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

The evaluation of hormonal adaptation of the fetoplacental unit (FPU) in pregnant women with somatic and obstetric complications has demonstrated 4 patterns of adaptation: normal, stressful, maladaptive and unstable. The distribution of FPU adaptive responses across diagnostic groups correlated with types of diseases and their duration in pregnant women. Controlled heart diseases, chronic pyelonephritis without exacerbations, mild toxemia were mostly associated with a normal FPU adaptation. Decompensated heart disease, acute episodes of chronic pyelonephritis, deteriorating toxemia, decompensated diabetes mellitus produced functional activation of FPU hormones. Pregnant women with stable hypertension in the presence of moderately severe toxemia and essential hypertension showed hormonal FPU maladaptation. Differential evaluation of FPU adaptation in pregnant women with somatic and obstetric diseases provides a guide to a range and sequence of interventions for fetal disorders.
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PMID:[Hormonal diagnosis of fetal adaptation disorders in pregnant women with extragenital and obstetric pathology and the principles of their correction]. 208 91

Despite the fact that numerous studies have been published regarding the possible presence in plasma of an endogenous Na-K pump inhibitor with a digitalis-like structure in essential hypertension, very little is known about this factor in heart disease in general, and in situations characterized by low cardiac output. We measured the ability of plasma obtained from the femoral vein to inhibit a human renal Na(+)-K+ ATPase before and immediately after percutaneous transluminal coronary angioplasty (PTCA) in 6 patients suffering from angina pectoris and severe coronary stenosis. Intraerythrocyte sodium and potassium concentrations were also measured simultaneously. Na(+)-K+ ATPase inhibition proved significantly greater after angioplasty as compared to basal activity (percentage inhibition: 31.5 +/- 7.8 vs 16.1 +/- 12.2). No significant changes in intraerythrocyte sodium and potassium were detected. Though we are not in a position to define the mechanism underlying the increase in the digitalis-like factor, a plausible hypothesis may be that the reduction in cardiac output during PTCA by raising cardiac pressures may stimulate the production of a factor of compensatory inotropic significance.
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PMID:Increase in plasma digitalis-like activity during percutaneous transluminal coronary angioplasty in patients with coronary stenosis. 216 10

Many advances have now been made in understanding the early natural history of coronary artery disease and essential hypertension, an understanding that these diseases begin in childhood and that CVD relates to clinical cardiovascular risk factors. Methods have now been established to determine risk factors in the pediatric age and, with a family history, to begin to identify children at potential risk for premature heart disease. Advances have also been made in developing models for intervention and beginning prevention through both high-risk and population strategies directed at schoolchildren. Obviously, both approaches are needed and complement each other. An impressive future is ahead for effective preventive cardiology beginning with children by incorporation of cardiovascular health education and health promotion in elementary schools. Applying behavioral concepts to intervention programs can strengthen their chances of success. The overall good of having children adopt healthy life-styles with an understanding of their necessity is now attainable. It will be the responsibility of physicians to guide the direction of programs being promoted for children.
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PMID:Prevention of adult heart disease beginning in the pediatric age. 218 63

Right (RV) and left ventricular (LV) diastolic function was evaluated in 50 patients with mild, uncomplicated essential hypertension using pulsed-wave Doppler echocardiography. Patients with pulmonary, valvular or coronary artery disease were excluded and antihypertensive drugs were discontinued for the 2 weeks preceding the study. Ten normotensive patients without heart disease acted as control subjects. In the hypertensive patients, RV peak velocity of atrial filling was higher (42 +/- 10 vs 31 +/- 7 cm/s, p less than 0.01) and deceleration half-time was prolonged (96 +/- 20 vs 83 +/- 10 ms, difference not significant); ratio of early/atrial filling velocity (1.1 +/- 0.3 vs 1.7 +/- 0.4, p less than 0.001) and peak filling rate corrected to stroke volume (3.6 +/- 0.7 vs 5.3 +/- 0.9 SV/s, p less than 0.001) were lower. LV filling parameters showed similar changes. RV filling parameters did not correlate with age, LV mass or septal thickness but correlated weakly with LV radius/thickness ratio. There was good correlation between RV and the following corresponding LV filling parameters: peak filling rate, r = 0.68, p less than 0.001; ratio of early/atrial filling, r = 0.88, p less than 0.0001; and deceleration half-time, r = 0.62, p less than 0.001. Data indicate that RV diastolic function is abnormal in essential hypertension and these abnormalities are closely related to those of LV diastolic function.
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PMID:Right ventricular diastolic function in systemic hypertension. 233 Aug 97

