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

Fifteen patients had left ventricular function measured by the angiotensin infusion method. Seven patients had no evidence of heart disease, and eight patients had angina pectoris and coronary arteriographic evidence of coronary disease without congestive heart failure. During angiotensin infusion, those patients without heart disease had a decrease in cardiac index (average, 0.63 L. per minute per square meter) and a decrease in heart rate (average, 12 beats per minute.) The ventricular function curve had a poor SWI response in four of the seven subjects. The patients with coronary artery disease also had a reduction in cardiac index during angiotensin (average, 0.44 L. per minute per square meter) and the heart rate was unchanged in four subjects, increased in two subjects, and decreased in two subjects. Six of the subjects had flat or descending slopes on the function curve, and in one subject there was only a very gradual ascending slope. Many of the curves of both groups looked similar so that the function curves did not differentiate between those patients with or without heart disease. The mechanism for production of bradycardia, reduction of cardiac output, and depressed function curves with angiotensin is multifactorial, but is probably due to the baroreceptor reflex response, the increase in coronary artery resistance, and possible to the direct effect of increased left ventricular afterload itself. The ventricular response to angiotensin is so variable that the angiotensin infusion method of evaluating ventricular function is not reliable.
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PMID:The angiotensin infusion test as a method of evaluating left ventricular function. 111 66

The series reported includes 85 patients who underwent arterial embolectomy for 101 embolic events. The over-all hospital mortality rate following embolectomy was 41 percent. The etiological factors for this high mortality rate are analyzed. The group includes 58 patients who had arteriosclerotic heart disease and 27 patients with rheumatic valvular disease. The mortality rate encountered in the arteriosclerotic group of patients was 52.9 percent, whereas that in the rheumatic group of patients was 18 percent. The major cause of death was cardiorespiratory failure (51 percent). Factors which weighed heavily on the final outcome were previous myocardial infarction, hypertension, diabetes, cardiac decompensation, and rhythm disturbances. Limb salvage was accomplished in 51 patients (60 percent). Amputation was performed in 17 patients (20 percent).
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PMID:Mortality rate following lower limb arterial embolectomy: causative factors. 112 92

Two patients are described who presented with congestive heart failure and were found to have an atrial septal defect with a pulmonary blood flow approximately twice the systemic blood flow. Most of the usual clinical signs of atrial septal defect were absent, and the diagnosis was established by right heart catheterization and radioisotopic angiography. Both patients had hypertension and coronary artery disease. Atrial septal defect in the adult patient may not be recognized because of associated cardiac disease, including coronary artery disease and hypertension, or pulmonary disease which may obscure the usual clinical signs of a septal defect. Radioisotopic angiography and right heart catheterization should be considered in any patients with heart disease or congestive failure of obscure cause even if the usual diagnostic signs of atrial septal defect are absent.
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PMID:Occult atrial septal defect in adults. 115 34

Seven infants under one month of age with controlled congestive heart failure showed a mean oxygen consumption of 9-4 +/- 1-6 SD ml/kg per min, a mean respiratory quotient of 0-71 +/- 0-05 SD, and a mean metabolic rate of 63 +/- 12 SD cal/kg per 24 h. This compares with a group of infants with congenital heart disease not in heart failure with Vo2 of 6-5 +/- 1-2 SD ml/min per kg, respiratory quotient of 0-80 +/- 0-11 SD, and basal metabolic rate of 45 +/- 8 SD cal/kg per 24 h. These differences are significant (P less than 0.001). The findings of a greater metabolic rate associated with congestive heart failure are thus extended to the newborn period.
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PMID:Metabolic rate of neonates with congenital heart disease. 116 66

Five cases of aortic incompetence and nodular seropositive rheumatoid arthritis are presented. Four cases underwent aortic valve replacement. Two of these had granulomatous involvement of the aortic cusps similar to subcutaneous rheumatoid nodules, and another showed a nonspecific fibrosis. One case had definite coincidental rheumatic aortic and mitral heart disease. Two patients had undergone pericardectomy previously for constrictive pericarditis. Good results were obtained in all four operated cases and cardiac surgery enabled continuation of rehabilitation for the rheumatoid arthritis, including major orthopaedic procedures. A review of 22 cases from the literature with rheumatoid granulomata within the aortic valve shows that they are associated with mitral valve granulomata in 63-6%. Congestive cardiac failure was found in 75%. Macroscopical evidence of aortic incompetence was seen in 36-8% and of aortic stenosis in 15-8%. Associated pericarditis occurred in 59-1%, which was severe or complicated in 13.6%. The associated arthritis was severe in 77-8% with subcutaneous nodules (71-5%), rheumatoid factor (83-6%), and episcleritis (66-6%). From these cases and a review of the literature the following points are emphasized. (1) Both the granulomatous and nonspecific aortic valvulitis of rheumatoid arthritis may result in significant haemodynamic abnormality. (2) The valve lesions found are often clinically and macroscopically indistinguishable from rheumatic valve lesions. (3) Granulomata, when present, are usually found in the valve cusp or ring and only occasionally in the aortic wall. (4) Associated joint disease, although usually severe, may be mild. (5) The valve lesion may be accompanied by a severe pericardial involvement--either tamponade or constriction. (6) Aortic valve replacement for aortic incompetence in rheumatoid arthritis is both feasible and worthwile, despite severe joint disease.
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PMID:Aortic valve incompetence and replacement in rheumatoid arthritis. 119 Aug 51

