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

Two children (aged 12 and 14 yr) with a history of complex congenital heart disease presented with symptoms and signs suggestive of pulmonary embolism. Initial ventilation-perfusion lung scans showed normal, approximately equal ventilation to both lungs. Global reduction of perfusion to the right lung was observed in one and was observed in the left lung in the other patient. It was not possible to exclude a large, central embolus in either case. Due to complex cardiac anatomy, however, which included bilateral cavopulmonary anastomoses in the first patient and SVC-right pulmonary artery and right atrial-pulmonary artery anastomoses in the second, repeat scans were performed within a short period in each case with different injection sites, including the contralateral arm and a leg injection, respectively. In both patients, these follow-up scans showed a different perfusion agent distribution to each lung when compared to the initial scans. These results demonstrated that there was no evidence of pulmonary embolism in either case.
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PMID:Pseudo pulmonary embolism in complex congenital heart disease. 870 73

The stroke patient often suffers additional medical complications related to age, heart and artery damage and immobility. Pulmonary embolism is one condition that can sometimes be prevented. Heart disease must be detected and treated, as it is the principal cause of death after stroke. Recent data describing the physiology of stroke suggest that hypotension, hyperglycemia and hyperthermia should be prevented, as these conditions increase the likelihood of death or sequelae. Stroke is no longer a "wait and see" disease.
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PMID:[Treatment of medical complications: hypertension/hypotension, hyperglycemia, hyperthermia, hypoxia, cardiac complications and pulmonary embolism]. 871 46

The author reviews the use of the main antithrombotic drugs (thrombolytics, dicumarol compounds, heparins and anti-platelet drugs) in the treatment and prophylaxis of the main nosographic syndromes of arterial and venous thrombosis. In the context of arterial thrombosis the paper initially reports the results of the main controlled trials on ischemic cardiopathy (treatment of acute infarction, primary and secondary prophylaxis for re-infarction, post-infarction ventricular thrombosis, stable and instable coronary angor, percutaneous angioplasty, aortocoronary by-pass, stent, valve prosthesis, atrial fibrillation). Turning to peripheral arteriopathies the treatment of acute attacks is death with separately from prophylactic treatment (reduction of atheromatous progression, improved vascular perfusion, reduction of concomitant cardiac and cerebral events, behaviour of carotid stenoses). Vascular cerebropathy is examined during the acute (treatment of ictus in early days) and later phases (prophylaxis of recidivation of ictus). With regard to venous thrombosis, the paper separates the treatment of profound thrombosis and pulmonary embolism (often secondary to the former) from prophylaxis of profound thrombosis; the latter is classified into forms occurring during general surgery (abdominal, pelvic, urologic), orthopedic surgery (hip prosthesis, gonopathies) and general medicine. The author ends the review by making a schematic analysis of the areas of elective use of the above antithrombotic drugs with reference to the nosographical forms examined in the paper.
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PMID:[Main antithrombotic drugs in the therapy and prevention of arterial and venous thrombosis]. 892 60

Syncope is a frequent clinical event. It is mainly caused by a suddenly reduced cerebral blood flow. There are two reasons for sudden cerebral underperfusion: cardiogenic - associated with cardiac disorders and neurocardiogenic - resulting from a sudden fall of arterial blood pressure due to impaired autoregulation of the circulation. Cardiogenic syncopes prevail in cardiac diseases associated with impaired blood flow and cardiac arrhythmias. They develop in aortic stenosis, hypertrophic cardiomyopathy, atrial myxoma, myocardial infarction, pulmonary embolism, cardiac tamponade. Cardiac arrhythmias associated with syncope include ventricular tachycardia, supraventricular tachycardia in the preexcitation syndrome, sinus bradycardia, II degrees and III degrees atrioventricular block, atrial fibrillation with rapid ventricular response. The prognostic value and pathomechanisms loss of consciousness in these disease states have been discussed. Neurocardiogenic syncopes include vasovagal syncope, carotid sinus syndrome, orthostatic hypotension, event-induced syncope. It is frequently difficult to establish the reason for syncope. Physical examination and a history should be taken first followed by noninvasive studies such as standard ECG, exercise testing, carotid sinus compression, Holter monitoring, tilt testing, signal-averaged ECG. Noninvasive diagnosis helps establish the cause of syncope in 53-62% of cases and is indispensable before proceeding to electrophysiological testing. Such testing should be limited to patients with organic heart disease, in whom previous examinations did not reveal the etiology of loss of consciousness.
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PMID:[Syncope as a cardiologic problem]. 892 55

