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

The prevalence and clinical significance of aortic valve prolapse were determined prospectively in 2000 consecutive patients undergoing routine clinical cross sectional echocardiography. Two hundred and twelve patients were excluded because the aortic cusps were not adequately visualised. Aortic valve prolapse was defined as downward displacement of cuspal material below a line joining the points of attachment of the aortic valve leaflets. Twenty four cases of aortic valve prolapse (1.2%) were identified. The patients were aged 12-64 years and nine were women. All had underlying valvar heart disease and the commonest lesion (in 11 cases) was prolapse of the larger cusp in bicuspid valves. Aortic valve prolapse was seen in four patients with mitral valve prolapse (two with severe regurgitation), one of whom had marfanoid aortic root dilatation. The remaining examples of aortic prolapse were seen in patients with various disorders including one with pulmonary atresia, two with aortic root disease (one with dissection and one with idiopathic dilatation), and one case of severe mitral regurgitation. Valves destroyed by infective endocarditis were seen in two cases. Aortic valve prolapse may be detected in various cardiac disorders and does not imply the presence of aortic regurgitation, but when bicuspid aortic valves are present it may well be important in producing such regurgitation. Although aortic valve prolapse may be associated with severe forms of mitral valve prolapse, these patients rarely have aortic regurgitation.
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PMID:Prevalence and clinical significance of aortic valve prolapse. 401 27

In an attempt to develop a new approach to the non-invasive measurement of mitral regurgitation, Doppler echocardiography and left ventriculography were performed in 20 patients without valvar heart disease (group A) and in 30 patients with pure mitral regurgitation (group B). Volumetric flows through the aortic and the mitral orifices were determined by Doppler echocardiography. Aortic flow (AF) was calculated as the product of the aortic orifice area and the systolic velocity integral. The mitral flow (MF) was calculated as the product of the corrected mitral orifice area and the diastolic velocity integral. The mitral regurgitant fraction (RF) was calculated as RF = 1 - AF/MF. In group A aortic and mitral flow were very similar and the difference between the two did not differ significantly from zero. In group B the mitral flow was significantly larger than the aortic flow. There was a good correlation (r = 0.82) between the regurgitant fraction determined by Doppler echocardiography and the regurgitant grades determined by left ventriculography. The regurgitant fraction increased significantly with each grade of severity. These results show that Doppler echocardiography can be used to give a reliable measure of both aortic and mitral flow. This technique is a new and promising approach to the non-invasive measurement of mitral regurgitation.
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PMID:Measurement of mitral regurgitation by Doppler echocardiography. 405 79

On the basis of a 10-year course examination of 21 patients with absolute arrhythmia (a. p.) should be tested whether it is justified to assume a purely functional cause of disturbances of rhythm in initially normal internal basis findings. In the period of the examinations no patient had died. Five patients showed an organic heart disease without any stronger functional effects (mitral insufficiency, coronary heart disease, hypertension, hypertrophic cardiomyopathy). In two of them complications had appeared (brain embolisms, myocardial infarction). The remaining patients were without any complaints and capable to work, apart from the intermittent or persisting disturbance of rhythm which continued to appear in all cases, and had again normal basis findings. However, in six of them echocardiographical deviations were found. In initially normal basis findings and a.p. at first a good prognosis is to be assumed. Regular control examinations are, however, necessary, that the manifestation of organic basic disease which appears among our patients in 1/4 of the cases is not overseen.
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PMID:[Absolute arrhythmia without an initially recognizable cause--prognosis and course]. 407 6

A retrospective study of the medical records filed at the University Hospital from 1965 to 1983 and of 18456 autopsies carried out in the Department of Pathology of this Institution from 1953 to 1983, referring to patients aged less than 18 years was performed in an attempt to fully characterize chronic Chagas' heart disease in children and adolescents. Only 19 of these patients fulfilled the criteria for inclusion in the present study (12 cases with only clinical information and 7 cases with clinical and pathological information). We noted that the clinical manifestations of chronic Chagas' heart disease are congestive heart failure, thromboembolism and sudden death. Radiologic, electrocardiographic and anatomo-pathological findings demonstrated serious myocardial involvement. This set of alterations is also detected in adults with chronic Chagas' heart disease. Among adolescents, however, the disease exhibits relevant peculiarities such as rapid evolution to death within a short period of time (128 days), diagnostic difficulty related to the presence of significant mitral regurgitation (61% erroneous initial diagnosis), and low frequency of right bundle branch block (11% of cases). These findings suggest that among children and adolescents, chronic Chagas' heart disease may be of a peculiar type and therefore may be useful to clarify the pathogenetic mechanism of the disease.
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PMID:Chronic Chagas' heart disease in children and adolescents: a clinicopathologic study. 407 2