Despite encouraging reductions in mortality rates from coronary heart disease (CHD), it remains a major public health problem and the leading cause of death in the United States. Although various explanations have been proposed for declining death rates, a consensus exists regarding the importance of lifestyle alterations for risk factor reduction. Because cardiovascular (CV) risk-related behavioral patterns are acquired during childhood, numerous school-based CV health promotion programs have been implemented. The effectiveness of CV research studies for children during the last decade are reviewed. Intervention strategies to prevent heart disease include (1) the population or public health approach and (2) the high-risk approach. The "Heart Smart" model intervention project is utilized to describe these two main strategies. Policy, position statements, and initiatives on CV risk factors from major professional societies and associations, in addition to governmental organizations and offices, are also provided. Primary care physicians, particularly pediatricians and family practitioners, as well as cardiologists can play a crucial role in the prevention of CHD and essential hypertension through efforts and practices in their offices, the schools, and the community at large. The changing and expanding role of physicians interested in preventive child health care is emphasized, including involvement in school- and community-based CV health promotion programs. More comprehensive CV model projects such as "Heart Smart," which intervene on the total school environment, are critical to the reduction of CV disease in the United States and abroad.
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PMID:Cardiovascular health promotion in children: "Heart Smart" and the changing role of physicians. 267 42

The adult heart diseases, coronary artery disease and essential hypertension, are now clearly recognized to begin in childhood. The evidence comes from autopsy studies of cardiovascular-renal changes in the first two decades of life. Cardiovascular risk factors can be identified in children just as in adults and these have a high correlation with the anatomic disease. This relationship underscores the importance of risk factor screening of children. Of interest is that clinical risk factors tend to persist within a rank (track) so that studies in childhood can be predictive of future levels. Behavior and lifestyle of eating, cigarette smoking, alcohol intake, and use of oral contraceptive pills influence risk factors in children. Familial aggregation of risk factors are also noted. Studies of apolipoproteins, B and A-I, have identified subsets of children that have a greater frequency of paternal myocardial infarction. The findings from the Bogalusa Heart Study and other epidemiological studies of children show the need to begin prevention of adult heart disease in early life. Approaches to prevention should include high risk families and children and a public health or population approach. Cardiovascular health education for elementary school children should be directed to children in the general population in an effort to encourage them to adopt healthy life styles.
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PMID:Risk factors in early life as predictors of adult heart disease: the Bogalusa Heart Study. 267 86

The maternal organism provides the developing embryo with its physical environment, nutrients, and a mechanism for eliminating metabolic wastes. Since the physiological state of the pregnant female affects her ability to provide those requirements for the developing embryo, it is not surprising that there are maternal factors that can affect the wellbeing of the embryo. Extremes of maternal age in both humans and animals have been implicated in growth retardation, as well as autosomal trisomies. The influence of maternal size on fetal size is more pronounced among larger species with longer gestation periods such as humans and domestic animals. A clear relationship between the parity of the mother and potential developmental toxicity in humans has not been established due to the confounding influences of maternal age. Among laboratory rodents, however, it appears that offspring of multiparous animals are at increased risk of developmental toxicity. A variety of infectious agents, particularly viruses, have either been demonstrated or implicated as causes of developmental toxicity. In addition, hyperthermia is a possible confounding factor inherent with maternal infection. Although under experimental conditions hyperthermia is teratogenic in laboratory animals, a causative role for transient hyperthermia, which occurs during febrile states concomitant with infections, cannot be clearly established. Chronic maternal vascular disease states including essential hypertension, heart disease, or diabetes mellitus are likely to contribute to uteroplacental insufficiency and developmental toxicity. Poor maternal nutrition among humans contributes to growth retardation, but not to malformations. The production of "abnormal" maternal antibodies, such as are present in Rh incompatibility, can cause fetal wastage. An important maternal factor in humans is uteroplacental insufficiency, which can occur in normal states like twinning, as well as in abnormal conditions including reduced placental size, chronic maternal hypoxia, or uterine ischemia. Although all these maternal factors can contribute to developmental toxicity, they do not necessarily occur as isolated events. Some developmental toxicants exert deleterious effects within both the embryo and the maternal system.
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PMID:Maternal factors in developmental toxicity. 288 3

