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

Present evidence suggests that venous thromboembolism is the third most common acute cardiovascular disease after cardiac ischemic syndromes and stroke. The frequency of the diagnosis of pulmonary embolism (PE) at a given hospital greatly increases if a referral unit for PE is set up in the hospital. Pulmonary embolism is characterized by a continuous spectrum of severity, from 2 to 3 to 15 to 16 embolized pulmonary segments (over a total of 19). Morbidity from PE increases with age and male sex (males/females ratio: 1.24). In only a minority (10%) of patients with PE and/or deep-vein thrombosis (DVT), primary deficiencies of coagulation-inhibiting proteins have been shown. Primary abnormalities of the fibrinolytic system seem even more rare. On the basis of the clinical conditions preceding the embolic episode, patients may be divided into different groups: apparently primary or idiopathic PE (40%), surgery or trauma (43%), heart disease (12%), neoplastic disease (4%), and systemic disease (1%). Patients with apparently primary or idiopathic PE often develop subsequent clinically overt cancer (9.1%), whereas surgery or trauma patients rarely do (1.4%). Furthermore, the former exhibit a significantly shorter survival than the latter mostly for causes of death that reflect increased predisposition to thrombogenesis. Thus, as for DVT, it is convenient to consider a primary or idiopathic form also for PE.
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PMID:Pulmonary embolism: epidemiology. 781 26

Pulmonary arterial hypertension (PAHT) is defined by an increase in mean pulmonary artery pressure above 20 mmHg. Its diagnosis is often easy by cardiac echo-Doppler. Hemodynamic investigation is required in non-echogenic patients or in order to define the type of PAHT: pre- or post-capillary. It is important to determine, on the basis of non-invasive clinical and paraclinical (echocardiography) studies, those patients in whom catheterisation is indicated. PAHT may be due to chronic respiratory disease, left heart disorders, congenital heart disease or follow pulmonary embolism. It is sometimes apparently primary. The prognosis of PAHT depends upon its etiology: when PAHT is secondary to heart disease, it reflects worsening of the causative cardiac problem, which must be corrected. PAHT is a prognostic factor in chronic obstructive lung disease. The course is particularly grave in primary PAHT.
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PMID:[Diagnosis, course and prognosis of pulmonary arterial hypertension]. 782 53

When atrial fibrillation (AF) complicates rheumatic heart disease, the risk of stroke is 17 times that of patients in sinus rhythm and full anticoagulation is mandatory. Non-rheumatic AF carries a lower risk--5% per annum, a 5-fold increase. Four major trials (SPAF, AFASAK, BAATAF, CAFA) have lately examined thromboembolic prophylaxis in this group of patients. These randomized prospective open studies showed a 56-86% reduction in stroke and systemic embolism in patients receiving full anticoagulation compared with placebo. In older people, the BAATAF trial of low-dose warfarin (INR = 1.5-2.7) showed an 86% reduction in stroke and a significant reduction in mortality. In all 4 studies the incidence of hemorrhagic complication was very low (0.5%). In SPAF trial, aspirin, 325 mg/day was found to be effective, but this was not the case in AFASAK, which used 75 mg/day and had an older population. In a double-blind randomized trial indobufene, 100 mg bid, was found effective in the 67% reduction of stroke, systemic and pulmonary embolism in patients with various cardiac diseases in AF or in sinus rhythm. Consequently, a reasonable policy would be to give full or low-dose anticoagulation to those patients with chronic AF who have structural heart disease or are over 65 years old; to consider low-dose anticoagulation or aspirin or indobufene in younger patients with chronic lone AF; and to give indobufene or aspirin or nothing to those with episodes of paroxysmal AF lasting hours only. In borderline cases, the use of transesophageal echocardiography to exclude left atrial thrombus and spontaneous echo contrast may aid decision-making.
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PMID:[Atrial fibrillation: embolic risk and prevention]. 802 31