Atrial fibrillation occurred in 16 (10%) of 167 patients with idiopathic hypertrophic subaortic stenosis. The clinical and haemodynamic findings in these 16 patients are presented. Atrial fibrillation appeared late in the course of the disease, and its occurrence did not seem to be related to the severity of left ventricular outflow obstruction or to the amount of associated mitral regurgitation. In each patient the onset of the arrhythmia was accompanied by severe clinical deterioration, which often necessitated urgent medical treatment. Digitalis was administered to all 16 patients with subsequent clinical improvement in 15. Electrical cardioversion was uniformly successful in restoring sinus rhythm, but atrial fibrillation usually recurred. In each of 8 patients catheterized during atrial fibrillation, cardiac output was strikingly low (average, 1.9 l./min./m.(2)), whereas it was normal in 10 of 13 patients studied in sinus rhythm. The duration of follow-up from the onset of atrial fibrillation has averaged 5 years, and 3 of the 16 patients have died of causes related to their heart disease. Four have suffered cerebral emboli. Only 5 patients are now in stable sinus rhythm; in general, they are less symptomatic than the patients in whom atrial fibrillation has recurred.The unusually severe clinical deterioration at the onset of atrial fibrillation and the low cardiac output measured during catheterization are thought to be related to the loss of the important contribution to ventricular filling of atrial systole in patients with poorly compliant ventricles, and to the effect of an irregular ventricular rhythm on the variable nature of the outflow obstruction.
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PMID:Atrial fibrillation in patients with idiopathic hypertrophic subaortic stenosis. 552 80

Mitral valve prolapse is the most common form of heart disease, as it occurs in 4 to 6 per cent of the population. It has a benign course in the majority of cases, but 5 types of severe complication can occur in 15 per cent of cases. Mitral incompetence occurs in 14.8 per cent of cases. It may develop gradually or suddenly, following rupture of the chordae, which requires rapid surgical repair. Mitral valve prolapse is complicated by infectious endocarditis in 2.9 per cent of cases, hence the need for antibiotic prophylaxis prior to dental treatment or surgery in patients with a pan-systolic or end-systolic murmur. The only arrhythmias which should be considered as complications and treated as such are frequent ventricular extrasystoles of more than 30 per hour, usually associated with bigeminy, runs or polymorphism, ventricular tachycardia and ventricular fibrillation. Treatment consists, primarily, of beta-blockers. Sudden death is of course the major complication, occurring in 1.4 to 2.4 per cent of cases. The patients at risk of this complication are middle-aged women (40 years) with a past history of syncope or faintness due, in most cases, to episodes of ventricular tachycardia or ventricular fibrillation. Apart from arrhythmia, coronary artery spasm has also been found to be a cause of sudden death in these patients. Transient or definitive ocular and cerebral ischaemic episodes can also complicate mitral valve prolapse. Mitral valve prolapse is found in 20 to 30 per cent of patients with neurological accidents before the age of 45. Preventative treatment consists of anti-platelet aggregation agents and anticoagulants in recurrent cases.
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PMID:[Complications of idiopathic mitral valve prolapse. Prevention and treatment]. 614 Aug 95

A negative U wave is highly specific for the presence of heart disease and is associated with other electrocardiographic abnormalities in more than 90 percent of patients. The three most common conditions associated with a negative U wave are systemic hypertension, aortic and mitral regurgitation and ischemic heart disease. The U wave vector is directed opposite to the QRS axis in the horizontal plane in patients with both left and right ventricular hypertrophy. In patients with ischemic heart disease, the U wave vector tends to be directed away from the site of the akinetic or dyskinetic region. The change from a negative to an upright U wave after a reduction in blood pressure, renal transplantation, insertion of a valve prosthesis or a coronary arterial bypass graft procedure is associated with a decrease in the QRS amplitude but with no consistent changes in T wave polarity. The timing of the U wave apex is dependent on the duration of ventricular repolarization but not on the duration of the QRS complex. This finding and other electrocardiographic observations are explained better by the ventricular relaxation than by the Purkinje fiber repolarization theory of U wave genesis.
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PMID:Negative U wave: a highly specific but poorly understood sign of heart disease. 621 Oct 85

