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

Coronary artery disease and ischemic cerebrovascular disease are leading causes of morbidity and mortality in the United States. Coronary artery disease often coexists with asymptomatic carotid artery atherosclerosis, transient ischemic attacks, or ischemic stroke. Numerous studies have shown that mortality from all forms of ischemic cerebrovascular disease is primarily due to coronary artery disease. Thus, there is increasing interest in identifying coronary artery disease in patients with cerebrovascular disease, including those without clinical manifestations of heart disease. We review the use of current noninvasive techniques to detect coronary artery disease and present practical approaches to screen for ischemic heart disease. Current diagnostic imaging methods for potential cardioembolic sources of cerebral infarction are also discussed.
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PMID:Cardiac evaluation of the patient with stroke. 230 Sep 82

By studying 3,408 consecutive autopsied elderly patients, we found that two thirds of the 132 massive cerebral infarctions (86) were embolic, of cardiac origin. Embolic infarction associated with nonvalvular atrial fibrillation was seen in 48 cases (36%), half due to the first stroke. Embolic infarction associated with heart disease other than nonvalvular atrial fibrillation was seen in 23 cases (17%), and that from nonbacterial thrombotic endocarditis was seen in 15 cases (11%). Thrombotic infarction or infarction of nonembolic cardiac origin was found in only 39 cases (30%). Of 56 patients with fatal massive cerebral infarction who died less than or equal to 2 weeks after their stroke, 25 (45%) had embolic strokes associated with nonvalvular atrial fibrillation. Our study shows that nonvalvular atrial fibrillation is a very important cause of fatal massive cerebral infarction in the elderly.
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PMID:Nonvalvular atrial fibrillation as a cause of fatal massive cerebral infarction in the elderly. 259 28

The prevalence of cerebrovascular disease risk factors and their immediate mortality prognostic value together with the initial analytical parameters are evaluated. 250 cases of cerebral infarction (CI), 150 cases of intracerebral hemorrhage (ICH) and 60 cases of transitory ischemic events (TIE) were studied and compared to a control group. A higher prevalence of arterial hypertension, cardiopathy, previous cerebrovascular disease and elevated hematocrit was found in the CI group. In the TIE group there was an increased prevalence of cardiopathy, previous cerebrovascular disease and high hematocrit. In the ICH group an increased prevalence of hypertension and left ventricular hypertrophy was found. We have to point out the importance of a global approach of the risk factors. The intrahospital mortality due to CI was associated with old age, low hematocrit, leukocytosis and high blood sugar at admission. ICH was associated with a higher systolic arterial pressure leukocytosis and elevated blood glucose at admission.
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PMID:[Risk factors in cerebrovascular disease and their prognostic importance]. 260 64

The validity of transcranial Doppler (tD) was evaluated for the identification of stenoses of the middle cerebral artery (MCA). Twenty patients with atheromatous stenosis of the proximal MCA of more than 30% (3 of these cases with stenosis of more that 75%) had repeated transcranial Doppler between 1975 and 1987 and conventional angiography. No patient had carotid stenosis nor embolus-producing cardiopathy. Ten patients had had infarcts or transient ischemic attacks (symptomatic group). Ten patients were asymptomatic (asymptomatic group). Cerebral infarcts in the MCA territory occurred in 1 patient of each group and 1 additional patient in each group had an infarct in another territory. Follow-up was possible in 15 patients. The stenosis remained unchanged in 14, occlusion occurred in 1. The results of transcranial Doppler were compared to those of angiograms in this series and in an additional series of 40 patients who had had a normal angiogram. Sensitivity of transcranial Doppler was 60% (75% when stenosis was over 50%). Specificity was 95%. Comparison with angiography findings showed, among causes of failure of tD, analysis of the artery over too short a segment or kinked artery of very long stenoses, or too decreased blood flow. The failure rate of tD due to failure of bone penetration by ultrasounds was 5%. This new reproducible, non-invasive method appears to be able to detect MCA stenoses of 50% or more and help in follow-up.
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PMID:[Long-term study of 20 cases of proximal stenosis of the middle cerebral artery. Role of transcranial Doppler ultrasound]. 265 77

Platelet aggregation inhibitors have been more extensively and better studied than all other treatments used in the prevention of cerebral ischaemia. It has been demonstrated that both aspirin (300 mg/day) and ticlopidine (500 mg/day) are effective in the secondary prevention of cerebral ischaemic accidents associated with atherosclerosis, with a 20 and 30 p. 100 respectively reduction of risk. At the moment, there is no evidence that these compounds are effective in the primary prevention or treatment of cerebral infarction in the acute phase. The best way of preventing thromboembolic stroke of cardiac origin is to treat the responsible heart disease and prescribe anticoagulants. However, several studies are in progress to evaluate the effectiveness of aspirin in the primary and secondary prevention of cerebral thromboembolism due to non-valvular atrial fibrillation.
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PMID:[Platelet antiaggregants in cerebral ischemic pathology]. 268 44

