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

The clinical features of endocarditis of the aortic valve in 24 dogs were reviewed. This condition was found most commonly in large-breed, middle-aged male dogs. Evidence of antecedent infection or immunosuppression was usually not historically verified or found at necropsy. However, an association with congenital heart disease, especially discrete subaortic stenosis, was demonstrated. The most frequent clinical findings were systolic and diastolic murmurs and bounding arterial pulses, with or without signs of congestive heart failure. The most commonly isolated organisms were Corynebacterium sp, Erysipelothrix rhusiopathiae, and Streptococcus sp. In addition to antibiotic therapy, treatment for congestive heart failure often was required. Despite aggressive therapy, most affected dogs died as a result of congestive heart failure, arrhythmias, infarction, sepsis, or renal failure.
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PMID:Endocarditis of the aortic valve in the dog. 670 2

In a clinical demonstration, case reports on 3 patients are presented: 1. In a 27-year-old male who developed severe multicentric atypical pneumonia, CNS, liver and renal involvement and signs of rhabdomyolyses suggested infection with Legionella pneumophila. Diagnosis was confirmed by the presence of Dieterle-stain positive organisms and positive culture of lung biopsy tissue. Antibiotic treatment, especially erythromycin, and prolonged mechanical respiration produced complete recovery. 2. The presence of chylomycrons Rin ascitic and pleural fluid in a patient with epimembranous glomerulonephritis and nephrotic syndrome was the first sign of malignant non-Hodgkin lymphoma. Chemotherapy with cyclophosphamid, oncovin and prednisone induced remission of tumor and nephrotic syndrome, which promptly recurred parallel to later reactivation of the malignancy. Paraneoplastically induced nephrotic syndrome, especially due to lymphoma, may precede the malignancy by months. 3. In a 52-year-old male with terminal renal failure due to primary oxalosis a cadaver renal transplant functioned for only 14 months because of oxalate deposits in the transplant. Hemodialysis before and after transplantation modified the clinical course. In place of uremia, the clinical picture was dominated by oxalate-induced gangrenous arteriopathy, arthritis, and heart disease.
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PMID:[Clinical demonstrations. Legionnaires' disease. Tumor-associated nephrotic syndrome. Primary oxalosis]. 703 33

The high mortality of open-heart operations in infants with congenital heart disease has traditionally led to deferral of definitive operation and to use of medical therapy or palliative procedures. The technique of deep hypothermia with circulatory arrest and advances in intensive care have made early repair possible. Since 1973, we have repaired life-threatening but correctable lesions in 11 infants in the first week of life. There are 7 survivors. Four patients had total anomalous pulmonary venous drainage, 2 had truncus arteriosus (1 with aortic arch interruption), and 1 each had pulmonary atresia and intact ventricular septum, critical pulmonary stenosis and intact ventricular septum, D-transposition of the great vessels, tetralogy of Fallot, and left ventricular-aortic tunnel. Postoperative hypoglycemia (less than 50 mg per 100 ml) developed in 4 patients and hypocalcemia (less than 7 mg per 100 ml), in 5. These problems responded appropriately to replacement therapy. Three of the survivors experienced renal failure, a complication subsequently prevented by use of mild hemodilution perfusion. Two patients had major bleeding, which now is prevented by finer suturing and administration of vitamin K and platelets. One infant, moribund with pH of 6.8 when brought to operation, sustained a cardiac arrest with subsequent brain damage. We conclude that newborns with life-threatening malformations can undergo successful repair. Attention must be paid to their unique metabolic demands, and surgical technique must be meticulous. Early operation before clinical deterioration is essential.
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PMID:Open-heart surgery in the first week of life. 735 63

The meaning of the term "health" is properly the subject of social, rather than natural, investigation. The structure of modern industrial capitalist society appears to materially and unavoidably produce a meaning of "health" intrinsically involving substantially preventable disese. Because in such a society private investment responds to cyclical and geographic fluctuations in rates of return and competitive labor markets, much of the disease structure (heart disease, stroke, kidney failure, and cancer, among others) encompasses diseases which captive citizens cannot afford to do without. To prevent those disease through environmental and workplace cleanup, full employment and geographic capital stability is to drive away the very private capital on which economic life is based. Consequently, those diseases are as intrinsic to modern capitalist society as the law of supply and demand and are, therefore, a characteristic component of the meaning of "health," the socially optimum level of organismic condition, in this epoch. A necessary condition for the emancipation of "health" from socially preventable disease would appear to be the social, rather than private, control of production and accumulation.
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PMID:Social organization and the meaning of health. 741 Sep 75

This article provides an in-depth overview of the relationship between primary hypertension and adult obstructive sleep apnea syndrome. The background data and research are taken from the English-language literature through 1993. Primary hypertension is a common cause of major medical illnesses, including stroke, heart disease, and renal failure, in middle-aged males. Its prevalence in the United States is around 20%, with the rate of newly diagnosed hypertensive patients being about 3% per year. Sleep apnea syndrome is common in the same population. It is estimated that up to 2% of women and 4% of men in the working population meet criteria for sleep apnea syndrome. The prevalence may be much higher in older, non-working men. Many of the factors predisposing to hypertension in middle age, such as obesity and the male sex, are also associated with sleep apnea. Recent publications describe a 30% prevalence of occult sleep apnea among middle-aged males with so called "primary hypertension." Is this association fortuitous, related to a high prevalence of both diseases in the same population, or is it caused by a factor common to both diseases, such as obesity? Should the diagnosis of apnea be actively sought with sleep studies in hypertensive populations? If a diagnosis of "asymptomatic" sleep apnea is made in a hypertensive person, should the apnea be treated? Current research data provide only partial answers to these and other questions regarding the association of apnea and hypertension. Logic dictates that clinically symptomatic patients in hypertensive clinics should receive appropriate evaluation for apnea, but broad populations of hypertensive individuals should not be referred for sleep studies.
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PMID:The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. 784 28

The development of renal failure necessitating peritoneal dialysis after cardiac operations is associated with a reported mortality greater than 50%. Improved fluid removal and nutritional support have been reported with the use of continuous arteriovenous hemofiltration and continuous venovenous hemofiltration techniques. We have compared our experience with all three techniques in managing children who required renal replacement therapy after cardiac operations in terms of efficacy (fluid removal, calorie intake, and clearance of urea and creatinine), complications, and outcome. Over a 5-year period renal replacement therapy was initiated in 42 children, and in 34 of them it was successfully established for more than a 24-hour period: 17 were managed with peritoneal dialysis, 8 with continuous arteriovenous hemofiltration, and 9 with continuous venovenous hemofiltration. A net negative fluid balance was achieved in only 6 (35%) patients treated with peritoneal dialysis compared with 50% of those treated with continuous venovenous hemofiltration and 89% of those treated with continuous venovenous hemofiltration. In terms of nutritional support, calorie intake increased by 43% after peritoneal dialysis was started compared with 515% and 409% in the arteriovenous and venovenous hemofiltration groups, respectively, (p < 0.005). The serum urea levels fell by 36% (p = 0.02) and 39% (p = 0.005) compared with pre-therapy levels with arteriovenous and venovenous hemofiltration, respectively, and the creatinine content was reduced by 19% and 33% (p = 0.003). Neither parameter was reduced in the peritoneal dialysis group. We conclude that the use of hemofiltration as a renal replacement therapy after surgical correction of congenital heart disease offers significant advantages over the more traditional approach of peritoneal dialysis. In addition, we suggest that a more aggressive approach to the management of fluid overload and nutritional depletion with hemofiltration may result in a decrease in the very high mortality seen in renal failure after cardiac operations.
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PMID:Renal replacement therapy after repair of congenital heart disease in children. A comparison of hemofiltration and peritoneal dialysis. 785 85

The cardiac valvular surgical experience of patients in the Duke Carcinoid Database was reviewed to assess operative outcome. Of the 604 patients in the database, 19 patients with carcinoid heart disease were identified by cardiac catheterization or echocardiography, or both. Eight of these underwent tricuspid valve replacement surgery with bioprostheses (2 also had open pulmonic valvuloplasty). Compared with patients medically managed, surgically treated patients were similar with the exception that they had higher right atrial mean (17 +/- 6 vs 9 +/- 4 mm Hg, p = 0.03) and v-wave (27 +/- 6 vs 17 +/- 7 mm Hg, p = 0.04) pressures. Of the 8 surgical patients, 5 (63%) died within 30 days. Causes of death included tricuspid valve thrombosis, cerebral vascular accident, coagulopathy, renal failure, and intractable right heart failure. High comorbidity was present in all 8 patients. There was a weak trend (p = 0.17) toward lower Charlson comorbidity indexes in survivors (6.7 +/- 0.6) compared with nonsurvivors (7.6 +/- 0.9). Age was significantly lower (p = 0.036) in survivors (46 +/- 13 years) compared with nonsurvivors (69 +/- 4 years). Extended follow-up revealed 2 patients who survived beyond a decade. Review of 47 carcinoid valve replacement cases (Duke Carcinoid Database and 39 published cases) revealed a 30-day mortality of 56% for patients > 60 years of age, and 0% for those < or = 60 years of age (p < 0.0001). Although valve replacement surgery can afford prolonged palliation from carcinoid heart disease, it is associated with a significant mortality risk. Careful preoperative risk stratification by age and comorbidity may provide a means for optimal selection of surgical candidates.
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PMID:Predictors of outcome of tricuspid valve replacement in carcinoid heart disease. 786 94

