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

The causes of heart failure may be classified into three groups, hemodynamic causes, disturbances of cardiac rhythm and conduction and diseases of the myocardium. Accordingly the different causes of heart failure are discussed and the technics for diagnosis reviewed. Particular diagnostic problems are mentioned, which may arise in connection with cardiac echinococcosis, atrial myxoma, sarcoid heart disease and myocardial aneurysm.
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PMID:[The differential diagnosis of heart failure (author's transl)]. 36 78

Postmortem findings within the cardiac conduction system are described from the case of a black woman with sarcoid heart disease who died suddenly. Her clinical course had been characterized by recurring ventricular arrhythmias and bouts of syncope. Both the sinus node artery and the atrioventricular (A-V) node artery were sites of focal fibromuscular dysplasia, which thickened slightly the wall of the former but markedly narrowed the lumen of the latter. Small foci of sarcoid infiltration were present in the sinus node and the A-V node. Fatty replacement within the His bundle was attributable to the probable ischemia caused by narrowing of the A-V node artery. Sarcoid granulomata and infiltration with epithelioid cells were present throughout the ventricular myocardium, but were conspicuously less prevalent in the atria. All the large coronary arteries were normal. Many small coronary arteries in the ventricular myocardium were involved by the sarcoidosis and their lumen were narrowed. These findings and analogous ones reported by others are discussed relative to the pathogenesis of syncopal attacks and sudden death which seem to peculiarly prevalent in sarcoid heart disease.
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PMID:Clinicopathologic correlations. De subitaneis mortibus. XXV. Sarcoid heart disease. 87 28

Cardiac dysfunction due to systemic sarcoidosis is most of ten due to severe restrictive pulmonary diseases. Although the diagnosis is frequently missed during life, direct granulomatous infiltration of the myocardium may occur with systemic sarcoidosis and, when present in the heart, is a major cause of death. To explore the possible use of radioactive 201thallium, a new agent for myocardial imaging, for improved clinical recognition of sarcoid heart disease, myocardial perfusion imaging with 201Tl was performed in six normal volunteers and in five patients with documented systemic sarcoidosis and clinically apparent cardiac dysfunction. Two of the patients with sarcoidosis had severe restrictive pulmonary disease. Their myocardial perfusion scans revealed relatively uniform uptake of 201Tl by the left ventricle, similar to that found in the normal volunteers; however, the right ventricular uptake of 201Tl and right ventricular thickness in these two patients with sarcoidosis was greater than normal. The other three patients with sarcoidosis had unexplained congestive heart failure, mitral regurgitation, or arrhythmias. Myocardial perfusion imaging in these patients revealed normal right ventricular uptake of radioactivity but segmental defects in the left ventricle compatible with an infiltrative disease of the myocardium. Segmental myocardial infiltration by sarcoid was confirmed by autopsy in one of these patients and at operation in another. Thus, myocardial imaging with 201Tl may provide a noninvasive technique for the improved clinical recognition of primary myocardial sarcoid and for distinguishing it from cardiac dysfunction secondary to pulmonary disease.
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PMID:The use of 201thallium for myocardial perfusion imaging in sarcoid heart disease. 87 50

Sarcoid lesions of the heart are reported in 13% to 20% of sarcoidosis patients. Sudden death and ventricular arrhythmias occur in 40% to 50%. In view of this frequency and life-threatening significance, review of military aircrew with documented sarcoidosis for myocardial involvement was undertaken. Case records were available for 11 US Army, 19 US Air Force, and 6 US Navy patients. Four patients (11%) had significant cardiac abnormalities to include sustained ventricular arrhythmias, and acquired anteroseptal infarction pattern by ECG with nomal coronary angiography. ECG abnormalities were found in eight additional patients. Suspected involvement of the heart in 33% of this series warrants complete cardiovascular evaluation of the sarcoid patient prior to return to flying duties. A case report demonstrates the difficulty in evaluating ECG abnormalities in the antemortem diagnosis of sarcoid heart disease.
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PMID:Joint Committee on Aviation Pathology: XIII. Sarcoid and the heart--an aeromedical risk. 92 58

Antisarcolemmal (ASAs) and antimyolemmal antibodies (AMLAs) are serological hallmarks of inflammatory heart muscle disease. They occur in a similar incidence in postcardiac injury syndromes, sarcoid heart disease or in dilated and hypertrophic cardiomyopathy. Rarely but still notably they are found with increasing age or in coronary artery disease. We therefore examined whether they are truly pathogenetic or whether they also possess properties of 'natural antibodies'. AMLAs and ASAs, like natural antibodies, have specificity for preserved structures on the membrane; they possess cross-reactivity and increase with age. In contrast to natural antibodies, however, they occur frequently after viral stimulation or other forms of trauma, are more often of the IgG and IgA than of the IgM isotype and fix complement in the acute stage of the disease. They also possess cytolytic and cytotoxic properties when incubated in vitro with isolated heart muscle cells. Antigenic mimicry has been demonstrated to be operative, since they are cross-reactive to viral proteins.
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PMID:Cytolytic anticardiac membrane antibodies in the pathogenesis of myopericarditis. 140 9