Hypertension and obesity are two disorders that are closely related; each occurs more frequently with the other than in an otherwise normal population. These two disorders, however, exert disparate effects on cardiovascular structure and function. The hallmark of essential hypertension is an increased total peripheral resistance, and hypertensive patients have a contracted intravascular volume and normal cardiac output but an increased left ventricular stroke work due to a high afterload. In contrast, obese patients have an increased intravascular volume, left ventricular filling pressure, cardiac output and a lower total peripheral and renal vascular resistance. Left ventricular adaptation will consist of eccentric hypertrophy in obesity regardless of the level of arterial pressure and concentric hypertrophy in lean hypertensive patients. Although obesity may mitigate the harmful effect of a chronically elevated total peripheral and renal vascular resistance and lessen target organ damage in essential hypertension, the combination of obesity and hypertension presents a double burden to the left ventricle and is associated with systolic and diastolic dysfunction and a propensity for high grade ventricular dysrhythmias. It is not surprising that congestive heart failure and sudden death are common sequelae of obesity hypertension. Weight reduction reduces arterial pressure by decreasing intravascular volume and cardiac output associated with a fall in sympathetic activity and reversal of cardiac hypertrophy. Therefore, weight loss unloads the heart from the two-fold burden caused by obesity and hypertension and should become a major goal in the prevention and treatment of heart disease.
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PMID:Cardiovascular adaptation to obesity and hypertension. 294 41

ANF is a newly discovered peptide hormone that has significant implications for critical care physicians. This hormone, released from the heart, is especially responsive to fluid challenges as well as to many of the drugs commonly used in the ICU, including pressor and anesthetic agents. It has potent arterial vasodilating effects in pharmacologic doses and may be an important natural vasodilating agent, especially in the renal vascular bed. In patients on dopamine, it may potentiate the renal vasodilating effect and may provide an effective therapy for developing acute renal failure. Children with congenital heart disease and patients with CHF have elevated levels that clearly alter the aldosterone-angiotensin II system and may help us to understand and treat these conditions more effectively. Additionally, ANF may be a marker for adequacy of treatment in these disease states. The potential uses for ANF include diuresis in patients with fluid overload and diuretic resistance, treatment of CHF, and as a short-acting vasodilator. In the ICU, many therapies affect cardiac pressures and volume regulation. Positive-pressure ventilation may decrease the release of ANF by decreasing venous return and thus contribute to water retention. Drugs used in the ICU may directly affect ANF levels and markedly affect the homeostasis of fluid and electrolyte balance. This hormone system interacts intimately with renin, angiotensin II, and aldosterone. These interactions may play a significant role in the development of essential hypertension. Although not addressed in this article, the treatment and understanding of essential hypertension may be significantly advanced by understanding these relationships. It is clear that ANF acts as a hormone with complex interactions between the heart, volume status, electrolyte balance, renin-angiotensin II-aldosterone, vasopressin, and vascular tone. Although currently no definitive picture exists for these complex interactions, this is an exciting new hormone with significant implications for patient management in the ICU. As research continues, the picture will become clearer and our understanding of this new hormone more precise.
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PMID:Atrial natriuretic factor in the pediatric intensive care unit. 297 48

Sleep apnea syndrome is a relatively common disease, with an overwhelmingly male predominance. The female:male ratio is about 1:15-20, depending on the specific age group. In light of findings linking sleep apnea syndrome to essential hypertension, it is hypothesized that the syndrome may contribute to the sex differential in mortality. In most of the developed countries women have longer life expectancy than men even after adjustment for various lifestyles and biologica variables Mortality from heart disease accounts for 40% of the total sex differential. The fact that the 2-5 fold sex differential for heart disease mortality is reduced to much lesser extent by multivariate adjustment than the sex differential for mortality from all causes, and that it is minimally affected by the exclusion of all persons with a history of chronic diseases, indicates that other risk factors should be sought. I propose the hypothesis that Sleep Apnea Syndrome (SAS), which almost exclusively affects males, contributes to the sex differential in mortality from coronary heart disease. Sleep Apnea Syndrome is a relatively common disease. It is the most preponderant finding among patients referred to diagnostic sleep laboratories, particularly among patients complaining of excessive daytime sleepiness. Its incidence among the adult male population (age greater than 21 years) was estimated to be at least 1-1.5%. It is considerably higher than that, at least 5 to 7 fold, in the 40 to 60 years age group, and in specific high-risk populations such as the morbidly obese. The female:male ratio is about 1:15-20, depending on the specific age group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sleep apnea syndrome: is it a contributing factor to the sex differential in mortality? 364 99


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