Current guidelines for heparin therapy in pediatric patients have been extrapolated from trials in adult patients without rigorous evaluation of efficacy and safety. We prospectively monitored consecutive pediatric patients receiving systemic doses of heparin over 10 mo at one institution using a predetermined nomogram to monitor maintenance therapy. Sixty-five consecutive children; 38 males and 27 females, received systemic doses of heparin. Thirty children had deep venous thrombosis and/or pulmonary embolism; 11 had arterial thrombi, most frequently after diagnostic angiography; and the remaining 24 received heparin prophylactically, for congenital heart disease. Twenty-nine (45%) of the 65 patients were less than 1 y of age and 22 (34%) were 10 y or older. Congenital heart disease was the predominant diagnosis under 1 y and deep venous thrombosis in older children. After a bolus dose of 50 U/kg, 39% of children (n = 30) achieved a minimal level activated partial thromboplastin time (APTT). Sixty-eight percent of children achieved a minimal level APTT by 24 h and 81% by 48 h. For all 65 children, APTT values were within the therapeutic range 43% of the time. APTT values outside the therapeutic range were twice as likely to be low as high. The average amount of heparin required to maintain therapeutic APTT values for children was 22 U/kg/h: 28 U/kg/h for infants < 1 y and 20 U/kg/h for the rest. Bleeding was rare (2%) and mild. Documented recurrent thrombotic disease was more common (7%) with associated morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heparin therapy in pediatric patients: a prospective cohort study. 813 3

Correlates of the size of infarcts, the time from stroke to death, and the mechanisms of death were studied in 77 consecutive patients who died from infarction in the middle cerebral artery territory. The area of infarcts was assessed by planimetry on schemas of representative brain levels and the results were expressed as a ratio of infarcted area on the whole MCA territory. No clear relationship was found between the size of infarcts in the MCA territory, and any of the characteristics of the patients, but extensive infarcts were more frequent when the internal carotid artery was occluded. No evidence was found of an adverse effect of age, diabetes or initial hyperglycemia on the size of infarcts. The mechanisms of death were not linked to sex, age, high blood pressure, diabetes, blood glucose level at admission, presence and location of an arterial occlusion, or etiology of the infarct. On the contrary, they varied as a function of interval from stroke to death. Transtentorial herniation, the main cerebral cause of death, occurred mainly in the first week and was related to the large size of infarcts. Rare recurrences of stroke and frequent extracerebral mechanisms of death (mainly pneumonia, pulmonary embolism and cardiopathy) occurred later on.
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PMID:Infarcts in the middle cerebral artery territory. Pathological study of the mechanisms of death. 833 39

To contribute for making early diagnosis and treatment of acute pulmonary embolism (APE), we investigated on clinical pictures of 225 patients with APE. Common underlying factors were heart disease, prolonged bed rest, post-surgical state, thrombophlebitis, malignant tumor and post-catheterization state in this order. Dyspnea, chest pain, tachycardia and shock were frequently seen as initial symptoms and signs. Blood screening showed leukocytosis, hypoxemia, hypocapnia and elevated serum LDH. Electrocardiographic findings highly demonstrated were ST.T abnormalities, such as T inversion with ST elevation in V1-3, ST depression in V4-6 and sinus tachycardia. Chest X-rays showed diminished pulmonary vascular marking and pulmonary artery dilation. Right ventricular dilatation were frequently seen on 2-dimensional echocardiograms. Pulmonary artery pressure were elevated up to 49/20 (30) mmHg. Twenty-five percent of the patients died, and the recurrence was seen in 4%. Thus, as soon as APE is suspected by above clinical findings, definitive diagnosis should be obtained by the lung perfusion scan and pulmonary arteriography, then oxygen and thrombolytic agents should be given immediately to prevent the fatal outcome.
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PMID:[Early diagnosis and management of acute pulmonary embolism: clinical evaluation those of 225 cases]. 835 37

A 57-year-old man without prior history of organic heart disease was admitted with a diagnosis of unstable angina because of chest pain and new electrocardiographic (ECG) changes of global T wave inversion and QT interval prolongation. Left and right heart catheterization with coronary angiography, pulmonary angiography, ventilation-perfusion scintigraphy, and echocardiography showed absence of coronary artery disease but unequivocally acute pulmonary embolism. Within days following anticoagulant therapy, the lengthened QT interval became normalized while the global T wave inversion persisted. A follow-up ECG 15 months later revealed complete resolution of the T wave inversion. The possible pathophysiologic mechanism of the ECG changes is discussed.
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PMID:Acute pulmonary embolism as the cause of global T wave inversion and QT prolongation. A case report. 822 24

