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

The incidence of intracranial haemorrhage (ICH) in newborns with haemophilia is unknown. Retrospective studies, estimate the incidence to be around 3%. Because of this uncertainty, we analysed the largest inpatient database in the USA, the Nationwide Inpatient Sample (NIS), to better approximate the incidence of ICH in these patients. ICD-9 coding data were used to reference NIS entries of haemophilia (A, B or C) or von Willebrand's disease (VWD), with intraventricular (IVH), subarachnoid (SAH), subdural (SDH) and/or intraparenchymal (IPH) haemorrhage. Of 9.2 x 10(7) hospitalizations from 1988 to 2001, 11% or 1 x 10(7) were newborns. Of these, 0.00527%, or 580 were diagnosed with haemophilia or VWD. Twenty of 580, or 3.4%, experienced an ICH. The ICH rate in non-haemophilic newborns was 0.11% (P value: <0.0001). The rate of ICH among term haemophilic newborns without sepsis, respiratory distress syndrome (RDS) or congenital heart disease (CHD), delivered without vacuum assist was 1.9%. One death occurred on the day of birth in a term neonate with haemophilia C. The mean length of stay for ICH patients with haemophilia was 28 days (median 28, range: 6-143 days). The mean hospital charges for the group were 102,072 dollars (median 67,551 dollars, range: 9624-467,132 dollars). These data add credence to the estimates of ICH in haemophilic newborns and may guide treatment strategies around the time of their birth. Further, uncomplicated delivery of term, otherwise healthy haemophilic newborns may carry a lesser risk of ICH.
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PMID:The incidence and outcome of intracranial haemorrhage in newborns with haemophilia: analysis of the Nationwide Inpatient Sample database. 1761 May 51

During the past 2 years the number of studies examining psychopathology and quality of life after ICD implantation has increased dramatically. Variables assessed have included recipient age, gender, and social support network. How recipients respond to having the device, particularly after experiencing firing, has been evaluated in light of new depression and anxiety disorder diagnoses as well as premorbid personality structure. Now the picture of what is known is, if anything, cloudier than it was 2 years ago, with little definitive and much contradictory data emerging in most of these categories. It still seems clear that in a significant minority of ICD recipients the device negatively affects quality of life, probably more so if it fires. Education about life with the device before receiving it remains paramount. Reports continue to appear of patients developing new-onset diagnosable anxiety disorders such as panic and posttraumatic stress disorder. Until recently the strongest predictors of induced psychopathology were considered to be the frequency and recency of device firing. It now seems that preimplantation psychologic variables such as degree of optimism or pessimism and an anxious personality style may confer an even greater risk than previously thought. Certainly many variables factor into the induction of psychopathology in these patients. Among these factors are age, gender, and perception of control of shocks, as well as the predictability of shocks and psychologic attributions made by the patient regarding the device. Another source of variability is this population's medical heterogeneity. Some patients receive ICDs after near-death experiences; others get them as anticipatory prophylaxis. Some have longstanding and entrenched heart disease; others were apparently healthy before sudden dangerous arrhythmias. Diagnoses as diverse as myocardial infarction in the context of advanced coronary artery disease and dilated cardiomyopathy after acute viral infection may warrant ICD placement. Moreover the course of cardiac disease after ICD placement may vary from relative stability to continuing disease progression and severe functional compromise. Unless these and other pre- and postimplantation differences are taken into account, it is almost impossible to make meaningful comparisons between studies. Ideally, future research would consist either of large-scale, randomized, prospective studies using validated structured-interview tools to supplement a literature dominated by self-report measures, unstructured assessments, and anecdotal reports, or of smaller studies designed to focus on particular diagnostic subsets. As ICDs become the standard of care for potentially life-threatening arrhythmias, the rate of implantations continues to increase. Because negative emotions have been linked to an increased incidence of arrhythmias, and untreated or unrecognized psychiatric illness can interfere with adaptation to an ICD, assessing and managing both pre-existing and induced psychiatric disorders becomes even more critical. Greater research attention should be paid to determining which patients meet criteria for anxiety disorders before and after implantation and what premorbid traits predispose to postimplantation psychopathology. The authors predict that psychiatrists will be involved increasingly in caring for this population, offering insights into treatment options that increase the likelihood of successful ICD acceptance and decrease the psychosocial costs of these devices.
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PMID:An updated review of implantable cardioverter/defibrillators, induced anxiety, and quality of life. 2110 13

