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

The aim was to determine if certain risk factors in the general population are more strongly related to peripheral arterial disease than to ischemic heart disease. Arterial disease in the lower limbs was measured by means of the World Health Organization questionnaire on intermittent claudication, the ankle brachial pressure index, and a reactive hyperemia test in 1,592 men and women aged 55-74 years selected randomly in 1988 from the age-sex registers of 10 general practices in Edinburgh, Scotland. Peripheral arterial disease was strongly related to lifetime cigarette smoking, with additional risks in current and exsmokers of less than 5 years. Multiple regression of risk factors on measures of peripheral arterial disease showed associations with diabetes mellitus (but not impaired glucose tolerance), systolic blood pressure, and serum cholesterol; inverse association with high-density lipoprotein cholesterol; and only univariate association with triglycerides. In multiple logistic regressions of risk factors on six separate indicators of cardiovascular disease, the only consistent difference was that smoking increased the risk of peripheral arterial disease (range of odds ratios, 1.8-5.6) more than heart disease (range of odds ratios, 1.1-1.6). Diabetes mellitus was not a stronger risk factor for peripheral arterial disease.
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PMID:Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh Artery Study. 155 87

Since 1984, 122 orthotopic heart transplants have been performed at the University of Ottawa Heart Institute. Of the 114 adult patients, 100 (87.8%) were males and 14 (12.2%) females, with mean ages of 45.8 and 47.9 yr, respectively. The hearts of these adults were pathologically diagnosed as chronic ischemic heart disease (CIHD) in 55 (48.2%), acute ischemic heart disease (AIHD) in 17 (14.9%), dilated cardiomyopathy (DC) in 30 (26.3%), valvular heart disease in five (4.4%), congenital heart disease in three (2.6%), myocarditis in three (2.6%), and other in one (0.9%) of the cases. The adult hearts (94) among the first 100 transplants were studied morphologically, to look for differences among the three major groups with clinical "end-stage" heart failure. The mean heart weights were 435, 356, and 463 gm in the CIHD, AIHD, and DC groups, respectively, with AIHD less than CIHD or DC (p less than 0.01). The ventricular wall thicknesses were similar in CIHD and DC, but the left ventricular (LV) wall thicknesses in AIHD were more than in CIHD or DC (p less than 0.01). The ventricular diameters were greater in DC than in CIHD or AIHD (p less than 0.01) and greater in CIHD than in AIHD (p less than 0.01). The mean LV cavity volumes were 158, 94, and 200 ml in CIHD, AIHD, and DC, respectively, with DC greater than in CIHD or AIHD (p less than 0.01) and CIHD greater than in AIHD (p less than 0.01). The relative differences in AIHD compared to CIHD and DC are referrable to the shorter duration of disease in the acute ischemic group.2+ off
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PMID:The University of Ottawa Heart Institute Cardiac Transplant Program: the first 100 transplants. A pathologic study of the explanted hearts. 157 94

Coronary risk profile screening was performed in 1065 volunteers during the National Heart Week 1988 as part of the National Heart Association's campaign against the increasing incidence of ischaemic heart disease. Of particular importance was the use of a desktop analyser for lipid screening of total cholesterol and high density lipoprotein (HDL) cholesterol. It was found that the mean serum cholesterol was 211 +/- 39.5 mg/dl, with 62% of the participants having a total cholesterol greater than 200 mg/dl and 23.1% having a total cholesterol greater than 240 mg/dl. For HDL cholesterol, the mean was 48.4 +/- 17 mg/dl, with 18.7% of the participants having a low HDL cholesterol of less than 35 mg/dl. The male Indians had a significantly lower HDL cholesterol compared to male Malays. Three or more risk factors for coronary artery disease was present in 21.7% of Chinese, 41.2% of Malays and 50% of Indians. We conclude therefore that a proportion of this volunteer population, the majority of which have no overt heart disease, is at risk from coronary artery disease from an elevated cholesterol or low HDL cholesterol level. A follow-up of 90 participants who were initially detected to have an elevated cholesterol in 1986, however, showed that only 54.4% still had an elevated cholesterol of greater than 240 mg/dl, thus suggesting that early detection may help to reduce this risk.
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PMID:Lipid screening in a volunteer population in Singapore. 159 Jun 57

The relationship between reported coffee consumption and specific causes of death was examined in 9484 males enrolled in the Adventist Mortality Study in 1960 and followed through 1985. Coffee consumption was divided into three levels: less than 1 cup per day, 1-2 cups per day, and greater than or equal to 3 cups per day. Approximately one third of the subjects did not drink coffee. Cause-specific mortality rates were compared using survival analysis including Cox's proportional hazard model, and controlling for potential confounders such as body mass index, heart disease and hypertension at baseline, race, physical activity, marital status, educational level, smoking history, and dietary pattern. Inclusion of interaction terms between coffee consumption and attained age as time-dependent covariates allowed the hazard ratio to vary with age. Univariate analyses showed a statistically significant association (p less than 0.05) for coffee consumption and mortality for most endpoints. Multivariate analyses showed a small but statistically significant association between coffee consumption and mortality from ischemic heart disease, other cardiovascular diseases, all cardiovascular diseases, and all causes of death. For the major causes of death, the hazard ratios decreased from about 2.5 at 30 years of age to 1.0 around 95 years of age. These results indicate that abstinence from coffee leads to compression of mortality rather than an increase in lifespan.
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PMID:Coffee consumption and cause-specific mortality. Association with age at death and compression of mortality. 161 53

