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

The blood flow velocity patterns within the left atrial appendage were studied by transesophageal color flow imaging and pulsed Doppler in 84 patients. At the time of the study, 57 of the patients were in sinus rhythm, 25 were in atrial fibrillation, and two were in atrial flutter. The relationships between atrial rhythm, blood flow pattern and the presence/absence of spontaneous echocardiographic contrast or thrombus within the appendage were investigated. Transesophageal echocardiography allowed recording of blood flow velocities in 81 of the 84 patients studied. In 51 of the 55 patients in sinus rhythm the pulsed Doppler study showed a biphasic blood flow pattern, whereas a multiphasic pattern was found in the two patients with atrial flutter and in 14 patients with atrial fibrillation. In four patients with sinus rhythm and 10 patients with atrial fibrillation, no significant blood flow velocity could be detected. Thrombus or spontaneous echocardiographic contrast were found within the left atrial appendage in 20 patients, and in all these patients blood flow was either absent or significantly reduced. Our findings indicate that an absent or low blood flow velocity within the left atrial appendage represents a predisposing factor for thrombosis. Isolated left atrial appendage dysfunction has been documented in four patients during sinus rhythm, which may lead to thrombosis. This observation may offer an explanation for cardioembolic events that occur occasionally in patients without apparent heart disease and sinus rhythm.
 ...
PMID:Left atrial appendage dysfunction: a cause of thrombosis? Evidence by transesophageal echocardiography-Doppler studies. 174 30

Thrombus formation in the left atrium and left ventricle is primarily due to stasis of blood which causes activation of the coagulation system. Migration of thrombotic material into the circulation depends on the dynamic forces of the circulation. Atrial fibrillation is the commonest underlying cardiac disorder predisposing to thromboembolism. Rheumatic mitral stenosis, left atrial enlargement, prior myocardial infarction, hypertension, and echocardiographic left ventricular hypertrophy are risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation. Non-valvular atrial fibrillation accounts for 45% of cardiac sources of thromboembolic stroke and includes patients with ischemic heart disease, hypertension, thyrotoxic heart disease, hypertrophic cardiomyopathy, chronic sinoatrial disorder, and idiopathic atrial fibrillation. 15% of cardiac sources of thromboembolic stroke are associated with acute myocardial infarction, 10% with left ventricular aneurysm and mural thrombi remote from an acute myocardial infarction, 10% with rheumatic valvular heart disease, and 10% with prosthetic cardiac valves. Mitral valve prolapse, mitral annular calcium, nonischemic cardiomyopathies, infective endocarditis, nonbacterial thrombotic endocarditis, left atrial myxoma, paradoxical embolism associated with congenital heart disease, calcific aortic stenosis, and complex atherosclerotic plaque within the proximal aorta also contribute to thromboembolism.
 ...
PMID:Etiology and pathogenesis of thromboembolism. 176 43

Stroke ranks third as a cause of death in much of the industrial world, surpassed only by heart disease and cancer. Thrombotic and embolic arterial occlusions are the leading causes of cerebral infarction. Once a major cerebral infarction has occurred, therapy is limited to the prevention of complications and rehabilitation. Identification and treatment of stroke-prone patients are now not a standard part of medical practice. However, the proper management of the patient with acute cerebral ischemic or progressing stroke is a subject of debate. Treatment of progressing or acute cerebral ischemia is aimed at prevention of infarction in areas of the brain that are still viable. A number of therapeutic strategies are currently being investigated in the management of ischemic stroke.
 ...
PMID:Medical management of acute cerebral ischemia in the elderly. 186 4