This research study examined the usefulness of the ICD-10-CM system in capturing public health diseases (reportable diseases or the nationally notifiable infectious diseases, leading causes of death, and morbidity/mortality related to terrorism), when compared to ICD-9-CM.1-3 It also examined agreement levels of coders when coding public health diseases in both ICD-10-CM and ICD-9-CM. Overall results demonstrate that ICD-10-CM is more specific and fully captures more of the public health diseases examined than ICD-9-CM. In the analysis of all the public health diseases, such as reportable diseases (p<0.001), top 10 causes of death (p<0.001), and those related to terrorism (p<0.001), it was found that the overall rankings for disease capture for ICD-10-CM were significantly higher than the rankings for ICD-9-CM. When examining whether diseases were captured more straightforwardly and clearly (regarding agreement levels) between coding systems, statistically significant differences were found for external causes of injury (p<0.001), diabetes (average rank only, p<0.05), lower respiratory disease (p<0.001), heart disease (p<0.001), and malignant neoplasms (p<0.05). Although this result may be due to the coder's higher level of experience with ICD-9-CM, it also points to the potential need for more specific coding education and practice with the ICD-10-CM system.
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PMID:The effectiveness of ICD-10-CM in capturing public health diseases. 1806 56

An increasing number of patients with congenital heart disease are surviving into adulthood and some have indications for device therapy. Complex anatomical abnormalities may hinder the operator and require the adaptation of standard implantation techniques. We present the first report of successful biventricular ICD implantation in a patient with mesocardia, congenitally corrected transposition of the great arteries, pulmonary atresia, and a left superior vena cava draining into the coronary sinus. This case posed challenges in lead placement due to both complex anatomy and the risk of inappropriate device therapies secondary to far-field oversensing.
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PMID:Biventricular device implantation in a patient with congenitally corrected transposition and left-sided superior vena cava. 1837 71

Risk stratification of patients with structural heart disease remains problematic. While patients with low ejection fractions have been shown to be at significant risk for sudden cardiac death, a risk that can be decreased by ICD implantation, the sensitivity and specificity of ejection fraction for predicting sudden death are sub-optimal. Contrast enhanced magnetic resonance imaging (CMRI) has been shown to carefully delineate the extent and morphology of myocardial scar. Recent studies have suggested that the extent of myocardial scar and potentially its heterogeneity can help risk stratify patient with coronary artery disease. Ongoing clinical studies will help determine the utility of incorporating CMRI into a risk prediction algorithm.
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PMID:Cardiac magnetic resonance for risk stratification: the sudden death risk portrayed. 1877 12

In the current study, the prevalence of the most common psychological disorders in COPD patients and their spouses was assessed cross-sectionally. The influence of COPD patients' and their spouses' psychopathology on patient health-related quality of life was also examined. The following measurements were employed: Forced expiratory volume in 1 second expressed in percentage predicted (FEV1%), Shuttle-Walking-Test (SWT), International Diagnostic Checklists for ICD-10 (IDCL), questionnaires on generic and disease-specific health-related quality of life (St. George's Respiratory Questionnaire (SGRQ), European Quality of Life Questionnaire (EuroQol), a modified version of a Disability-Index (CDI)), and a screening questionnaire for a broad range of psychological problems and symptoms of psychopathology (Symptom-Checklist-90-R (SCL-90-R)). One hundred and forty-three stable COPD outpatients with a severity grade between 2 and 4 (according to the GOLD criteria) as well as 105 spouses took part in the study. The prevalence of anxiety and depression diagnoses was increased both in COPD patients and their spouses. In contrast, substance-related disorders were explicitly more frequent in COPD patients. Multiple linear regression analyses indicated that depression (SCL-90-R), walking distance (SWT), somatization (SCL-90-R), male gender, FEV1%, and heart disease were independent predictors of COPD patients' health-related quality of life. After including anxiousness of the spouses in the regression, medical variables (FEV1% and heart disease) no longer explained disability, thus highlighting the relevance of spouses' well-being. The results underline the importance of depression and anxiousness for health-related quality of life in COPD patients and their spouses. Of special interest is the fact that the relation between emotional distress and quality of life is interactive within a couple.
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PMID:Mental disorders and quality of life in COPD patients and their spouses. 1928 Oct 87