Although recent advances have been made in understanding its epidemiology, diagnosis and treatment, pulmonary embolism (PE) is still largely undetected and untreated, and the mortality rate has not appreciably changed in the last decades. The aim of this study was to: compare the postmortem frequency of massive and sub-massive PE during two different time periods in the same general hospital; ascertain whether the percentage of correct clinical diagnosis of PE has changed; identify factors which might contribute to the inaccuracy of the clinical diagnosis of PE. Altogether, 288 patients with autopsy-proven PE and adequate clinical data were collected in the first period; 182 subjects with the same characteristics were found in the second period. Cases observed from 1989 through 1994 were evaluated in terms of frequency of false negatives and false positives, predictive value of the clinical diagnosis of PE, and correlations between clinical and post-mortem diagnosis of PE on one side and several independent variables such as age, gender, associated diseases, recent surgery on the other. In our hospital the frequency of massive and submassive PE at autopsy was 8.6% from 1966 through 1974, 12.6% from 1989 through 1994 (p < 0.01). The percentage of correct clinical diagnosis of PE was 19.6% in the former period, 21.6% in the latter (NS) with 78.57% of false negatives and only 1.73% of false positives. Altogether the true positives were 21.42%, most of them being patients with massive PE. Clinical findings showed the coexistence of heart disease in 51.6% of the cases, congestive heart failure in 20.15%, metabolic disease in 7%, stroke in 12.5%, recent surgery in 12.5%. Autopsy revealed the presence of pulmonary infarction in 22% of cases, malignancy in 24.0%, pneumonia in 17.05%, acute myocardial infarction in 14.8%. Seventy percent of the cases in whom the point of origin of thromboemboli could be demonstrated had one or more thrombus in the district of inferior vena cava, more frequently at the level of the femoral and iliac veins. The positive predictive value of the clinical diagnosis of PE was 0.60, the negative predictive value 0.84. Multivariate logistic regression analysis showed that the clinical diagnosis of PE was hindered by the presence of pneumonia, facilitated by admission to the Cardiological Department. Age, duration of hospitalization, presence of pulmonary infarction, cancer, obesity, stroke, heart failure and recent surgery did not influence the clinical diagnosis of PE in this series. A positive correlation (p < 0.05) was found between autopsy rate and the percentage of correct clinical diagnosis of PE in the various hospital departments. This relationship needs further investigation, all the more so as in most countries the autopsy rate has been dramatically declining in recent times, especially in late life. In conclusion, at least in some institutions, the autopsy frequency of PE has increased during the last decades, and this increase has not been paralleled by a significant improvement in clinical diagnosis.
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PMID:"False negatives" and "false positives" in acute pulmonary embolism: a clinical-postmortem comparison. 909 Jan 62

Early diagnosis is important for the prognosis of patients affected with pulmonary embolisms. The mortality rate ranges from 30% in untreated cases to 10% in cases getting early treatment. In this context, it is essential to obtain a correct diagnosis in order to start the best treatment for each patient. The aim of our study is to evaluated the contribution of mono- bidimensional echocardiography and color-doppler for the early diagnosis of acute massive pulmonary embolism. We examined 23 patients (14 women with a mean age of 67 +/- 13 years; 9 men with a mean age of 58 +/- 16 years) who were referred to us for observation over a 30-month period. These patients had been admitted to the intensive care unit for suspected acute massive pulmonary embolism and the diagnosis was subsequently confirmed by a pulmonary scintigraphy. None of the 23 patients showed a positive case history of previous heart disease and/or pulmonary disease. The patients were checked using 2D-doppler echocardiography, 120 +/- 45 minutes from the onset of the symptoms. They were then divided into two groups (A and B) based on the presence or absence of thromboembolus in the right cavity of the heart. Seven patients (30%) revealed thromboemboli and were treated effectively with rt-PA (100 mg/2 hours). An increase in the size of the right ventricle with an affected rate RV/LV > 0.6 and the abnormal kinetics of the ventricular septum proved to be the most sensitive parameters for right ventricular overload, as signs of acute massive pulmonary ambolisms were observed in all 23 patients. Tricuspid regurgitation speed (from 2.9 to 3.6 m/sec) and peak systolic pulmonary pressure (67 mmHg) were recorded in all patients. Our observations suggest that the hemodynamic effects of an acute massive pulmonary embolism can be enumerated and monitored by analyzing ventricle size and septum kinetics. To summarize, echocardiography proved to be a simple and realistic test. It enabled correct diagnosis and made it possible not only to start thrombolytic therapy without requiring other exams, but also to monitor and evaluate the effects of this therapy.
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PMID:[The role of 2D-doppler electrocardiography in the early diagnosis of massive acute pulmonary embolism and therapeutic monitoring]. 924 51