Left ventricular luminal changes were examined by percutaneous fiberoptic angioscopy in 13 patients with dilated cardiomyopathy and in four patients with acute myocarditis. Angioscope-guided endomyocardial biopsy was also performed in six patients with dilated cardiomyopathy and in two with acute myocarditis. A balloon-tipped guiding catheter (9F) was introduced through the right femoral artery into the left ventricle, the balloon was inflated, and a 1.6 or 4.3F fiberscope was introduced through the catheter into the ventricle so as to locate the fiberscope tip at the tip of the catheter shaft. The balloon was then pushed against the desired portion of the ventricle and warmed saline was infused to observe the luminal changes. In contrast to the patients without organic heart disease whose left ventricular luminal surface was brown in color, the luminal surface was white or light yellow in four, light brown in one, bluish-white in one, with white and brown portions distributed in a mosaic pattern in four, and it was reddish brown in the remaining one patient with dilated cardiomyopathy. Mural thrombi were observed in two of the patients. The luminal surface was light brown in one, reddish brown in one, rose in one, and red in one patient with acute myocarditis. Thrombi and scattered bleeding were observed in two and one of these patients, respectively. The changes in luminal coloration in patients with dilated cardiomyopathy and acute myocarditis had no obvious relation to left ventricular volume and ejection fraction. Angioscope-guided biopsy revealed that the white and light yellow portions were due to endocardial fibrosis, that the endocardia of brown portions were not fibrotic, and that the myocardium in the red portions contained mononuclear cells, indicating inflammation. The results indicate that the angioscopic features of the left ventricular luminal surface were not uniform in patients with dilated cardiomyopathy or in those with acute myocarditis, and that angioscopy can be used as a guiding tool for endomyocardial biopsy.
 ...
PMID:Percutaneous fiberoptic angioscopy of the left ventricle in patients with dilated cardiomyopathy and acute myocarditis. 238 3

An analysis was made of 2093 autopsies of children aged 0-14 years. Thromboembolic complications (TEC) were detected in 6.68% of the victims who had died from acute infections, chronic inflammatory diseases, congenital malformations. Thromboses of venae cava superior and umbilicalis were found to predominate in the children. Thrombogenesis was due to the damage to the venous wall during catheterization and to phlebitis. Thrombi of cardiac cavities and arteries occur rarely and develop in heart disease and arteritis and after correction of congenital heart disease. Thromboembolism occurred in 29.28% of thrombosis largely in the pulmonary artery. According to the contribution to the thanatogenesis, 3 groups of TEC were classified as (1) the main cause of death; (2) one of the causes of death; (3) being insignificant in the outcome of the disease. The life-time diagnosis of TEC is insufficient.
 ...
PMID:[Thromboembolic complications in children]. 274 29

Cerebral venous thrombosis is an infrequent cause of childhood stroke. It is reported most frequently in the setting of acute dehydration, cyanotic congenital heart disease, or the nephrotic syndrome and it is commonly found in patients with hereditary coagulation or immunologic disorders. Thrombotic tendencies may also occur in children with iron deficiency anemia. We describe a 11-months old boy with cerebral venous thrombosis likely attributable to dehydration and iron deficiency anemia by intestinal chronic blood loss, caused by food allergy.
 ...
PMID:[Cerebral venous thrombosis in a child with iron deficiency anemia caused by food allergy]. 931 49

Healing characteristics of small-caliber vascular prostheses used in small children have rarely been observed because removing specimens are troublesome. Modified Blalock Taussig shunt procedures were performed using small caliber expanded polytetrafluoroethylene (ePTFE) vascular grafts and fabric grafts in 13 patients with congenital heart disease. At the time of total corrective procedures, a piece of 10 ePTFE grafts in 10 patients and six fabric grafts in four patients were removed from the distal pulmonary anastomosis, and evaluated. The implantation duration was from 11 months to 5 years and 7 months (mean, 2 years and 6 months). At removal, average patient age was 4 years and all grafts were patent. Microscopically, the wall of three ePTFE grafts were calcified, and macrophages were immunohistologically observed in the graft wall. Thrombus formation, intimal hyperplasia, and pannus detachment was common. In the fabric grafts, many capillaries infiltrated the interstices and often reached the lumen from the perigraft side. These results suggested that in cyanotic small children, angiogenesis in and around fabric grafts was active and calcification was accelerated in ePTFE grafts. Complete endothelialization throughout the length, caused by angiogenesis, might be possible in small children when highly porous fabric vascular prostheses are used.
 ...
PMID:Evaluation of small caliber vascular prostheses implanted in small children: activated angiogenesis and accelerated calcification. 980 80