The day vs night values of variables that may be related to the autonomic nervous system were compared in 50 individuals without obvious heart disease. Using ambulatory electrocardiographic monitoring and heart rate variability analysis, it was found that in contrast to daytime, nocturnal heart rate and total heart rate variability were reduced and low (0-0.05 Hz) and high (0.2-0.35 Hz) frequency power of nocturnal heart rate variability were increased, whereas mid-frequency (0.05-0.2 Hz) power was reduced. In addition, nocturnal episodes of trapezoidal-shaped waveforms of heart rate increase were present primarily at night and ST was elevated to a greater extent at night. Many of these factors were related to age and tentatively, despite the small sample size, reflect an age-related diminished autonomic nervous system response. These results serve to establish a circadian basis for comparison when evaluating disease states such as ischemic heart disease and its prognosis.
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PMID:Day vs night ECG and heart rate variability patterns in patients without obvious heart disease. 164 57

From 1978 to 1980, 260 healthy subjects, 40-79 years of age, underwent 24 h ambulatory electrocardiography in order to determine the prevalence and complexity of ventricular premature beats (VPBs) in adults without apparent heart disease. The number of types of VPBs seem in 5% or less were considered 'abnormal' and the present follow-up study undertaken in order to assess the significance of such 'abnormal' VPBs as predictors of subsequent ischaemic heart disease (IHD). Information concerning cardiac events within the follow-up period was available in 237 subjects. Nine were lost to follow-up and 24 refused clinical examination. IHD was documented in 13 (eight myocardial infarction, five angina pectoris). 'Abnormal' VPBs occurred in six out of 13 (46%) who later developed IHD compared to only 24 out of 213 (11%) without IHD (P less than 0.001). The presence of either more than 900 VPBs 24 h-1 or ventricular tachycardia of more than three beats, identified five out of 13 patients with IHD (sensitivity 38%), whereas 210 out of 213 with no evidence of IHD at follow-up were identified (specificity 98%). Four out of seven who initially had more than 900 VPBs 24 h-1 had IHD on follow-up. Our results have demonstrated a strong positive association between 'abnormal' VPBs observed in a random 24-h electrocardiographic recording of apparently healthy subjects 40-79 years of age and subsequent IHD. They also suggest that a 24-h ECG may be useful for the assessment of coronary risk even in asymptomatic subjects.
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PMID:Predictive value of ventricular premature beats for subsequent ischaemic heart disease in apparently healthy subjects. 171 40

It is a real challenge, for the doctor internist-cardiologist, who deals everyday, with problems of arrhythmia, especially in pilots of combat aircraft, to discover those rare cases of premature ventricular contractions (PVC) where exists great probability that PVC were caused by ischemic heart disease. Appearance of complex PVC in aircrew is seldom. Isolated appearance of single, unifocal PVC in young pilots without any symptoms and in absence of organic changes or functional heart disorder, should be considered as normal medical finding.
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PMID:[Incidence and prognostic significance of ventricular extrasystole in pilots of combat aircraft and civilian planes]. 172 25

Invasive electrophysiological testing has contributed importantly to the objective evaluation and management of patients at high risk for sudden cardiac death. The clinical application of the technique is based on the hypothesis that the reproducible induction of ventricular arrhythmias by programmed cardiac stimulation constitutes a marker of risk for spontaneous ventricular arrhythmias and sudden death as well as an objective end point to guide the selection of antiarrhythmic therapy. The value of electrophysiological testing is well established in patients with ischemic heart disease and a history of sustained ventricular tachycardia or fibrillation and in some subsets of patients with unexplained syncope. More recently, the technique has been used by some investigators to identify individuals at high risk for sudden death among patients with recent myocardial infarction and those with left ventricular dysfunction and recurrent nonsustained ventricular tachycardia. The predictive value of the technique in patients with nonischemic heart disease is unknown. In addition to its use as an objective end point in the selection of antiarrhythmic drug therapy, invasive electrophysiological testing has advanced our knowledge of the mechanisms of life-threatening ventricular arrhythmias and contributed importantly to the development of new therapies, such as implantable arrhythmia control devices and catheter ablation techniques.
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PMID:Role of invasive electrophysiological testing in the evaluation and treatment of patients at high risk for sudden cardiac death. 172 98

"Corkscrew oesophagus" is characterised on the basis of two case reports and attention is drawn to thoracic pain of oesophageal origin. Corkscrew oesophagus is a radiological diagnosis and is characterised by twisted segments in the distal third of the oesophagus. The condition can sometimes be demonstrated endoscopically and it is due to a basic disturbance in the motility of the oesophagus. Painful conditions in the oesophagus are most frequently caused by gastro-oesophageal reflux or disturbances in motility and the latter is frequently complicated by reflux oesophagitis. Pain of oesophageal origin is frequently a diagnosis by exclusion and requires exclusion of ischaemic heart disease. The initial treatment should be directed to the reflux oesophagitis. The diagnosis and information about the origin of the pain and the benign course of the condition will calm the majority of the patients and remove their fear of a possible fatal heart disease.
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PMID:[Corkscrew esophagus]. 173 62

An initial study of the use of open access exercise electrocardiography by general practitioners (GPs) in South East Kent showed that patient selection and interpretation of test results was frequently incorrect. After issuing guidelines, modifying the request form and instituting registrar review of all requests, significant improvements in both referral pattern, result interpretation and patient management have resulted. Forty-nine GPs requested 110 exercise tests during 1988/89. Twelve per cent were not undertaken after discussion with the referring practitioner. