Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Factor VII (FVII) is a plasma vitamin K-dependent glycoprotein that plays an important role in the initiation of tissue factor-induced coagulation (extrinsic pathway of blood coagulation). An increase in FVII coagulant activity (FVIIc) has been proposed as an independent risk factor for coronary artery disease. Recently, the coagulation assay using soluble tissue factor(sTF) enables us to measure the plasma levels of the activated form of factor VII(FVIIa) without the effect of the FVII zymogen form. We have developed the fluorogenic assay for FVIIa using sTF and measured the plasma FVIIa in atherosclerotic diseases. The FVIIa level in the Japanese was lower than that reported in Caucasians, suggesting that the incidence of ishemic heart disease is lower in the former. The FVIIa level was higher in the patients with cardiovascular diseases (ischemic heart disease and cerebral infarction), non-insulin-dependent diabetic mellitus, hypertension with microalbuminuria, and renal failure than in the healthy controls. The FVIIa levels were also increased in non-insulin-dependent diabetic patients, and this FVIIa increase was positively correlated with urinary albumin excretion. Furthermore, FVIIa levels were not correlated with the levels of lipids and the activity of hepatic synthesis, indicating that FVIIa may be an independent risk factor for cardiovascular disease.
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PMID:[Activated factor VII as a new cardiovascular risk factor of atherothrombotic disease]. 856 29

Considerable progress has been made in the medical treatment of chronic heart failure. A large number of patients with NYHA class II and III heart disease can be improved to class I and II. Treatment is maintained on an outpatient basis in order to prevent episodes of acute failure, while avoiding the adverse effects of drugs at high doses or in combination. Diuretics are still the drug class most frequently prescribed, especially loop diuretics (furosemide) which have the advantage of being able to be used in patients with renal failure. Aldosterone antagonists have the pathophysiological value of reducing the development of myocardial fibrosis. Digitalis alkaloids have a positive inotropic effect, which is even observed in the presence of sinus rhythm and which is associated with slowing of the heart rate in tachyarrhythmias. Angiotensin converting enzyme inhibitors are among the most recently used drugs. They decrease the left ventricular post-load and prevent activation of the renin-angiotensin-aldosterone system. Phosphodiesterase inhibitors cannot be administered orally in the long-term and are therefore not suitable for outpatient treatment. However, they are very effective by intravenous injection during the acute phase of heart failure and cardiogenic shock in hospital.
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PMID:[Ambulatory treatment of chronic cardiac insufficiency]. 866

Patients with severe hypertension with retinoscopic bilateral papilloedema only are not classically regarded as having malignant hypertension (MHT). We have encountered 23 such patients between 1965-1993, whilst over a similar period we have seen 315 patients who fulfilled the conventional criteria for MHT with bilateral retinal haemorrhages, exudates with or without papilloedema. We hypothesised that patients with "lone" papilloedema and severe hypertension were suffering from a disease which was identical in aetiology and outcome to conventional MHT. There were no significant differences in age, mean blood pressure, proteinuria or renal function at presentation, ethnic composition, smoking status and followup blood pressure control between the papilloedema group and those presenting with conventional MHT. Clinical features at presentation in the papilloedema only group included strokes in 4, visual disturbance in 2, headaches in 3 and heart failure in 1 patient. Many patients however had no complications at presentation. After a mean followup of 59.8 months, of the "lone" papilloedema group, 7 patients (30.4%) were still alive, 1 patient was on renal dialysis therapy, 13 were dead (56.5%) and 2 (8.7%) were lost to followup. The commonest causes of death were stroke in 4 patients, renal failure in 4 and heart disease in 2. This was a similar pattern of mortality to those patients with "conventional" MHT. Lifetable analyses showed a median survival of 35.9 months for the papilloedema group which was significantly worse than the 108.7 months for the conventional MHT group (Lee-Desu statistic 4.04, p = 0.045). We suggest that patients with high blood pressure and lone bilateral papilloedema may comprise a hitherto unrecognised subgroup of patients with MHT. Once intracerebral pathology has been excluded, these patients need to be treated as aggressively as those with MHT.
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PMID:Severe hypertension with lone bilateral papilloedema: a variant of malignant hypertension. 874

The hospice approach to terminal care will benefit patients with advanced chronic illnesses other than cancer. This article describes general criteria that will help clinicians assess when patients may be appropriately referred for hospice care. Common illnesses, such as dementia, heart disease, lung disease, and renal failure for which terminal care in advanced stages is appropriate, are discussed. Specific palliative management issues regarding these advanced disease states also are addressed.
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PMID:Terminal care for noncancer patients. 879 52

Women with end-stage renal disease (ESRD) have a higher rate of death from heart disease than women with normal renal function. Because estrogen replacement therapy may significantly decrease the incidence of death due to cardiovascular disease in postmenopausal women with normal renal function, their use has been considered for women with ESRD. However, the pharmacokinetics of estrogen have not been studied in postmenopausal women with ESRD to determine the optimal estrogen dose. Six postmenopausal women with ESRD receiving maintenance hemodialysis and six controls matched for body mass index were admitted to the in-patient Clinical Research Center. A 1- or 2-mg oral estradiol (E2) pill was given while subjects fasted. Blood sampling was performed over the next 24 h for measurement of E2, estrone (E1), albumin, and sex hormone-binding globulin (SHBG). Three weeks later, the subjects were given the other E2 dose under identical conditions. At baseline, total and free E2 levels were higher in the subjects with ESRD than in controls (P = 0.0005 and 0.0035, respectively). After ingestion of 1 and 2 mg E2, total and free E2 levels remained significantly higher in the ESRD subjects from 2-8 h after treatment (P < or = 0.05). After 1 mg oral E2, total serum E2 peaked at 65 pg/mL at 4 h in ESRD subjects and at 27 pg/mL in control subjects at 8 h. After 2 mg oral E2 treatment, total serum E2 peaked at 8 h in both ESRD and control subjects, with levels of 99 and 37 pg/mL, respectively. E1 was higher in the subjects with ESRD than in the control subjects at baseline (P < 0.05). After ingestion of 1 mg E2, E1 concentrations were not significantly higher in ESRD than in control subjects, peaking at 180 and 121 pg/mL, respectively (P = 0.3). E1 concentrations were higher in ESRD than in control subjects after the ingestion of 2 mg E2, with peak levels of 376 and 201 pg/mL, respectively (P = 0.03). Total and free E2 levels are higher in patients with ESRD than in control subjects at baseline and after E2 ingestion, indicating that renal failure alters the pharmacokinetics of both endogenous and exogenous E2. Therefore, conventional E2 doses used in individuals with normal renal function may be excessive for patients with ESRD.
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PMID:Estrogen absorption and metabolism in postmenopausal women with end-stage renal disease. 895 51

On the average, 10-15% of patients who undergo cardiopulmonary resuscitation (CPR) following a cardiopulmonary arrest in the hospital environment will survive to be discharged. The purpose of this study was to determine objective factors influencing patient outcome after CPR to determine who should be resuscitated and when to end CPR efforts. The records of 266 patients who underwent in-hospital CPR over a 3-year period were retrospectively analyzed with regard to age, gender, co-morbid conditions, setting of arrest, duration of resuscitation, initial pH and PO2 during resuscitation, and outcome of resuscitative efforts. Twenty-four (9%) patients survived to be discharged from hospital. Eighty-seven (33%) patients arrested in the intensive care unit, 77 (29%) on the ward, 91 (34%) in the emergency room, six (2%) in the cardiac catheterization laboratory and five (2%) in the operating room. There was no significant difference in survival based on location of arrest. Factors associated with a poor prognosis included age greater than 60, co-morbid disease (i.e. pneumonia, sepsis, renal failure, heart disease, etc.), an initial PO2 < 50 mmHg and CPR efforts extending beyond 10 min. Based on this data, guidelines regarding initiation and termination of CPR should be instituted in light of poor outcome in patients over 60 years of age with co-morbid conditions, specifically after 10 min of CPR.
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PMID:Predicting in-hospital mortality during cardiopulmonary resuscitation. 895 68

The burden of cardiac disease in dialysis patients is high, resulting from cardiomyopathy and from coronary artery disease. Asymptomatic dialysis patients, patients with heart failure, patients with symptomatic ischaemic heart disease, and patients being evaluated for renal transplantation all require investigation to determine the presence or the extent of heart disease. Echocardiography is very useful for screening for cardiomyopathy, but should be undertaken when patients are euvolaemic. Non-invasive tests for coronary artery disease, particularly exercise-based tests, are less sensitive and less specific in dialysis patients than in the general population. Dobutamine stress echocardiography may be more sensitive in patients with renal failure than other investigations. Patients with abnormal screening tests or symptomatic ischaemic heart disease should undergo coronary angiography and subsequent revascularization procedures if indicated.
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PMID:Screening for cardiovascular disease in dialysis patients. 897 3

