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

To assess the etiology of depressed ventricular function in cyanotic congenital heart disease, an experimental model in immature puppies was devised in which the left atrial appendage is directly anastamosed to the distally banded pulmonary artery. The preparation results in significant cyanosis during a 3-month study period (PO2 = 91 +/- 4 vs 43 +/- 3, hematocrit = 33 +/- 3 vs 55 +/- 5). Compared to age- and weight-matched unoperated controls, cyanotic animals developed significant depression of biventricular ejection fraction (P less than 0.05), increased heart weight indexed for body weight (P less than 0.05), increased right ventricular weight (P less than 0.02), and increased right ventricular free wall thickness (P less than 0.05). There was no alteration in ventricular volumes. In addition, mean myocardial stores of high-energy phosphate compounds were unaltered. The model allows a reproducible level of hypoxemia to be produced in young animals, utilizes no prosthetic materials, and allows future experiments to be performed to ascertain the metabolic response of the cyanotic myocardium to exercise or surgically induced ischemia.
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PMID:A model of cyanotic heart disease: functional, pathological, and metabolic sequelae in the immature canine heart. 648 24

Although exercise-induced ventricular tachycardia (VT), whether sustained or nonsustained, is usually associated with significant organic heart disease, its prevalence, associated characteristics and prognostic significance in an asymptomatic, unreferred community-dwelling population are unknown. Therefore, the prevalence of VT associated with maximal treadmill exercise was assessed in 597 male and 325 female volunteers, aged 21 to 96 years (mean +/- standard deviation 54 +/- 16), from the Baltimore Longitudinal Study on Aging who were without apparent heart disease. Ten subjects, 7 men and 3 women, with exercise-induced VT were identified, representing 1.1% of those tested; only 1 was younger than 65 years. All episodes of VT were asymptomatic and nonsustained. In 9 of 10 subjects, VT developed at or near peak exercise. The longest run of VT was 6 beats; multiple runs of VT were present in 4 subjects. Two subjects had exercise-induced ST-segment depression, but subsequent exercise thallium scintigraphic results were negative in each. Compared with a group of age- and sex-matched control subjects, those with asymptomatic, nonsustained VT displayed no difference in exercise duration, maximal heart rate, or the prevalence of coronary risk factors or exercise-induced ischemia as measured by electrocardiography and thallium scintigraphy. Over a mean follow-up period of 2 years, no subject has developed symptoms of heart disease or experienced syncope or sudden death. Thus, exercise-induced VT in apparently healthy subjects occurs almost exclusively in the elderly, is limited to short, asymptomatic runs of 3 to 6 beats usually near peak exercise, and does not portend increased cardiovascular morbidity or mortality rates over a 2-year period of observation.
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PMID:Prevalence and prognosis of exercise-induced nonsustained ventricular tachycardia in apparently healthy volunteers. 648 25

Situs inversus (SI) complicating neonatal bowel obstruction presents a challenging complex, and to facilitate rational decision making for treatment, we have reviewed 23 cases of abdominal SI seen in our hospital over the last 25 years. Preoperative roentgenographic studies most always predicted SI, the specific patient groups including: 12 abdominal SI with dextrocardia, 10 abdominal SI with levocardia, and 1 with partial heterotaxia. Major intraabdominal anomalies produced surgical emergencies in 7 neonates in the first year, 6 of these 7 being in the first month of life. In these 7 patients, multiple anomalies occurred including 1 child with a rotational anomaly with reversible ischemia secondary to midgut volvulus, and 4 with a rotational anomaly without volvulus, all being treated with a modified Ladd procedure. One of these children had an unrecognized intraluminal duodenal membrane, 1 an operatively diagnosed intraluminal membrane, 1 had annular pancreas, and 1 had a discontinuous jejunal atresia. A preduodenal portal vein was present in 4 of the 7 children, a branch being divided in 1 and the full vein bypassed in 2 of the other 3 patients. Two patients had biliary atresia, one of whom also had a diaphragmatic hernia. Five of the 7 neonates had associated major congenial heart disease accounting for 2 of the 3 deaths in this series. This review emphasizes the protean nature of abdominal SI, especially as it may cause or contribute to neonatal intestinal obstruction; and it is this understanding which is a prerequisite to optimal operative management.
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PMID:Situs inversus: the complex inducing neonatal intestinal obstruction. 666 1