This study assesses the incidence of sudden death and classifies the causes of death following radiofrequency ablation of the atrioventricular (AV) junction. We studied 220 patients with paroxysmal (n = 105) or chronic (n = 115) atrial fibrillation (AF) and a mean age of 64 +/- 12 years. These patients were followed 31 +/- 15 months after radiofrequency ablation of the AV junction and pacemaker implantation. In 86 patients, structural heart disease was identified before the procedure. All patients were traced via the Swedish National Civic Registry and Cause of Death Registry. The cause-of-death was classified according to data from death certificates, autopsy protocols, and medical records. Thirty-one patients (mean age 69 +/- 11 years, 16 men) died 15 +/- 15 months (range 0.2 to 60) after the procedure. There were 6 sudden unexplained deaths, 14 cardiovascular deaths, and 11 deaths from noncardiovascular causes. Eleven patients, all with structural heart disease, died suddenly out of hospital 16 +/- 16 months (range 0.2 to 42) after the procedure. In 6 of these there was no obvious cause of death. Three of these 6 patients underwent autopsy, which showed extensive coronary artery disease (n = 1), severe heart failure (n = 1) and cardiac hypertrophy and dilation (n = 1). The remaining 3 all had depressed left ventricular systolic function and a history of congestive heart failure. Five of the patients who died suddenly from cardiovascular causes had autopsies that revealed acute myocardial infarction (n = 4) and massive pulmonary embolism (n = 1).
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PMID:Incidence of sudden death after radiofrequency ablation of the atrioventricular junction for atrial fibrillation. 935 45

A 52-year-old man with neither congenital heart disease nor history of drug abuse had a spiking fever after dental treatment and was diagnosed with pneumonia at a local clinic. He was treated with antibiotics and his fever went down. Ten months later, he had again pyrexia and suffered from congestive heart failure. He admitted to our hospital and tricuspid valve endocarditis was proved by echocardiography. He was treated with penicillin. However, during the treatment, he developed a pulmonary embolism. So he underwent surgical treatment. We should take dental treatment into account one of predisposing causes of tricuspid endocarditis.
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PMID:Tricuspid valve infectious endocarditis associated with dental treatment. 938 93

Triflusal is an antiplatelet agent structurally related to the salicylate group of compounds, but it is not derived from aspirin (acetylsalicylic acid). Platelet antiaggregant properties of triflusal and its active 3-hydroxy-4-trifluoro-methylbenzoic acid metabolite are primarily mediated by specific inhibition of platelet arachidonic acid metabolism. Triflusal, compared with placebo for 6 months, significantly reduced the incidence of nonfatal myocardial infarction in patients with unstable angina. In patients with peripheral arteriopathy, total and pain free walking distances were markedly improved in triflusal compared with placebo recipients. The cumulative event rate for stroke, ischemic cardiopathy and vascular death was lower, but not significantly different, in patients with atherothrombotic stroke who received triflusal than in aspirin recipients. Differences were significant, and favoured triflusal, in a subgroup of patients with > 70% carotid stenosis. Prophylaxis with triflusal for 6 months after aortocoronary vein grafting reduced the number of new distal anastomosis occlusions and the graft attrition rate more than aspirin or placebo. The incidence of deep vein thrombosis or pulmonary embolism in more than 500 patients undergoing hip surgery was similar for these 3 treatments. The amount of blood transfused was significantly reduced in triflusal compared with aspirin recipients who underwent hip surgery. Risk of haemorrhage was also reduced in ischemic stroke patients receiving triflusal versus aspirin.
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PMID:Triflusal. 961 97

We review our 10-year (June 1987-June 1997) experience in 26 children requiring early surgery due to active infective endocarditis (AIE) refractory to medical therapy. Mean age at operation was 5.0 (SD 3.5) years. Nineteen patients (73%) had predisposing factors: congenital heart disease (CHD) was the most common (10/19, 53%); endocavitary foreign materials (6/19); and previous cardiac surgery (3/19). Vegetations or valve dysfunction was detected by transthoracic echocardiography in all cases but one. Valvular location (17/26, 65%) was the most common; others locations included cardiac chambers (8/26) and intravascular thoracic aorta (1/26). Bacterial isolation was achieved in 19 patients (73%): Staphylococcus (10 patients); Streptococcus (6 patients); and Candida albicans (3 patients). The indication for surgery was progressive or persistent cardiac failure (2 patients) or infection (9 patients), or a combination of these (7 patients), despite adequate medical therapy; major embolic accident with a mobile vegetation (4 patients), recurrent pulmonary embolism with a mobile vegetation (3 patients), and mobile vegetation (> 10 mm) in left cardiac chambers (1 patient). All the patients required surgery before 6 weeks of antibiotic therapy had been completed. The hospital mortality was 19% (5/26, 70% confidential limits[CL]: 2-35%). Deaths were due to infective causes in all cases but one. No late deaths occurred in 18 patients followed up for a mean of 4.2 years (SD 2.4). Three patients needed four reoperations. We conclude that improvement in the treatment of children with AIE can be obtained with an early and accurate diagnosis, an adequate antibiotic treatment, and a more aggressive surgical approach.
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PMID:Active infective endocarditis in infants and childhood: ten-year review of surgical therapy. 969 May 1


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