medical comorbidity, type of heart disease, number and hemodynamic tolerance of tachycardias) and the previous history of antiarrhythmic drug exposure (eg, side effects, inefficacy). In patients with mild left ventricular dysfunction and well-tolerated tachycardia, ablation may be offered as primary definitive therapy in selected individuals. In patients without structural heart disease, ablation is usually offered as primary definitive therapy to highly symptomatic patients, and is strongly recommended for patients with recurrent tachycardia following initial attempts at drug suppression. Optimal outcome of VT ablation depends on the availability of an experienced team and sophisticated facilities to accommodate the technical challenges associated with the broad spectrum of clinical presentations and arrhythmia mechanisms. Historically, major complications have been reported in up to 10% of patients, including death, stroke, cardiac tamponade, complete heart block, and myocardial infarction. In our own experience with VT ablation over the past 10 years, major complications occurred in three (1.8%) of 168 patients with structural heart disease and one (0.7%) of 142 patients without structural heart disease.
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PMID:Catheter Ablation of Ventricular Tachycardia. 1294 Dec 6

Acute heart failure is always an indication for referral to an intensive care unit. In the widest sense, the term acute heart failure includes the manifestation forms of pulmonary edema, cardiogenic shock or rapid-onset decompensated cardiac insufficiency unaccompanied by shock or pulmonary edema (low-output syndrome). Acute heart failure may occur in the absence of previously known heart disease. Existing prior specific diseases that may end in acute cardiac insufficiency include acute myocardial infarction, decompensated cardiomyopathy, myocarditis, cardiac tamponade, endocarditis or arrhythmogenic heart failure.
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PMID:[Acute heart failure]. 1537 19


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