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

Acute heart failure is always an indication for referral to an intensive care unit. In the widest sense, the term acute heart failure includes the manifestation forms of pulmonary edema, cardiogenic shock or rapid-onset decompensated cardiac insufficiency unaccompanied by shock or pulmonary edema (low-output syndrome). Acute heart failure may occur in the absence of previously known heart disease. Existing prior specific diseases that may end in acute cardiac insufficiency include acute myocardial infarction, decompensated cardiomyopathy, myocarditis, cardiac tamponade, endocarditis or arrhythmogenic heart failure.
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PMID:[Acute heart failure]. 1537 19

We sought to measure plasma endothelin-1 (ET-1) concentrations in normal dogs and to compare them with those measured in dogs with acquired heart disease with or without pulmonary edema. A sandwich enzyme-linked immunosorbent assay kit was validated and used to measure ET-1 immunoreactivity in plasma samples obtained from 32 normal dogs and 46 dogs with either dilated cardiomyopathy (DCM, n = 27) or degenerative valvular disease (CDVD, n = 19) with (n = 30) or without (n = 16) overt congestive heart failure (CHF). Plasma ET-1 concentrations (geometric mean, 95% confidence interval of geometric mean) were 1.17 (1.04-1.32) fmol/mL in the 32 normal control dogs, 1.25 (0.981-1.60) fmol/mL in 16 dogs with DCM (n = 9) or CDVD (n = 7) without CHF, and 2.51 (2.10-3.01) fmol/mL in 30 dogs with DCM (n = 18) and CDVD (n = 12) with CHE Plasma immunoreactivity of ET-1 was significantly higher in dogs with CHF in comparison with normal dogs (P < .001) and dogs with heart disease without CHF (P < .001). No significant difference was found between normal dogs and dogs with heart disease but without CHF (P > .05). Significant correlations were between plasma ET-I concentrations and left atrial:aortic ratio (P < .0001, r2 = .39), left ventricular internal dimension at end-diastole indexed to aortic diameter (P < .0001, r2 = .30) or body surface area (BSA) (P = .0071, r2 = .10), and left ventricular internal dimension at end-systole indexed to aortic diameter (P = .0003, r- = .17) or BSA (P = .0008, r2 = .15).
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PMID:Plasma endothelin-1 immunoreactivity in normal dogs and dogs with acquired heart disease. 1563 67

All newborn infants have limited pulmonary reserve compared with older children. This puts them at increased risk of respiratory complications, such as those associated with infection by the respiratory syncytial virus. Young children with congenital cardiac disease are particularly likely to suffer severe disease related to infection by the virus. In these children, the extreme vulnerability of the lung to pulmonary oedema is compounded by the additional burden caused by the respiratory syncytial virus. In addition to the well-documented acute pulmonary effects of infection with the respiratory syncytial virus, there may also be consequent long-term respiratory morbidity. Clinical studies have shown that infection by the virus in infancy is associated with a higher risk of developing subsequent bronchial obstructive disease. Much debate surrounds the mechanisms underlying this association. It is thought that a combined immunological and neurogenic response mechanism is likely. Prevention of severe respiratory disease in infants and young children with congenital heart disease due to infection by the virus may, therefore, offer both immediate and long-term benefits. Indeed, an increasing body of evidence supports this hypothesis, indicating a clinical rationale for prophylaxis against the virus in infancy, in order to reduce the chance of developing reactive airways disease and asthma in later life.
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PMID:Acute and long-term effects of infection by the respiratory syncytial virus in children with congenital cardiac malformations. 1586 28

A 3-week-old Thoroughbred colt was presented for weakness and cyanosis. A pansystolic regurgitant murmur and other physical findings suggested that the foal developed pulmonary oedema as a consequence of congenital heart disease. A large atrial septal defect, a high ventricular septal defect and dysplasia of the atrioventricular valves were visualised echocardiographically. A persistent common atrioventricular canal was observed at necropsy.
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PMID:Common atrioventricular canal in a foal. 1603 29

Children who have heart disease may present to the emergency department (ED) in many stages of life with a range of cardiovascular manifestions, from minimally irritating palpitations to the life-threatening derangements of shock or lethal dysrhythmia. They can present with congenital heart disease, after a temporizing procedure has been performed or after their definitive repair. Children can also present with fever, weakness, dyspnea, syncope, or chest pain; alternatively, children may present to the ED with active dysrhythmia, pulmonary edema, or cardiogenic shock . These symptoms and presentations may result from Kawasaki disease,hypertrophic cardiomyopathy, or arrhythmia; therefore, emergency physicians must also be comfortable with the most common types of heart disease associated with these symptoms and presentations. The purpose of this article is to describe the physiology and presentation of undiagnosed congenital heart disease, to describe the complications that can occur after a staged or definitive repair,and to discuss acquired heart disease in children.
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PMID:Cardiovascular emergencies in the pediatric patient. 1619 47

