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)

A patient with Bence-Jones myeloma and amyloidosis was treated with cytotoxic drugs and plasmapheresis, resulting in rapid improvement of myeloma-associated symptoms and signs. However, amyloidosis-associated symptoms, especially hypotension, grew worse. Echocardiographic examination demonstrated hypertrophy and a hyperrefractile appearance of the myocardium, thought to be pathognomonic of amyloid heart disease. A permanent pacemaker was inserted for treatment of Adams-Stokes attacks caused by sick sinus syndrome and atrioventricular conduction disturbances. Postmortem examination of the heart demonstrated abundant amyloid deposits corresponding to the altered acoustic qualities of the myocardium. Echocardiographic examination is a valuable non-invasive method for demonstration of amyloid deposits in the heart in multiple myeloma.
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PMID:Myeloma-associated cardiac amyloidosis. A case report. 670 98

We tested the effectiveness and safety of i.v. diltiazem in the management of paroxysmal supraventricular tachyarrhythmias in 39 patients, 21 with organic heart disease and seven in heart failure. Fifteen patients presented with supraventricular tachycardia, 12 with atrial fibrillation and 12 with atrial flutter. End points were conversion to sinus rhythm or slowing of the ventricular rate to 100 beats/min or less. Diltiazem was given as an i.v. bolus of either 150 or 300 micrograms/kg over 2 minutes. A second injection was administered to patients who received the lower dose and failed to reach either end point within 30 minutes. The overall success rate was 82% (32 of 39 patients). Time to end point was 5 minutes or less in 20 patients. Conversion to sinus rhythm occurred in 13 of 15 patients (87%) with supraventricular tachycardia and in two of 12 patients with atrial fibrillation. Treatment side effects included a slow ventricular rate in one patient who had a sick sinus syndrome and hypotension in two patients that rapidly responded to fluid administration. We conclude that i.v. diltiazem is effective and well tolerated and advocate its use in the management of paroxysmal supraventricular tachyarrhythmias.
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PMID:Beneficial effect of intravenous diltiazem in the acute management of paroxysmal supraventricular tachyarrhythmias. 684 9

The clinical significance of corrected sinus node recovery time (CSNRT) and the natural and unnatural history of sinus node dysfunctions are not completely known. To gain some insight into this problem, 101 patients (pts) (54M, 47F, mean age +/- SD = 62.02 yrs +/- 14.42) with clinical and ECG signs of definite or suspected sick sinus syndrome (SSS) underwent an electrophysiologic study and then were prospectively followed for a mean period of 44.36 months +/- 18.96 (range: 2-78 months). The pts were divided into two groups: 1) Group A: 68 pts with prolonged CSNRT (greater than 500 msec); 2) Group B: 33 pts with normal CSNRT. Thirty-three pts of Group A (48.5%) and 2 pts of Group B (6.1%) received VVI pacemaker implantation (PM) immediately after the electrophysiologic study. The following results were obtained: 1) Pts of Group A showed a higher prevalence of organic heart disease and of ECG signs of definite SSS than pts of Group B. (p less than 0.05). Moreover, the higher the CSNRT in Group A pts, the more severe the ECG abnormalities of SSS. 2) Pts without PM, both of Group A and Group B, noted during the follow-up period a disappearance of neurological symptoms (syncopes and/or dizziness) and of ECG abnormalities of SSS in more than 50% of the cases. However, this was less evident in Group A pts compared with Group B pts (53.8% vs 78.6% regarding neurological symptoms and 54.3% vs 74.1% regarding ECG abnormalities of SSS) as well as in pts with organic heart disease in comparison with those with primitive SSS. Moreover, the number of pts who needed PM implantation during the follow-up period due to the worsening of clinical and ECG signs of SSS were higher in Group A than in Group B (20% vs 6.5%). The occurrence of cardiac death among the pts without PM was similar in pts of Group A (8.5%) and in those of Group B (9.7%). One pt of Group A without PM died suddenly (less than 1 hour). 3) Pts who required PM implantation were older (p less than 0.01) and showed a prevalence of organic heart disease higher (p less than 0.05) than those who did not require PM implantation. Pts with PM, both of Group A and Group B, showed a complete disappearance of syncopes and a clear-cut reduction of dizziness after implantation of it. On the contrary, dyspnea nearly always persisted and sometimes appeared when initially absent. Sudden and non-sudden cardiac death in PM pts (13.6%) was somewhat more frequent than in those without PM. 4) The incidence of stable atrial fibrillation was 12.1% in pts without PM and 27.2% in pts with PM. The occurrence of stable atrial fibrillation in pts without PM was generally not followed by clinical improvement. 5) The incidence of cerebrovascular accidents was approximately 8%. The accidents always occurred in pts with organic heart disease and often in the older pts (mean age: 75.1 yrs +/- 5.7) particularly in those with PM. A bradycardia-tachycardia syndrome was observed only in 3 pts who had a stroke...
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PMID:[Clinical significance of corrected sinus node recovery time and natural and unnatural history of sinus node dysfunctions. A four-year prospective follow-up of 101 cases]. 716 55