In 2 patients arrhythmias and conduction disorders were the first symptoms at presentation of cardiac sarcoidosis. One patient with severe conduction disorders showed normalisation of the EKG during steroid treatment. The other patient developed an overall cardiomyopathy and the arrhythmia was treated with conventional drugs. The frequency of cardiac involvement in sarcoidosis is much higher than that of clinical symptoms of sarcoid heart disease. Cardiac sarcoidosis is increasingly diagnosed in the last few decades. In most cases, it presents with sudden death, arrhythmia, conduction disorders or cardiomyopathy. The main diagnostic pathological feature is evidence of noncaseating granulomas, but mononuclear cell infiltration and focal interstitial fibrosis have also been found. The basal part of the interventricular septum is particularly prone to involvement. If conventional therapy in clinically important cases proves inadequate, steroid therapy should be added. It is recommended to make an EKG in every patient presenting with sarcoidosis even in the absence of cardiac symptoms. Sarcoid heart disease should be considered in every patient with diagnostic sarcoidosis and heart disease but also in every case of difficult heart disease without an obvious aetiology. Because of the relatively early age at onset, life expectancy is shortened.
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PMID:[Sarcoidosis of the heart]. 202 54

Whereas the total mortality rate for sarcoidosis is 0.2 per 100,000, the prognosis, when the heart is involved, is very much worse. The authors used the difference in mortality rate to infer whether thallium 201 myocardial perfusion scan abnormalities correspond to myocardial sarcoid by making the simplifying assumption that if they do, then patients with abnormal scans will be found to have a death rate similar to patients with sarcoid heart disease. The authors therefore analyzed complete survival data on 52 sarcoid patients without cardiac symptoms an average of eighty-nine months after they had been scanned as part of a protocol. By use of survival analysis (the Cox proportional hazards model), the only variable that was significantly associated with survival was age. The patients' scan pattern, treatment status, gender, and race were not significantly related to survival. The authors conclude that thallium myocardial perfusion scans cannot reliably be used to diagnose sarcoid heart disease in sarcoid patients without cardiac symptoms.
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PMID:Do thallium myocardial perfusion scan abnormalities predict survival in sarcoid patients without cardiac symptoms? 238 39

Heart disease responsive to steroids is well described in many disorders, including sarcoidosis, systemic lupus erythematosus, polyarteritis nodosa, myocarditis and Churg-Strauss syndrome. The underlying disorder is often obvious and the response is usually slow. We describe a woman who had severe left ventricular failure, cardiac dilatation and pericardial effusion which were rapidly rectified by steroid therapy. Steroid withdrawal led to recurrence of signs, which were reversed by recommencing steroids. The aetiology was not determined.
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PMID:Steroid responsive cardiomyopathy. 239 29

Thirty nine cases, in which sudden cardiac death (SCD) was suspected, were studied to evaluate the mechanism and the prediction of SCD in arrhythmia-patients using electrophysiological studies (EPS). The 39 cases (28 male and 11 female) were located by surveying 2098 patients who underwent EPS for the evaluation of arrhythmias. Age at time of EPS ranged from 4 to 86 years, average 50.5 years. Time from EPS to death was 2 to 163 months, average 27.9 months. Underlying heart disease was: dilated cardiomyopathy in 11, old myocardial infarction in 5, ischemic heart disease in 5, hypertensive heart disease in 5, valvular heart disease in 3, hypertrophic cardiomyopathy in 2, arrhythmogenic right ventricular dysplasia in 1, myocarditis in 1, sarcoidosis in 1, cor pulmonale in 1, and no obvious heart disease in 4. Fifteen had a permanent pacemaker implanted. SCD in cases without a permanent pacemaker (24 cases): 2 had chronic complete A-V block (one BH block, one HV block), 1 had advanced A-V block (HV block), 3 had bundle branch block with first degree HV block, 9 had ventricular tachycardia (VT), 3 had sick sinus syndrome (SSS), 3 had paroxysmal atrial flutter, 1 had WPW syndrome and paroxysmal atrial fibrillation, 1 had paroxysmal atrial tachycardia, and 3 had premature ventricular beats and first degree HV block. SCD in cases with permanent pacemaker (15 cases): 5 had SSS, and 10 had A-V block. In 3 of the 5 with SSS and 7 of the 10 with A-V block, VT was found before pacemaker implantation. In our study, brady and tachyarrhythmias coexisted in 25 cases (64%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mechanism and prediction of sudden cardiac death in arrhythmia patients using electrophysiological studies. 263 27

Although, the diagnosis of myocardial sarcoidosis is difficult to establish clinically, the heart may be involved at autopsy in upto a third of cases of sarcoidosis. Cardiac sarcoidosis may remain occult, may present with arrhythmia, or may even cause sudden death. In order to avoid a diagnostic oversight, sarcoid heart disease should be considered in any patient with unexplained heart block, cardiac arrhythmia, or heart failure.
Sarcoidosis 1989 Sep
PMID:Myocardial sarcoidosis: a review. 269 Feb 42


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