Older adults with burns are at risk for worse outcomes because of factors related to age, comorbidities, and response to treatment. Although the impact of pneumonia has been previously described in burn patients, less is known in the older adult population. In this study, we used the National Burn Repository to characterize patient and injury factors associated with pneumonia development in older adults with burns. We examined the records of all patients in the National Burn Repository aged 55 years and older from 1995 to 2007. To better characterize the effects of age on outcomes, patients were stratified into three categories: 55 to 64 years, 65 to 74 years, and 75 years and older. Pneumonia was identified by listed complications and ICD-9 codes. Comorbidities were classified by Charlson Comorbidity Index Score. Unadjusted and multivariate regression analyses were performed to distinguish the impact of age, comorbidities, and injury factors on pneumonia development and mortality. A total of 23,794 patient records met inclusion criteria during the study period, and 2,052 (8.6%) had pneumonia. Patients who developed pneumonia were more likely to be men (65 vs 56%, P < .001), have higher TBSA (21 vs 13%, P < .001), have sustained inhalation injury (21 vs 7%, P < .001), and have comorbid condition (34 vs 13%, P < .001). On multivariate analysis, factors significantly associated with pneumonia development were male sex, percent TBSA, inhalation injury, and presence of comorbidity. Specifically, chronic lung and heart disease had adjusted odds ratio (OR) of 2.70 and 3.48, respectively, for development of pneumonia (P < .001). By logistic regression, adjusted OR for pneumonia were 0.89 (95% CI 0.74-1.06, P = .18) in the 65 to 74 years age group and 1.26 (95% CI 1.07-1.48, P = .005) in the oldest group compared with the 55 to 64 years age group. Pneumonia during hospitalization was associated with an adjusted OR of 1.91 for death (95% CI 1.61-2.27, P < .001) after controlling for the factors of age, sex, comorbidity, TBSA, and inhalation injury. Injury factors and the presence of comorbidities consistently predicted the development of pneumonia in this large national patient sample. Higher age category also predicted higher pneumonia risk, although this association was only significant in the highest age group. This study, thus, highlights the importance of comorbidities over chronological age in pneumonia development in older adults with burn injuries.
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PMID:Risk factors for the development of pneumonia in older adults with burn injury. 2006 44

Ventricular tachycardias (VT) associated with the His-Purkinje system may occur in patients with and without organic heart disease. The former may encounter bundle branch reentrant VT, a macroreentrant VT utilizing the specific conduction system. It frequently occurs in patients with preexisting conduction disturbance such as complete left bundle branch block and may be eliminated by catheter ablation of the right bundle branch. After successful ablation, patient's prognosis depends on the presence or absence of structural heart disease.In patients without structural heart disease, VT with right bundle branch block pattern and superior axis, referred to as idiopathic left ventricular tachycardia, is observed. It is a reentrant VT utilizing the posterior left fascicle and the Purkinje network. The two treatment options include antiarrhythmic drug therapy with verapamil or curative catheter ablation.Another form of ventricular arrhythmia originating in the Purkinje network is idiopathic ventricular fibrillation (IVF). Focal triggers from the right and left ventricular Purkinje network induce premature ventricular contractions inducing IVF. This is amenable to catheter ablation leading to a significant reduction in ICD (implantable cardioverter defibrillator) interventions in sudden cardiac death survivors.
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PMID:[Ventricular tachycardias originating in the his-purkinje system. Bundle branch reentrant ventricular tachycardias and fascicular ventricular tachycardias]. 2009 Dec 55

Diabetes mellitus (DM) and hypertension (HTN) are common risk factors for heart disease in the population. The goal of this study was to evaluate independent association between type 2 DM and HTN using a very large database. We used ICD-9 codes for type 2 DM (250.00, 250.02) and HTN (401.0, 401.1, 401.9) from the Nationwide Inpatient Sample (NIS) database. We randomly selected the years in the database between 1992 and 2002. We used uni- and multi-variate analysis to evaluate any association between type 2 DM and HTN adjusting for co-morbid conditions. The 1992 database contained a total of 6,195,744 patients. Type 2 DM was associated with 37.5% of patients with HTN vs. 11.4% of the control group (odds ratio (OR): 4.63, Confidence interval (CI) 4.61-4.693, p < 0.001). The 2002 database contained a total of 7,853,982 patients. Type 2 DM was associated with 57.2% of patients with HTN vs. 22.9% of the control group (OR: 4.49, CI 4.47-4.52, p < 0.001). Using multivariate analysis adjusting for age, gender, hyperlipidemia, obesity, smoking, and chronic renal failure, type 2 DM remained independently associated with HTN in both years (for the year 1992: OR: 2.49, CI: 2.47-2.51, p < 0.001 and for the year 2002 OR: 2.19, CI: 2.18-2.20, p < 0.001). The same association was persistently found using samples for each year between 1992 and 2002. The presence of type 2 DM is strongly associated with HTN. This association is independent of co-morbid conditions and was persistent with similar odds ratio over a period of 10 years.
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PMID:Independent association between type 2 diabetes mellitus and hypertension over a period of 10 years in a large inpatient population. 2050 28

Torsade de pointes (TdP), a ventricular tachycardia (VT) with the peaks of QRS complexes twisting around the iso-electric baseline and progressive amplitude and polarity variations, is mostly associated with long (congenital or acquired) QT syndromes (LQTS) and long coupling intervals of the initiating complex. We describe a patient with variant, short-coupled TdP, a normal QTc interval and without demonstrable structural heart disease. Mechanisms remain unclear but there may be a relationship with autonomic nervous system imbalance. Since anti-arrhythmic drug efficacy is uncertain, ICD-implantation seems the first-line therapy. If ventricular arrhythmia recurs despite drug therapy, catheter-ablation of initiating premature ventricular beats may be warranted.
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PMID:Torsade de pointes with short coupling interval. 2066 75


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