Four hundred and sixteen patients with documented arteriosclerotic heart disease (ASHD) underwent 424 diagnostic and therapeutic surgical procedures during the year 1970 at the Henry Ford Hospital. They were classified according to the specific clinical manifestation of their cardiac abnormality. Patients with a history of old, well-compensated myocardial infarction, and those with cardiac arrhythmia, bundle-branch block, congestive heart failure and A-V block (pacemaker-protected) but no evidence of previous myocardial infarction fared almost as well as subjects of the same age without cardiac disease, and were considered to run the lowest operative risk. Patients with angina, especially if there was a history of infarction, were an intermediate risk in terms of complications and mortality. Patients with a history of previous infarction complicated at the time of the surgical procedure by arrhythmia, A-V block, bundle-branch block, or congestive heart failure were in the "highest risk" category. A severe A-V block indicated the need for insertion of a "prophylactic" pacemaker before any attempt at a diagnostic or therapeutic procedure. No patient with clinical or electrocardiographic evidence of a recent infarction (less than three months' duration) should undergo any elective surgical procedure under any form of anesthesia unless the surgeon is prepared for a high mortality rate that may approach 90 percent. In contrast, the patient with old, well-compensated myocardial infarction and no evidence of dysrhythmia, block or congestive failure can tolerate even a major surgical operation under any form of anesthesia extremely well.
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PMID:Operative and nonoperative risks in the cardiac patient. 120 86

The effect of congestive cardiac failure, hypoxia and hypoglycaemia on glucose tolerance and insulin secretion were studied in selected groups of infants with congenital heart disease. Fasting blood glucose level was significantly decreased in patients with congestive heart failure and in cyanotic infants without congestive heart failure. In the former it seemed to be correlated with the degree of malnutrition, while in cyanotic infants it was independent of the nutritional state. Plasma insulin levels were reduced in infants, with congestive cardiac failure, although their glucose tolerance test and free fatty acid concentrations were normal. It is suggested that the decreased plasma insulin concentration was a consequence of adaptation to reduced requirements. Glucose tolerance and insulin secretion were not affected by hypoxia or hypoglycaemia.
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PMID:Plasma glucose, insulin and free fatty acids in infants with congenital heart disease. 124 3

His bundle electrograms were recorded in 308 adults with chronic bundle branch block. The A-H interval was normal in 249 patients and prolonged in 59. Comparison of patients with normal and prolonged A-H intervals revealed a greater incidence of demonstrable organic heart disease in the latter (P less than 0.01). Dyspnea, cardiomegaly and congestive heart failure were more frequent in patients with A-H prolongation. These patients also had longer P-R intervals and atrioventricular (A-V) nodal effective refractory periods, lower paced rates producing second degree A-V block proximal to the His bundle and a greater frequency of H-V prolongation. All patients were prospectively followed up in a conduction disease clinic with mean follow-up periods (+/- standard error of the mean) of 523 +/- 23 and 588 +/- 47 days in the patients with normal and prolonged A-H intervals, respectively. Seven (3 percent) of the patients with a normal A-H interval had A-V block with probable or definite site of block proximal to the His bundle in three and distal to the His bundle in four. In five of the six patients with a prolonged A-H interval who experienced A-V block (10 percent), the probable or definite site of block was proximal to the His bundle. Mortality (both sudden and nonsudden) was not significantly different in the patients with normal and prolonged A-H intervals. In summary, A-H prolongation was associated with increased incidence of organic heart disease and myocardial dysfunction. The risk of development of A-V nodal block was greater in patients with a prolonged A-H interval but appeared to be of minimal clinical significance.
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PMID:Significance of A-H interval in patients with chronic bundle branch block. Clinical, electrophysiologic and follow-up observations. 124 55

The prognostic significance of ventricular premature beats (VPB) and their proper management are still a subject of controversy, particularly since during the last few years a number of publications have raised doubts as to the effectiveness and safety of antiarrhythmic drugs. An appropriate assessment of the VPB must consider: 1) electrocardiographic characteristics. 2) Associated symptoms. 3) Presence or absence of underlying disease, and 4) Ventricular function (VF). On this basis VPB may be classified as "Benign" (isolated; asymptomatic; mild or absent cardiopathy, and preserved VF); "Hazardous" (presence of complex VPB; with or without symptoms, and recognized organic heart disease), and "Malignant" (complex VPB and ventricular tachyarrhythmias; symptomatic cardiac disease, and compromised VF). Antiarrhythmic drugs are indicated for "Hazardous" and "Malignant" VPB. However, selection and efficacy must be documented by objective testing (Holter, stress, plasma levels). When utilized in well defined groups of patients, with reduction in the hourly number of VPB (more than 50-70%) and mainly of complex forms, there is clear benefit in terms of long-term survival, including coronary disease and congestive heart failure.
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PMID:[Ventricular extrasystole and coronary disease: to treat or not to treat?]. 128 78

The authors describe a case of congenital heart disease no longer frequent in adults, due to an early diagnosis and surgical treatment. The patent ductus arteriosus in adults who received no therapy can present several forms of evolution, depending on its own hemodynamic profile. The present case is an example of a congenital heart disease not diagnosed during the childhood, that developed pulmonary hypertension and congestive heart failure. These clinical situations have a bad prognosis and place this patient in a group of high surgical risk. Thus, surgery is not advisable considering the bad prognosis and early high mortality rate.
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PMID:[Persistent ductus arteriosus in the adult--report of a case]. 129 Jun 45


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