We investigated the prevalence of stroke in Taiwan in an epidemiologic study of stroke, diabetes, and cardiovascular disease that used a two-phase survey design. The study population was drawn by cluster sampling and consisted of both urban and rural communities from four regions of Taiwan. There were 8,705 people 36 years of age or older interviewed during the period of October 1 to December 31, 1986, and 143 cases of completed stroke were later identified by a neurologist. The point prevalence rate for people aged 36 or older in our study was 1,642/100,000 population (95% confidence interval 1,389-1,942/100,000). Prevalence rates differed significantly among the four study regions and between urban and rural communities; prevalence was greater in northern Taiwan and in urban communities. Percentages of the major types of stroke in 143 stroke survivors were as follows: cerebral infarction 67.1% (96 cases), cerebral hemorrhage 14.0% (20 cases), subarachnoid hemorrhage 4.2% (six cases), and unclassified 14.7% (21 cases). Of the stroke survivors, 67.1% were independent in activities of daily living, and 75.5% were independent in ambulation. Hypertension, heart disease, diabetes mellitus, and a family history of stroke were significantly more common in stroke survivors than in strokefree individuals.
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PMID:Prevalence of stroke in Taiwan. 274 45

One hundred and two stroke patients were studied. Thirty-three (32 per cent) were hypertensive by the WHO criteria. Eighty-three (83 per cent) had cerebral infarction and three patients suffered from spontaneous intracerebral haemorrhage. The mean left ventricular mass was calculated from echocardiographic measurements and compared with that of controls. Neither cases nor controls had valvular or congenital heart disease, or disease processes that may be associated with myocardial infiltration. Mean left ventricular mass of all cases was significantly greater than that of controls (p less than 0.025) and that of the cases over the age of 50 years was also significantly greater than that of controls of the same age (p less than 0.02). The clinically normotensive cases had greater left ventricular mass than the normotensive controls (p less than 0.02). Meanwhile left ventricular mass in patients aged 50 and under was not significantly different from the appropriate control group (p greater than 0.2). These data indicate that the frequency of arterial hypertension among victims of cerebral infarction is greater than may be ascertained clinically particularly in those over 50.
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PMID:Cerebral infarction and left ventricular mass: a clinical and echocardiographic study. 297 19

Hematologic management of adults with cyanotic congenital heart disease has received little recent attention. The lack of practical therapeutic guidelines prompted us to consolidate our observations on 124 cyanotic adults for general physicians, cardiologists, and hematologists who care for these patients. Specific attention focused on regulation of erythrocyte mass and concepts of compensated and decompensated erythrocytosis, symptoms of deficient tissue oxygen transport, hyperviscosity and iron deficiency, the potential relation between elevated hematocrit levels and brain injury, hemostasis, urate metabolism, and renal function. Cerebral infarction was not seen in any patient. Phlebotomy is best reserved for treatment of symptomatic hyperviscosity. Iron therapy is indicated for symptomatic iron deficient erythropoiesis. Abnormal hemostatic mechanisms are the rule. Antithrombotic medications have little or no role in treatment. Hyperuricemia is the result of abnormal renal uric acid excretion not urate overproduction, and serves as a marker of abnormal renal function. Drugs that promote urate excretion are the preferred maintenance treatment in symptomatic hyperuricemic patients.
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PMID:Adults with cyanotic congenital heart disease: hematologic management. 304 12

A long-term prognosis and outcome study of elderly hypertensives (aged 60 years or over) was made based on the 20-year prospective population survey conducted in a Japanese rural community (Hisayama) and the results were compared with those for younger subjects (aged 40-59 years). The risk of cardiovascular mortality related to blood pressure level increased with the elevation of either systolic or diastolic pressure in both younger and elderly groups. Cardiovascular mortality increased markedly at a systolic pressure of greater than or equal to 160 mmHg, or a diastolic pressure of greater than or equal to 100 mmHg for those aged 40-59 years. There was no cut-off level for increased risk of cardiovascular mortality for either systolic or diastolic pressures for those aged 60 years or over. Stroke mortality was seven times higher in systolic, and 10 times higher in diastolic hypertensives than in normotensives (P less than 0.01) for the group aged 40-59 years. However, deaths due to stroke and heart disease were more frequently associated with borderline (relative risk 2.3 and 2.3, respectively; P less than 0.01), systolic (relative risk 3.2 and 3.7, respectively; P less than 0.01) and diastolic hypertension (relative risk 2.1 and 4.8, respectively; P less than 0.01), compared to normotension for those aged 60 years or over. Intracerebral hemorrhage and cerebral infarction occurred more frequently in diastolic hypertensives for both young (relative risk 9.8 and 4.8, respectively; P less than 0.01) and elderly subjects (relative risk 3.4 and 1.5, respectively; P less than 0.01) than in normotensives.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prognosis and outcome of elderly hypertensives in a Japanese community: results from a long-term prospective study. 322 Oct 98

We report on four children who had cerebral vascular events in the first three months after the Fontan procedure for complex cyanotic congenital heart disease. Potential risk factors in these children included congestive heart failure, postoperative thrombocytosis, and cardiac arrhythmias. These cases suggest that children who undergo Fontan surgery may be at increased risk for cerebral infarction.
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PMID:Cerebral infarction complicating Fontan surgery for cyanotic congenital heart disease. 349 7


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