The case of an eight-year old child suffering from sick sinus syndrome (SSS) is reported. The patient showed S-A conduction disturbances (Mobitz 1 sinoatrial exit block) as noted in two sequential 24-hour recording periods, and a pathologic response to atropine test. An involvement of the A-V node was also present, made clear by a first and a second degree Mobitz 1 block. The clinical, laboratory and noninvasive data excluded an organic cardiopathy. Idiopathic SSS was, therefore, diagnosed. The rare occurrence of this syndrome in the childhood, and the usefulness of Holter monitoring in its detection is emphasized.
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PMID:[Sick sinus syndrome in childhood. A case report (author's transl)]. 728 13

Single-chamber ventricular pacing has been implicated in the development or progression of congestive heart failure in patients with sick sinus syndrome (SSS). To define the exact role of pacing modality in causation of congestive heart failure, quantitative two-dimensional echocardiographic examination was performed in 51 consecutive patients with SSS who received an initial pacemaker from January 1979 to September 1989 and were free of any structural heart disease at the time of implant. Atrial or dual chamber pacemakers were implanted in 21 patients (Group I) and ventricular pacemakers in 30 (Group II). The two groups were matched for age, gender, paced rate, blood pressure and duration of pacing. After a mean follow-up of 64 +/- 34 months, congestive heart failure developed in one patient in group I and 3 in Group II. Patients in group II, had larger left atrium (41 +/- 5 vs 37 +/- 6 mm, p < 0.05) and left ventricular end-diastolic volume (64 +/- 18 vs 54 +/- 12 ml/m2, p < 0.01) but similar left ventricular end-systolic volume (27 +/- 12 vs 24 +/- 9 ml/m2, p = NS), ejection fraction (59 +/- 10 vs 57 +/- 8%, p = NS), left ventricular mass (84.8 +/- 31 vs 85.6 +/- 29.2 gm/m2, p = NS), meridian end-systolic wall stress (48.3 +/- 22.1 vs 49.8 +/- 25 Kdynes/cm2, p = NS) and wall stress/end-systolic volume ratio (1.27 +/- 0.94 vs 1.42 +/- 0.59, p = NS). Pacing mode does not appear to influence left ventricular systolic function in patients with SSS.
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PMID:Comparative evaluation of left ventricular function in sick sinus syndrome on different long-term pacing modes. 779 15

Survival after closed-chest ablation of His bundle with DC shock for supraventricular arrhythmias was analyzed for a 10-year period (May 1982-December 1992) with 317 consecutive patients (167 males, 150 females; mean age 66 years; range 33-93 years). Of these, 54 patients died (17.3%) and 5 were lost to follow-up. The mean age at ablation was 70.3 +/- 8.3 years with a range of 49-93 years. Of those who died, the mean survival was 30.5 +/- 28.6 months with a range of 36 hours to 120 months; the diagnosis of heart disease was: hypertension (n = 14), cardiomyopathy (n = 8), ischemic (n = 7), valvular (n = 6), cor pulmonale (n = 3), valvular and ischemic (n = 2), hypertension and ischemic (n = 1), miscellaneous (n = 3), and none (n = 10). Of the patients who died after ablation, the arrhythmias at the time of the ablation were atrial fibrillation (AF; n = 33), sick sinus syndrome (n = 5), atrial flutter (AFL; n = 4), paroxysmal AV junctional tachycardia (PAVJT; n = 4), AF + AFL (n = 4), atrial tachycardia (n = 2), PAVJT + AFL (n = 1), and AF +AFL + atrial tachycardia (n = 1). Death was sudden in 13 patients (25%), due to heart failure in 10 (19.2%), myocardial infarction in 4 (7.7%), stroke in 4 (7.7%), aortic vascular accident in 3 (5.8%), miscellaneous in 18 (34.6%), and undetermined in 2.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term survival after closed-chest His-bundle ablation with DC shock for supraventricular arrhythmias: a 10-year experience with 317 consecutive patients. 784 34