We performed M-mode echocardiography on 100 subjects with idiopathic mitral valve prolapse (IMVP) and on 100 normal control subjects to determine if differences exist between the two groups in cardiac chamber size, left ventricular performance or left ventricular mass. Subjects with IMVP demonstrated significantly greater left ventricular mass than normal control subjects. There were no significant differences in fractional shortening of the left ventricle or left ventricular end-diastolic volume. There was no significant difference in left ventricular mass between asymptomatic subjects with IMVP and those with chest pain, palpitations, syncope or presyncope. Subjects with and without mitral regurgitation showed no significant difference in mass. The results indicate that subjects with IMVP demonstrate subtle left ventricular hypertrophy which does not appear to be caused by underlying organic heart disease, mitral regurgitation or sustained hypercontractility. This suggests that myocardial involvement is an integral part of the IMVP syndrome.
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PMID:Increased left ventricular mass in idiopathic mitral valve prolapse. 621 84

Accurate assessment of ventricular muscle contractile function in patients with heart disease is impaired by alterations in afterload, preload and wall thickness which often accompany the disease. The relationship between pressure and volume at end systole is considered to provide a contractile index which is independent of preload and which accounts for afterload. Use of the index prerequisites determinations of the left ventricular end systolic pressure, wall thickness as well as the dimensions or volumes, respectively, which may be assessed with either invasive or noninvasive methods. In patients with aortic stenosis and congestive heart failure, there was a significantly reduced slope (0.9 +/- 0.5) of the end systolic stress-volume relationship as compared with healthy subjects (5.8 +/- 1.3) or patients with aortic stenosis without congestive heart failure (3.9 +/- 1.3), while the ejection fraction showed no significant differences. In patients with mitral regurgitation with no or only minimal symptoms postoperatively, preoperatively the end systolic index (ESS/ESVI) was higher (3.3 +/- 0.4) than in patients with marked symptoms postoperatively or those who died perioperatively (2.2 +/- 0.2) and the values of both patient groups were lower than those of normals. In contrast, the values for ejection fraction among the normals and both groups of patients showed substantial overlap. In patients with aortic insufficiency and congestive heart failure, as opposed to patients with aortic insufficiency and only slight symptoms, there was a significantly compromised ejection fraction as well as diminished end systolic index (ESS/ESVI). Patients with hypertension accompanied by congestive heart failure had a significantly diminished slope of the relationship between end systolic left ventricular stress and volume while the values for hypertensive patients without congestive heart failure were within normal limits; in both groups of patients, the ejection fraction was normal. In patients with mitral stenosis, the end systolic index at 5.28 +/- 0.53 did not differ significantly from that of healthy subjects at 4.87 +/- 0.53, while the velocity of circumferential fiber shortening was diminished. Patients with large atrial septal defects and symptoms of congestive heart failure did not differ with respect to end systolic index or ejection fraction as compared with atrial septum defect patients without symptoms. In children with aortic stenosis and high pressure gradients, there was an increased ejection fraction together with a normal end systolic index.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Assessment of systolic ventricular muscle function in man: the end systolic index. 623 85

Between 1976 and 1981, 173 patients with severe symptomatic mitral incompetence were referred for preoperative assessment. The etiological diagnosis was based on echocardiography, catheterisation, angiography, and, in the 71 patients operated on, the surgical findings. Rheumatic valvular disease was demonstrated in 40 cases (23,1 p. 100), bacterial endocarditis in II cases (6,3 p. 100), myocardial disease in 30 cases (17,3 p. 100) including 19 cases of mitral incompetence during cardiomyopathy with dilatation, and II cases of mitral incompetence during hypertrophic obstructive cardiomyopathy: ischemic heart disease was the underlying cause in 27 patients (15,6 p. 100), congenital heart disease in 9 patients (5,3 p. 100); dystrophic valvular disease (mitral valve prolapse with or without chordal rupture) was detected in 56 cases (32,3 p. 100). These results show a continuing reduction in the incidence of rheumatic fever and an increase in the number of cases of dystrophic mitral valve disease in patients of 50 to 70 years of age, a condition often rapidly progressive with hemodynamic characteristics very similar to those of mitral incompetence observed in ischemic heart diseases.
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PMID:[Current etiology of organic mitral insufficiency in adults]. 641 10


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