Atrial fibrillation (AF) is the most common cardiac arrhythmia. AF is paroxysmal or persistent and becomes permanent when it does not convert to sinus rhythm spontaneously or when attempted cardioversion fails. The prevalence of AF is 0.4% in the general population and increases with age up to 6-8% in octogenarians. In men, the age-adjusted prevalence is generally higher than in women. During AF, synchronous mechanical atrial activity is disturbed, resulting in haemodynamic impairment. This can give rise to thrombus formation and embolism to the systemic circulation. Thrombus associated with AF arises most frequently in the left atrial appendage. Cerebrovascular emboli in AF patients most often manifest as transient ischaemic attacks or ischaemic strokes. The overall rate of ischaemic stroke among patients with nonrheumatic AF averages 5% per year, but the rate increases with age. Patients with AF are at higher risk of cerebrovascular events from all causes. Of all strokes, one in every six occurs in patients with AF. Including transient ischaemic attacks and silent strokes detected radiographically, the overall rate of all cerebrovascular events in AF patients rises to more than 7% per year, although approximately one third of these are due to causes that are only secondarily or incidentally associated with AF or related anticoagulant therapy. Antiarrhythmic therapy is useful to improve cardiac rate and function in AF. However, to reduce first or recurrent emboli, antithrombotic therapy is of paramount importance. Results from several randomized clinical trials of antithrombotic therapies have shown that adjusted-dose warfarin reduces first or recurrent stroke by about 60% compared with placebo. When patients with nonvalvular AF are anticoagulated, the odds against ischaemic stroke and intracranial bleeding favour an INR between 2.0 and 3.0. Acetylsalicylic acid is less efficacious than warfarin in AF patients, reducing the risk of stroke by about 20%. Therefore, this antiplatelet agent should be used only for AF patients at low risk. Anticoagulation is the current treatment modality in AF patients at high or intermediate risk, i.e. patients with history of transient ischaemic attack or stroke, those aged >65 years, those with a history of hypertension, diabetes, heart failure or structural heart disease, valvular disease or significant systolic dysfunction. The benefit of dual antiplatelet regimens in AF patients is unknown, and combining antiplatelet agents with different mechanisms of action is an important topic for future investigation.
 ...
PMID:Long-term outcome after stroke due to atrial fibrillation. 1269 12

Thrombus formation can be a significant cause for morbidity and mortality after Fontan operation. Intracardiac thrombus formation can lead to chronic pulmonary embolic disease if formed on the right side, or stroke, if on the left side of the heart. Right-sided embolism may result in ventilation/perfusion mismatch or elevation of pulmonary vascular resistance, both of which may seriously hamper cavopulmonary physiology. We report the case of a 22-year-old patient, with past history of classic Fontan procedure performed at the age of six to palliate a single-ventricle tricuspid atresia, who presented with a massive pulmonary embolism and hemodynamic instability. Due to his critical status, mechanical fragmentation of the clot using the angiography catheter was started, followed by a local catheter-directed infusion of urokinase. This case demonstrated that pharmacomechanical thrombolysis therapy with a standard Pig-tail catheter and thrombolytic therapy with urokinase is secure, effective, and appropriated to manage heart chamber and pulmonary arterial thrombosis in patients with congenital heart disease.
 ...
PMID:Late complication of classic Fontan operation: giant right atrial thrombus and massive pulmonary thromboembolism. 1901 11

Thrombotic complications in pediatric patients are increasingly recognized due to increased use of invasive procedures, heightened awareness, improved imaging and prothrombotic lifestyle choices. Multiple risk factors are often present in pediatric patients with thrombosis. The most common risk factor is an indwelling catheter, followed by inflammatory conditions, malignancy, immobilization, thrombophilia and congenital heart disease. Rare severe thrombophilias, whether acquired or congenital, often present in children. Neonates have distinct patterns of thrombosis promoted by sepsis, inflammation, hypotension, hypoxia and the use of intravascular catheters in small caliber and umbilical vessels. Treatment of pediatric thromboembolic disease requires an understanding of developmental hemostasis, application of nonpediatric drug formulations and consolidation of expert guidelines and relevant adult literature. The acute and chronic consequences of thrombosis can be devastating in pediatrics and correlate with the length of time of vessel occlusion, underscoring the importance of rapid diagnosis and initiation of therapy. As trials begin to define recurrence risks, outcome predictors and optimal therapy for children with thrombosis and thrombophilia, consultation with an experienced pediatric hematologist provides the best available therapy today.
 ...
PMID:Thrombosis and thrombophilia: principles for pediatric patients. 2085 87


1 2 Next >>