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

A multidimensional relationship exists between cardiovascular disease and affective disorder that includes the observations that (1) there is a high rate of depression in the postmyocardial infarction period, (2) the presence of depressive illness adversely affects the prognosis of cardiac disease, and (3) depressed patients have a higher-than-expected rate of sudden cardiovascular death. The authors discuss these topics and the clinical management of depression in patients with significant preexisting heart disease. The cardiovascular effects of the tricyclic antidepressants and recently introduced nontricyclic antidepressants are reviewed with a focus on how the clinician can safely and effectively treat affective disorder in patients with severe cardiac disease.
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PMID:Treating the depressed patient with cardiovascular problems. 152 77

We recently observed a newborn affected by a Tetralogy of Fallot with pulmonary atresia. We describe clinical presentation, diagnostic and therapeutic topics of such congenital heart disease. Particularly we focused our attention on the utilization of EKG in "silent" cardiovascular disease in children.
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PMID:[Description of a clinical case of pseudotruncus arteriosus: considerations on the diagnostic role of ECG in congenital heart disease]. 152 9

The concept of community intervention in the field of cardiovascular disease prevention was introduced in the late sixties and early seventies. The WHO European Collaborative Trial in the multifactorial prevention of coronary heart disease used communities (factories) in a traditional controlled trial. The intervention used in this trial was an extension of a medical care model with preventive elements. The first two major community intervention projects in CVD prevention--the North Karelia Project and the Stanford Heart Disease Prevention Programme--were the basis of further WHO and NHLBI coordinated projects. They have used community-based population-wide strategies including existing community leadership, social networks, mass campaigns and extensive direct education for the general population. In the evaluation of those projects quasi-experimental models are used because "perfect experiments" are not possible. Some projects have proven the feasibility of community intervention and its positive impact on lifestyles and cardiovascular risk factors in a whole population and that such a development is associated with reduced cardiovascular mortality rates.
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PMID:Review of community intervention studies on cardiovascular risk factors. 154 Oct 38

The aim was to determine if certain risk factors in the general population are more strongly related to peripheral arterial disease than to ischemic heart disease. Arterial disease in the lower limbs was measured by means of the World Health Organization questionnaire on intermittent claudication, the ankle brachial pressure index, and a reactive hyperemia test in 1,592 men and women aged 55-74 years selected randomly in 1988 from the age-sex registers of 10 general practices in Edinburgh, Scotland. Peripheral arterial disease was strongly related to lifetime cigarette smoking, with additional risks in current and exsmokers of less than 5 years. Multiple regression of risk factors on measures of peripheral arterial disease showed associations with diabetes mellitus (but not impaired glucose tolerance), systolic blood pressure, and serum cholesterol; inverse association with high-density lipoprotein cholesterol; and only univariate association with triglycerides. In multiple logistic regressions of risk factors on six separate indicators of cardiovascular disease, the only consistent difference was that smoking increased the risk of peripheral arterial disease (range of odds ratios, 1.8-5.6) more than heart disease (range of odds ratios, 1.1-1.6). Diabetes mellitus was not a stronger risk factor for peripheral arterial disease.
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PMID:Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. 155 87

We discuss how to identify the child at risk for developing or having heart disease. We describe both the child at risk for developing adult-onset heart disease and the child or fetus at risk for having congenital heart disease. With respect to the child at risk for developing adult-onset heart disease, we concentrate on how four risk factors (cigarette smoking, hyperlipidemia, reduced physical activity, and obesity) affect the development of cardiovascular disease, and we review the types of therapy currently being used to modify them. We also discuss the etiological factors related to the risk of developing congenital heart disease, such as single-gene conditions, known cardiac teratogens, chromosomal anomalies, and multifactorial inheritance.
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PMID:The child at risk for developing heart disease. 3. 156 69

First-year medical students have been previously reported to have positive attitudes about disease prevention, in general, and about cardiovascular disease prevention, in particular. Whether medical school experiences exert a positive, negative, or neutral effect on prevention-oriented attitudes in medical students is not known. We assessed attitudes toward heart disease prevention in 770 entering medical students enrolled at six selected American medical schools, each having some curricular emphasis on preventive cardiology, and repeated the attitude survey near graduation in the 750 fourth-year students enrolled in the six schools. Response rates were similar at each of the schools for each administration and averaged 88% in entering students and 74% in the graduating students. We used two mean attitude scores, ranging from 1.0 to 5.0 on a Likert scale, 5.0 representing the most positive attitude. The score treating the importance of primary prevention increased from 4.08 +/- 0.39 to 4.35 +/- 0.41. The attitude score concerning the importance of research in preventive cardiology also increased from 3.65 +/- 0.56 to 3.90 +/- 0.64 (P less than .0001 for both comparisons of first-year to fourth-year students). Analyses by school revealed similar increases, as did analyses for men, women, whites, and nonwhites. The results indicate that positive attitudes toward heart disease prevention can become even more positive during medical school. The perpetuation of positive attitudes should contribute to improved clinical prevention behaviors when these graduates embark on careers in medicine.
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PMID:Medical students' improved attitudes toward prevention of cardiovascular diseases from entry to graduation. Preventive Cardiology Academic Cooperative Research Group of the National Heart, Lung, and Blood Institute. 157 1