Adolescents and adults with congenital heart disease have become a new, continuously growing group of patients, because currently improved diagnostics and therapy allow the majority of newborns with congenital heart disease to survive to adulthood. The objective of this retrospective study was to investigate lethality and morbidity after surgery for congenital heart disease in adolescents and adults. Between 1989 and 1994, we operated 137 patients (age between 15 and 75 years; mean 33.8 +/- 15.1) because of congenital heart disease. This was equivalent to 2.7% of all patients, who were operated during this period of time. 101 cases were primary operations, in 36 cases (26.3%) a reoperation was performed. The most frequent diagnoses were ostium-secundum-defect (37.9%), anomalies of the aortic valve including sub- and supravalvular stenoses (9.5%), anomalies of the mitral valve (8%), ventricular septal defect (7.3%) and aortic coarctation (7.3%). Overall lethality was 5.8%, including emergency cases and all late deaths, which have been reported so far. Evaluation of morbidity showed an intraoperative cardiac low-output-syndrome in 3.7%, pulmonary failure in 5.8%, postoperative renal failure in 4.4% and postoperative bleeding complications in 7.3% of cases. Mean duration of postoperative ventilation and intensive care treatment were 2.3 +/- 5.3 and 3.6 +/- 7.3 d, respectively. In comparison to their preoperative status, 71% of patients had improved by one or two NYHA classes. We found that the higher perioperative risk related to reoperation had no impact on the operation's functional result, as evaluation of postoperative functional class showed no difference between primary and re-do cases. The general term congenital heart disease describes a very inhomogeneous group of patients with a broad spectrum of different diagnoses. The variable morphology and pathophysiology of the different congenital heart defects require an individual surgical strategy for each patient, in rare cases even the decision for a heart- or heart-lung-transplantation. Furthermore, adequate follow-up and competent ambulatory treatment of these patients require the cooperation of pediatric and adult cardiologists and cardiac surgeons in interdisciplinary outpatient clinics.
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PMID:[Congenital heart defects in adolescence and adulthood: fatalities and morbidity in primary and reoperation]. 903 4

This study determines the early and late survival rates, the causes of death, and prognostic variables that are associated with early and late survival after for ruptured abdominal aortic aneurysm (AAA). These are based on the prospective analysis of 628 variables of data on 158 consecutive patients in 24 centers of our association in 1989. Patients were followed up for a mean of 42.1 +/- 21.0 months. Six patients were lost to follow-up. To identify the variables that were associated with early and late survival, statistical methods included logistic regression analysis, Kaplan-Meier analysis, and Cox regression analysis. The survival rate was 52.9% +/- 14.4% at 1 month, 48.8% +/- 15.8% at 1 year, 48.1% +/- 16.0 at 2 years, 40.3 +/- 19.2% at 3 years, and 35.0 +/- 21.8 at 4 years. The cause of the 73 (46.2%) early deaths were cardiac (33), hemorrhage (29), colonic necrosis (5), stroke (2), graft infection (2), pneumonia (1), and kidney failure (1). Significant predictors of early death were the presence of a common iliac aneurysm (p < 0.02), the age of the patient (p < 0.02), a previous history of stroke or transient ischemic attack (TIA) (p < 0.04), a bifurcated graft (p < 0.04), a saccular aneurysm (p < 0.06), the blood creatinine level (p < 0.06), and hypotension on admission (p < 0.06). The causes of the 28 (17.7%) late deaths were heart disease (11), cancer (8), stroke (3), another operation (3), graft infection (1), pneumonia (1), and Alzheimer disease (1). Significant predictors of late death were heavy smoking (p < 0.03) and chronic obstructive pulmonary disease (p < 0.07). Rupture of an abdominal aortic aneurysm remains a catastrophic event. Even after a successful cure of a ruptured AAA, cardiovascular causes of death are responsible for survival rates that are significantly lower than that in a matched nonaneurysmal population.
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PMID:Surgery for ruptured abdominal aortic aneurysm: early and late results of a prospective study by the AURC in 1989. 906 Nov 46

Hepatitis C virus (HCV) infection is common in end-stage renal failure patients. It is not known whether the prognosis of HCV-positive patients differs depending on whether they remain on dialysis or receive a kidney transplant. To address this question, we compared the outcomes of HCV-positive renal transplant recipients and HCV-positive patients who were acceptable candidates but had not yet received transplants. We reviewed all patients referred to our institution for renal transplantation evaluation between January 1992 and December 1995. Anti-HCV antibody was detected in 151 of 2,053 (7.4%) patients. HCV-positive patients were more often male (74% v 56%; P < 0.0001), black (68% v 49%; P = 0.001), unemployed (87% v 74%; P = 0.0004), on dialysis (88% v 78%; P = 0.0026), and on dialysis longer (30 +/- 44 months v 13 +/- 23 months; P = 0.0001) than HCV-negative patients. We determined the outcomes of HCV-positive patients who had at least 2 years' follow-up. Thirty-three HCV-positive patients received kidney transplants (group I); 25 HCV-positive patients were acceptable transplant candidates but had not yet received an allograft (group II). Group I and II HCV-positive patients were similar with respect to age, race, duration of dialysis, cause of renal failure, prevalence of heart disease, and results of liver function tests. Survival was significantly decreased in group II versus group I (P = 0.043). Our study showed that HCV-positive renal transplant recipients had a better survival than similar HCV-positive patients awaiting transplantation.
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PMID:The impact of renal transplantation on survival in hepatitis C-positive end-stage renal disease patients. 910 52


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