Gravid patient cardiopulmonary bypass remains a high-risk procedure with regard to fetal preservation. Maternal mortality is similar to that of the nonpregnant female at 1.5-5%. However, fetal mortality remains high at 16-33%, with an average of 19% over the past 25 years, with no correlation to gestational age. Teratogenesis is a major consideration in the first trimester. Variations in the timing of surgical intervention, gestational age, maternal health status, type of procedure, pre- or postorganogenesis, perfusion protocol, and pharmaceutical therapy are all factors that can influence fetomaternal outcome. In this report, we present a literature review along with our experience of a 26-year-old female who developed complications with her pregnancy at approximately 17 weeks gestation, with adverse neurological sequelae. The patient was 152 cm in height and weighed 48 kg, with a calculated body surface area of 1.40 M2. She had no prior history of cardiac disease and, upon admission to our institution, presented with a declining health status in pulmonary edema and was treated medically, with an ultimate requirement for mitral valve replacement. The total cardiopulmonary bypass time was 99 min with an aortic crossclamp time of 83 min. The literature, as expected, is limited to case reports and reviews since a controlled clinical trial during pregnancy is nonexistent, using extracorporeal circulation. This greatly challenges the medical staff in managing such difficult cases, with an incidence of heart disease during pregnancy of 1.2-3.7%.
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PMID:Cardiopulmonary bypass and mitral valve replacement during pregnancy. 1636 22

The fixed incidence of congenital heart defects and improved survival have resulted in increasing numbers of adults with congenital heart disease (CHD) who have undergone complex repairs and/or palliations. Eventually, there will be more adults with CHD than children. They will require cardiac surgical interventions associated with progression of their CHD or for age-related disease, such as coronary revascularization. During bypass, anatomical shunts may exist within or without the heart. Left-to-right shunts can result in dramatically lower systemic blood flow than pump flow due to 'steal', while pulmonary edema ensues due to excessive pulmonary flow. Right-to-left shunts carry risks of massive air embolism and double or triple venous cannulation may be necessary. Cannulation of composite reconstructed aortas may be difficult, risking dissection or aortic obstruction, and double arterial cannulation may be indicated. Aberrant coronary arterial and venous anatomy may .preclude adequate myocardial preservation with common techniques and can be complicated by aortic insufficiency. Valves and conduits may exhibit failure. Conventional monitoring, such as central venous oximetry, may be misleading. Monitoring, such as serial lactate measurement, near-infrared spectroscopy and transcranial Doppler blood velocity, offer advantages for such patients. The perfusionist needs to be aware of such conditions as much congenital aberrancy may present unexpectedly during cardiac surgery.
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PMID:Cardiopulmonary bypass for adults with congenital heart disease: pitfalls for perfusionists. 1648 99

Wider selection of young patients for prosthetic valve replacement for valvular heart disease has resulted in an increase in number of women with heart disease reaching childbearing age. Such patients presenting in labor for emergency cesarean section require special consideration. We present a report of a parturient who presented at 36 weeks of gestation with severe aortic and mitral stenosis, pulmonary edema and severe preeclampsia. The goals of our anesthetic management included (1) careful airway management (2) maintaining stable hemodynamics (3) optimizing fluid status, and (4) preventing seizures. Issues related to management of patients with severe valvular disease, prosthetic valves and complications due to anticoagulant therapy during pregnancy are discussed.
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PMID:Anesthetic management for emergency cesarean section in a patient with severe valvular disease and preeclampsia. 1679 54

Lung capillary pressure in healthy humans at rest ranges between 6 and 10 mmHg. At maximal effort or in pathophysiological conditions such as left sided heart disease or massive pulmonary vasoconstriction, for example in high-altitude pulmonary disease, capillary pressure may be markedly elevated. Increased capillary pressure directly affects transendothelial fluid dynamics and thus results in the formation of hydrostatic lung edema. Excessive pressure increases may cause capillary stress failure. Recent studies, however, suggest that the microvascular response to lung capillary hypertension is more complex. Pressure, strain and shear stress cause dysfunction of the capillary endothelium characterized by an imbalanced release of vasoactive mediators. Endothelial dysfunction evokes a multicellular response with features of vasoconstriction, inflammation, and vascular leakage, thrombosis, and remodeling. These active cellular reactions contribute to the pathophysiological process and may be specifically targeted by new therapeutic strategies.
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PMID:Capillary pressure-induced lung injury: fact or fiction? 1701 85

Cardiac diseases are present in 0.5-4% of pregnancies, and they remain a frequent cause of death during pregnancy. Pregnancy per se imposes significant hemodynamic changes, placing a major burden on the cardiovascular system. The early recognition and close follow-up of patients with cardiac diseases will improve maternal tolerance to the cardiovascular burden imposed by pregnancy, promote fetal growth and neonatal survival. Rheumatic heart disease remains the most frequent heart disease in the pregnant population with pulmonary edema as the most frequent complication. Atrial septal defect is the most frequent congenital heart disease in the adult population, whereas tetralogy of Fallot is the most common cyanotic congenital heart disease. An improvement in modern techniques of monitoring, a better understanding of the pathophysiology of cardiac disease, as well as multidisciplinary care has led to a substantial improvement in outcome of the pregnant cardiac patient. Management should be initiated before conception as it will provide optimal clinical conditions and sufficient information on the underlying pathophysiology.
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PMID:The pregnant cardiac woman. 1701 14


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