Heart disease, stroke, and kidney failure are leading causes of death. Essential hypertension is the major predisposing risk factor of cardiovascular disease. Yet, after several decades of intensive investigation, the initiating causative mechanism of essential hypertension is still unknown. However, investigators in the field generally agree that an increased total peripheral resistance (TPR) is the fundamental hemodynamic disorder in essential hypertension. This review addresses the hypothesis that the increased TPR of essential hypertension is due to a defective mechanism in the contractility of arterial smooth muscle. Force-velocity and length-tension studies have shown that both caudal arterial muscle and mesenteric resistance arterial muscle from spontaneously hypertensive rats (SHR) can shorten more and faster than muscle from normotensive control Wistar-Kyoto rats (WKY). In addition, the SHR muscle relaxation rate is slower compared with the WKY muscle. These alterations in mechanical behavior of SHR arterial muscle appear to be primary to the high blood pressure since MK-421 (enalapril maleate)-treated SHR arterial muscle shows the same increased velocity of shortening, increased shortening ability, and decreased relaxation rate as the untreated SHR muscle. MK-421 is an angiotensin-converting enzyme blocker. SHR maintained on MK-421 treatment have normal blood pressures in spite of being of the genetically hypertensive strain. While these findings are encouraging, several other important issues supporting the hypothesis require resolution and warrant review. Firstly, structural alterations of blood vessel walls in hypertension cause the walls to thicken and encroach on the vessel lumens contributing to the increased TPR. Whether such wall thickening is the cause or consequence of high blood pressure has been controversial in the literature. In this report, data are presented from a study in which MK-421-treated SHR were utilized as a model of prehypertensive SHR. Light micrograph observations and morphometric analyses were made of cross-sections of mesenteric resistance arteries from SHR, MK-421-treated SHR, and WKY. Results show that the MK-421-treated SHR resistance arteries had media thicknesses and a number of smooth muscle cell layers that were significantly less than in the untreated SHR and not different from the WKY. Secondly, velocity of shortening is dependent on actomyosin ATPase activity, and, since maximum velocity of shortening has been shown to be increased in SHR arterial muscle, it became necessary to know whether or not an increased actomyosin ATPase activity might be responsible. Therefore, data from a study of SHR and WKY caudal arterial myofibrillar ATPase activities are compared.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Changes in arterial smooth muscle contractility, contractile proteins, and arterial wall structure in spontaneous hypertension. 793 46

During the past decade, the annual incidence of patients entering long-term dialysis for end-stage renal disease (ESRD) has been increasing, while mortality from stroke and coronary artery heart disease has been decreasing. In the Southeast, hypertension is the most common cause of ESRD, followed closely by diabetes mellitus occurring most frequently in older minority patients, particularly blacks. The causes of the increase in ESRD are not known. Although control of any degree of hypertension with any antihypertensive drug will slow the progression of renal failure from any cause, captopril, an angiotensin-converting enzyme (ACE) inhibitor, has been shown to slow progressive renal failure in patients with insulin-dependent diabetes mellitus to a greater degree than that expected from only its antihypertensive effect. This series of articles, originally presented at the 1993 annual meeting of the Southern Medical Association, reviews the epidemiology and pathophysiology of ESRD and offers a clinical approach to this serious problem.
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PMID:End-stage renal disease: a southern epidemic. 793 13

All episodes of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus were prospectively analyzed for a 30-mo period. Methicillin-sensitive S. aureus (MSSA) was isolated in 38 episodes and methicillin-resistant S. aureus (MRSA) in 11 others. The two groups were similar regarding sex, severity of underlying diseases, prior surgery, and presence of renal failure, diabetes, cardiopathy, and coma. MRSA-infected persons were more likely to have received steroids before developing infection (relative risk [RR] = 3.45, 95% confidence interval [CI] = 1.38-8.59), to have been ventilated > 6 d (RR = 2.03, 95% CI = 1.36-3.03), to have been older than 25 yr (RR = 1.50, 95% CI = 1.09-2.06), and to have had preceding chronic obstructive pulmonary disease (RR = 2.76, 95% CI = 0.89-8.56) than MSSA-infected patients. MSSA-infected persons were more likely than MRSA-infected patients to have cranioencephalic trauma (RR = 1.94, 95% CI = 1.22-3.09). All patients with MRSA VAP had previously received antibiotics, compared with only 21.1% of those with MSSA infection (p < 0.000001). The incidence of empyema was similar in both groups; nevertheless, the presence of bacteremia and septic shock was more frequent in the MRSA group. Finally, mortality directly related to pneumonia was significantly higher among patients with MRSA episodes (RR = 20.72, 95% CI = 2.78-154.35). This analysis was repeated for monomicrobial episodes, and the difference remained statistically significant. We conclude that MRSA and MSSA strains infect patients with different demographic profiles; previous antibiotic therapy is the most important risk factor for developing MRSA infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ventilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes. 795 12


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