In 1991, the U.S. Food and Drug Administration approved Norplant manufactured in Finland for American use. It has had over 500,000 users in almost 50 nations. It is sold as a set of 6 capsules, each containing 36 mg of levonorgestrel, which are implanted subdermally no on the medial upper arm. An American cohort of Norplant users had the following annual Pearl pregnancy rates: (a) 355 women at 1 year, 0; (b) 283 women at 2 years, 2.1; (c) 191 women at 3 years, 3.1; (d) 69 women at 4 years, 0; and (e) 25 women at 5 years, 0. The cumulative continuation rates for 396 American Norplant users were 82% at 1 year, 65% at 2 years, 50% at 3 years, and 44% at 4 years. A 2nd American cohort and groups of Norplant users in Chile, Egypt, and Thailand had higher continuation rates. Among 110 former Norplant users in San Francisco, 61% planned to use it again. The user can conceive in just 1 month after Norplant removal Many women do experience alterations in menstrual patterns, including prolonged bleeding, spotting between periods, and very light or no bleeding. The ectopic pregnancy rate has been 0.28 per 1000 woman-years of Norplant use, an incidence lower than that of ectopic pregnancies in women not using family planning. Norplant is appropriate for many women who want continuous long-term contraception. Definite contraindications to Norplant include: (a) acute liver disease, including benign or malignant tumors; (b) jaundice; (c) undiagnosed vaginal bleeding; (d) a history of thrombophlebitis, pulmonary embolism, or blood clots in the eyes; (e) a history of heart attack, chest pain as a symptom of diagnoses heart disease, or stroke (coronary artery or cerebrovascular disease); (f) possible pregnancy; (g) lactation until at least 6 weeks postpartum; (h) hemorrhagic disorder; (i) anticoagulation therapy; and (j) drugs such as rifampin, barbiturates, phenytoin, carbamazepine, phenylbutazone, and isoniazid, which may interact with the levonorgestrel in Norplant and decrease its effectiveness.
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PMID:Norplant: a welcome new contraceptive. 848 56

Chronic Chagas' disease shows several progression modes. Usually, the different clinical syndromes manifest themselves together, however, isolated forms can occur. Cardiac arrhythmias, which are very frequent, are present in about 50% of patients. The cardiac damage manifests itself later, with the emergence of heart failure. Thromboembolism can occur in both pulmonary and systemic circulation. Pulmonary embolism is the most frequent, appearing in more advanced phases of heart disease. Sudden death is the fatal outcome of these patients. It predominates in males and generally occurs in a disease stage when patients have their highest productivity. The presence of serious ventricular arrhythmias, conduction disturbances in the electrocardiogram, and heart failure, provide an unfavorable prognosis.
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PMID:Natural history of chronic Chagas' heart disease: prognosis factors. 865 Apr 78

Over an 11-year period, autopsies were performed on 957 of 1038 nontraumatic deaths in the Emergency Department of the Central Hospital in Ferrara, Italy. Of these 957 cases, 732 (76.5%) met criteria for sudden death. In 100 (14%) of these cases, the death could be attributed to pulmonary embolism (55 cases), stroke (17), or rupture of aortic aneurysm (28). Acute myocardial infarction accounted for 403 (55%) of all sudden deaths. Severe coronary artery disease was found in 340 (84%) of these 403 deaths, with plaque fissuring or thrombi in 189 or 151 cases, respectively. Among the 229 sudden deaths for whom no immediate cause could be determined (31% of the total population), all had evidence of heart disease: 147 individuals had severe coronary artery disease, with plaque fissuring or thrombi found in 72 or 43, respectively. The remaining cases with no immediate cause of death had evidence of a cardiomyopathy (61) or valvular disease (21). We conclude that acute myocardial infarction accounts for the majority of cases of nontraumatic sudden death in our Emergency Department. Altogether, 84% of these patients had severe coronary artery disease. In approximately one-third of cases for whom no immediate cause of sudden death could be determined, all had evidence of heart disease, and about two-thirds had severe coronary artery disease.
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PMID:Out-of-hospital sudden death referring to an emergency department. 869 5


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