Chronic atrial fibrillation is a very common arrhythmia affecting 2 to 4% of the population older than 60 years of age. Atrial fibrillation may cause disabling symptoms and serious adverse effects, such as impairment of cardiac function or thromboembolic events. It is also associated with an increased risk of death. In the past, the most common underlying heart disease related to chronic atrial fibrillation was rheumatic heart disease. Today, this disease occurs relatively rarely. Nevertheless, the incidence of atrial fibrillation is likely to increase in the future due to the aging of the population, since its prevalence increases with age. In most patients with chronic atrial fibrillation, the arrhythmia can be attributed to organic heart disease or metabolic disorders. In western countries ischemic and hypertensive heart disease (including sick sinus syndrome) and alcohol (holiday heart syndrome) are numerically more important than the classical causes of atrial fibrillation--rheumatic heart disease and thyrotoxicosis--which are declining in incidence. Overall, atrial fibrillation is associated with an increased mortality. In about 15% of patients with chronic atrial fibrillation, no underlying cardiac or metabolic abnormality can be found, also the arrhythmia can itself give right to atrial dilatation. Atrial fibrillation consists most probably of several coexisting reentrant wave fronts of activation within the atria. Atrial activation and atrial fibrillation is as follows: multiple wavelets sweep round the atria in irregular, shifting patterns; completed reentrant circuits are the exception. Atrial flutter in its common form is characterized by evidence of atrial activity at a rate of 250-350 bpm, and usually almost exactly 300 bpm.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Atrial fibrillation and atrial flutter: pathophysiology and pathogenesis]. 784 37

In this population-based study, long-term survival and prognostic factors were examined in 148 patients, 55 men and 93 women, from Olmsted County, Minnesota, who had permanent pacemaker implantation for sick sinus syndrome between 1969 and 1991. The overall survival for patients who had received a permanent pacemaker for sick sinus syndrome was significantly worse than that of an age- and sex-matched control population (p < 0.0001). The increased mortality was attributable at least in part to the presence of structural heart disease in patients with sick sinus syndrome who had undergone permanent pacemaker implantation (82 of 148 patients, 55%). Survival of patients with isolated sick sinus syndrome was comparable (p = 0.6729), whereas in patients with structural heart disease it was significantly worse than expected (p < 0.0001). Symptoms were eliminated or improved in 116 patients (78%) after pacemaker implantation. Multivariate analysis identified congestive heart failure, valvular heart disease, history of stroke or transient ischemic attack, and age as independent risk factors for mortality. However, there was a trend toward decreased survival in patients who had received ventricular pacing compared with those who had received dual-chamber pacing, but this difference did not reach statistical significance (p = 0.0556). The mode of pacing was not an independent risk factor (p = 0.23). The observed survival of patients aged < 80 years was significantly worse than expected (p < 0.0001), whereas that of patients aged > or = 80 years was similar to the expected (p = 0.22).
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PMID:Long-term survival after permanent pacemaker implantation for sick sinus syndrome. 797 39

The most important manifestations of heart disease in hemochromatosis are congestive heart failure and cardiac arrhythmia. The spectrum of disturbances in cardiac rhythm ranges from minor abnormalities on the electrocardiogram to supraventricular arrhythmia, atrioventricular conduction block, and ventricular tachyarrhythmia. Sinus node dysfunction is, however, rarely mentioned. The authors report a case of massive transfusion-induced hemochromatosis in which the patient presented with sick sinus syndrome as the early manifestation of cardiac involvement.
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PMID:Sick sinus syndrome as the early manifestation of cardiac hemochromatosis. 812 Apr 81

Pacemaker implantation was performed in 26 children aged from 5 months to 15 years (mean 4.6). The indications for pacemaker implantation were: sick sinus syndrome in 4 patients, III degrees idiopathic A-V block in 2 both with congenital heart disease and III degrees post-op. A-V block in 20 patients. 34 pacemakers produced by seven different companies were implanted. Epicardial electrode was used in all but one patient in whom endocardial electrode was introduced. Demand for impulse voltage was 2.4-5.2 V (mean 4.4 V), impulse duration was from 0.25 ms to 1.65 ms (mean 0.62 ms). Three out of 26 pts. (11.5%) died (1-intraoperative bleeding, 1-ventricular rhythm disturbances, 1-sudden death). In seven children first exchange of the pacemaker (one for mechanic damage and 6 for exhausted batteries) was performed mean 4.3 years after previous implantation. In two children second battery exchange was necessary mean 7.5 years after previous (both exhausted batteries). In five children a damaged epicardial electrodes were exchanged (21%).
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PMID:[Permanent cardiac pacing in children. Personal experience]. 823 Sep 73


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