Cardiomyopathies are an important cause of congestive heart failure in the elderly, and the magnitude of the problem is compounded by changing population demographics and the frequency of congestive heart failure in the elderly. Although the data are far from complete, differences in the clinical presentations and natural history of the cardiomyopathies in older and younger patients are becoming more clearly appreciated. Dilated cardiomyopathy (DCM) is clearly more common than previously appreciated, and elderly patients have a worse prognosis than their younger counterparts with this disease. The medical management of DCM is often more difficult in the elderly, and the problem is compounded by the relatively infrequent use of cardiac transplantation as a therapeutic option. Hypertrophic cardiomyopathy is also more common than previously appreciated, and changes in left ventricular structure often create difficulties in differentiating pathologic states from physiologic. Fortunately, the prognosis for HOCM is more favorable in the elderly than in younger patients and may be partly accounted for by the different structure of the left ventricle. If needed, surgery is an option for elderly patients with medically refractory HOCM, but particular attention must be paid to the presence and severity of associated cardiovascular disease. Restrictive cardiomyopathy with diastolic dysfunction is increasingly recognized as a cause of congestive heart failure. The differentiation from systolic dysfunction is crucial, because the treatments are so markedly different. Age-related changes in diastolic function are becoming more apparent and better characterized, but standardization of age-related "normal" values is still not available. The diagnosis of restrictive heart disease should stimulate a search for an underlying cause, inasmuch as restrictive cardiomyopathy remains a diagnosis of exclusion. Advances in noninvasive imaging have led to a resurgence of interest and have enhanced our knowledge of the cardiomyopathies. Further investigation should proceed in conjunction with studies aimed at defining the characteristics and variables of "normal" aging. For the present, the enigmatic, poorly identified "cardiomyopathies" remain a problem for both young and old.
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PMID:Cardiomyopathies in the elderly. 158 13

The postoperative course in two children with extrahepatic biliary atresia and cardiovascular disease was reviewed and the correlation between biliary drainage and cardiac function was analyzed. Both patients obtained satisfactory biliary drainage after Kasai's hepatic portoenterostomy. One patient developed heart failure postoperatively due to severe viral myocarditis. This child's total serum bilirubin concentration remained elevated for eight months, despite adequate bilirubin excretion, until her cardiac function returned to normal. Another patient died of cardiac failure due to congenital heart disease 83 days after Kasai's operation, but his postoperative biliary drainage was satisfactory as long as cardiac function remained compensated. In both cases, fluid intake was restricted severely (30 to 70 ml/kg body weight/day), as titrated by echocardiographic assessment of cardiac function, but biliary excretion was satisfactory as long as the cardiac fractional shortening ratio was greater than 30% and the ejection fraction was greater than 55%. This suggests that cardiac decompensation affects postoperative biliary excretion in patients with biliary atresia; however, with careful medical management satisfactory biliary drainage can be achieved even in patients with severe heart diseases.
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PMID:Postoperative management of children with biliary atresia and heart failure. 161 Jul 49

Cardiomyopathy (Cm), a rare form of cardiac disease in infancy, is receiving increasing attention stimulated by the availability of endocardial biopsy and new forms of therapy. Population-based information on frequency of occurrence, types, and maternal and infant characteristics of this diverse group of heart muscle disorders has been obtained in the course of an etiologic study on cardiovascular disease in infancy. The Baltimore-Washington Infant Study (BWIS) enrolled 2659 infants with heart disease and 2801 control infants between January 1, 1981 and March 31, 1987, a 6-year prevalence of 4.46/1000 live births. Fifty-six infants had cardiomyopathy, in the absence of a structural defect (prevalence 1/10,000). The cases were classified clinicopathologically as follows: dilated Cm (n = 17), hypertrophic Cm (n = 26), tumor (n = 5), endocardial fibroelastosis (n = 5), glycogen storage (n = 1), mucocutaneous lymph node syndrome (n = 1), and infarction (n = 1). Eleven syndromic associations and six metabolic disturbances indicate genetic risk factors. Some of the same syndromes occurred in other infants who had structural cardiac abnormalities. This overlap suggests that embryonic myocardial disease might sometimes be responsible for altered cardiac structures, possibly secondary to hemodynamic changes. Familial myocardial disease occurred in two infants with hypertrophic Cm. The Cm group did not differ by race and sex from controls, but the mothers were of lower educational and occupational status with less private care and with later registration for pregnancy care. The descriptive epidemiology of this population-based case group provides evidence of greater etiologic heterogeneity than has been shown in clinical reports.
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PMID:Cardiomyopathy in infancy: observations in an epidemiologic study. 161 21

Heart disease is the number 1 cause of death among women in the US, yet health providers, the public, women's health organizations, and women overlook this fact. Risk factors and the progression of cardiovascular disease (CVD) are different in women than in men. For example, women are more likely to develop and succumb to heart disease at more advanced ages than men. This may be due to the protective effect of estrogen that occurs to at least middle age when menopause occurs. The clinical studies examining means to prevent CVD in the 1960s and 1970s basically included only middle aged or older men. Yet scientists have since learned that reproductive hormones do not allow them to extrapolate the results of these studies to women. For example, some interventions identified in those trials do not as effectively affect lipoprotein levels in women as they do in men. These interventions include diet, weight loss, and exercise. Instead, cholesterol screening and management, hormone replacement therapy for cardiovascular indications, and public health messages promoting a low fat diet can be effective in women. As is the case with men, women often have a genetic predisposition for dyslipoproteinemia. High density lipoprotein cholesterol is a more significant CVD risk factor in women than in men while low density lipoprotein is more significant in men than in women. Even though estrogen therapy may prevent heart attacks, its price may be too high since it increases the risk of breast cancer. Many obstetrician-gynecologists feel confident of their ability to screen for cholesterol, yet they are not as confident in their ability to provide dietary counseling or managing drug therapy.
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PMID:Lipids and cardiovascular disease: do the findings and therapy apply equally to men and women? 161 6


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