Quantitative myocardial scintigraphy was performed in 40 patients with a medium prevalence of coronary artery disease (CAD), i.e. in cases with diagnostic difficulties. The results were compared with those of coronary angiography and ventriculography performed within 6 months thereafter. Sensitivity of scintigraphy in 16 patients with CAD was 88% and specificity in 14 individuals without heart disease was 93%. But in 10 patients with non-coronary heart disease specificity decreased to 30%. Scintigraphic evidence of ischemia increased specificity to nearly 100% including patients with non-coronary heart disease but sensitivity was reduced to 69%. The results demonstrate that myocardial scintigraphy with 201Tl is useful in cases with suspected CAD if diagnostic difficulties arise during the early phase of investigation. But there are limitations due to a rather high prevalence of non-coronary heart disease in such groups.
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PMID:[Prognostic value of thallium scintigraphy in diagnostic problem cases]. 666 75

Ischemic cardiopathy in its various clinical manifestations, whether acute (angina pectoris or myocardial infarction) or chronic (chronic coronary insufficiency), has shown in recent years particular hemorheological characteristics of its own. The observation of patients with such diseases has allowed us to record the existence of modifications in the parameters indicative of rheological damage. Numerous studies have been made, many of which are still in progress, with the aim of clarifying the relationships between these data and the disease. In our experience an increase in blood and plasma viscosity and a decrease in red cell deformability are often present in a manner which is statistically significant, if these patients are compared with normal subjects. Hemorheological change is more evident in the acute forms of myocardial ischemia. In fact, in angina pectoris the occurrence of pain is always accompanied by an increase in blood viscosity and by a worsening of red cell deformability both during spontaneous crises and during provocative tests. The hemorheological damage tends to diminish fairly rapidly when the crisis is over, even if the level of stabilization proves to be still higher than normal. In myocardial infarction higher levels of viscosity appear for a brief period after the onset with a slight tendency to diminish up until the 30th day. With the aim of ascertaining whether the alteration is more evident precisely at the point where the ischemia occurs, we chose a necessarily limited number of subjects, undergoing coronarography and atrial pacing for diagnostic purposes, and decided to control the hemorheological data not only in the systemic venous blood but also in the blood taken from the coronary sinus. Our data has shown that the level of viscosity and of red cell filtrability, in the blood taken from the coronary sinus, is worse than those of the systemic venous blood and that, after atrial pacing, in negative pacing subjects the variations are of slight significance whilst in positive pacing subjects we observe a rapid increase in viscosity and a decrease in red cell filtrability. This seems to confirm what we have already observed in the limbs affected by peripheral ischemia, and to demonstrate the existence of a local hyperviscosity syndrome which, even in the myocardium, appears to be dependent on the tissue ischemia.
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PMID:[Hemorrheological changes in ischemic heart disease]. 667 96

Nonocclusive intestinal ischemia is closely associated with heart disease and digitalization. Animal experiments and indirect evidence in man suggest that digitalis significantly decrease splanchnic blood flow. A case is described where peroperative intravenous digitalis caused profound intestinal ischemia. The report constitutes the first direct observation relating heart glycosides with intestinal ischemia in man.
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PMID:Intestinal ischemia after a single intravenous injection of deslanoside. A case report. 670 99

Nineteen patients survived a cardiac arrest not associated with an acute myocardial infarction, and had a normal electrophysiologic study with no inducible ventricular tachycardia despite programmed stimulation with one to three extrastimuli at two or more ventricular sites. Among 14 patients who had obstructive coronary artery disease, cardiac arrest occurred during exertion or an episode of angina pectoris in 11; 24 hour ambulatory electrocardiographic recordings demonstrated infrequent or no premature ventricular complexes in 10 and an ischemic response occurred during stage I or II (Bruce protocol) in 6 of 9 patients who underwent exercise testing. Treatment of these patients consisted of myocardial revascularization (eight patients) or antianginal medications (six patients). Only three patients were also treated with an antiarrhythmic drug. Over a follow-up period of 26 +/- 15 months (mean +/- standard deviation), only one patient died suddenly. Two patients who had coronary artery spasm were treated with coronary vasodilator medications and had no recurrence of cardiac arrest over 7 and 36 months of follow-up, respectively. Three patients who had cardiomyopathy or no identifiable structural heart disease were treated with nadolol or amiodarone and had no recurrence of cardiac arrest over 3 to 27 months of follow-up. Among patients who survive a cardiac arrest and have a normal electrophysiologic study, those with obstructive coronary artery disease or coronary artery spasm generally have an excellent prognosis with treatment directed primarily at the underlying heart disease. The clinical features of these patients suggest that cardiac arrest was related to ischemia rather than a primary arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical features and prognosis of patients with out of hospital cardiac arrest and a normal electrophysiologic study. 673 52

Three cases of radiation-related chronic heart disease are reported. All three patients had been treated for Hodgkin's disease with a mantle technique six to ten years earlier. Ten years after radiation treatment, a 34-year-old woman had dyspnea during exercise. Her heart was enlarged, and an ECG showed a RBBB. An echocardiogram showed pericardial effusion. Right-sided catheterization revealed an infundibular stenosis. A 31-year-old man had chest pain nine years after radiation. An ECG showed complete RBBB and an exercise stress test signs of ischemia; a coronary angiogram showed three proximal stenoses; and an echocardiogram revealed pericardial effusion. A 12-year-old boy had angina pectoris six years after radiation; one year later, he suffered an acute posterior infarction. Two weeks later he died suddenly. An autopsy showed a severe fibrotic and calcified narrowing of the proximal part of the left main coronary artery. Regardless of the patient's age, radiation-related cardiac complications must be kept in mind. Echocardiograms and, in cases of chest pain, exercise stress tests should be a part of routine postradiation follow-up.
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PMID:Radiation-related chronic heart disease. 685 89

1. Ergometric studies enable comparable and reproducible determinations of the cardio-pulmonary-corporeal performance. Prerequisite, however, is a well-based knowledge of the methodology and exercise-physiologic principles of ergometry. 2. With respect to the methodologic prerequisites, consideration must be given to the length of shaft displacement and the inertial mass of the ergometer. Additionally, at submaximal workloads, standardized performance at 50 revolutions/min must be ensured. This also holds true for r.p.m.-independent ergometers since the biologic capacity varies at differing r.p.m. values. Furthermore, the results of ergometric examinations are comparable only on standardization of workload and duration (for example, 10 watts/1 min, 25 watts/2 min). Consideration should also be given to ancillary determinants of exercise capacity such as environmental factors, previous physical exertion, nutrition, medications and other self-administered drugs or stimulants as well as the clothing worn at the time of examination. 3. Based on the limited equipment necessary and the good reproducibility, the physical working capacity 170 (the capacity in watts at a heart rate of 170 beats/6 min) is well-suited for assessment of cardio-pulmonary-corporeal performance. The results do not differ significantly at workloads of 25 watts/min or 50 watts/6 min. The decreasing maximal heart rate with increasing age (on the average 10 beats/min per decade; in the individual case, substantially more) may result in a marked misestimation in elderly subjects. This also applies to patients with coronary artery disease in whom, for example, a slow heart rate during ergometry is caused by ischemia and only mimics an economic circulatory function. Evaluation of the systolic and diastolic blood pressure during ergometry is, to some degree, indicative of the pump function in patients with coronary artery disease. Measurement of oxygen uptake alone at submaximal workloads does not permit differentiation between healthy and diseased subjects since the latter compensate for a reduced cardiac output by a more marked oxygen extraction with subsequently greater arterio-venous oxygen differences. On calculation of the oxygen uptake per stroke, however, in relation to the heart volume, a clinically relevant differentiation between healthy subjects and diseased patients can be established. Thus, in patients with heart disease, noninvasive parameters also enable assessment of the cardio-pulmonary-corporeal performance. 4. Under physiological conditions, there is a close relationship between invasively and noninvasively-measured parameters during ergometry. In patients with heart disease, however, the response of noninvasively-measured parameters is not a reliable indicator of pressure in the pulmonary circulation and the cardiac output.
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PMID:[Methodologic and exercise-physiologic principles of ergometry: value of noninvasive parameters in the detection of compromised exercise capacity due to heart disease (author's transl)]. 703 82

Eighty-five cases treated for acute nontraumatic ischemia of the extremities have been reviewed. Eighty per cent were diagnosed as emboli and the remaining 20% were considered to have acute thrombosis. The most common embolism source was the heart and the most common heart disease causing embolism was atrial fibrillation. Seventy patients were treated surgically (80 surgical procedures) and 14 conservatively. All surgical patients received pre-, per- and postoperative anticoagulants. Limb-salvage rate was 76% in patients with emboli and 60% in the thrombosis group. The amputation rate was significantly higher in the thrombosis group. The overall mortality was 12% and was slightly but not significantly higher in the embolism group. It is concluded that acute arterial emboli should be treated rapidly by embolectomy. Acute thromboses carry a higher amputation rate if treated by thrombectomy alone and thus reconstruction should be considered. The relatively low mortality rate in the present material could be due to the routine use of anticoagulants.
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PMID:Acute thrombosis and embolism of the extremities: factors influencing the result of treatment. 714 10


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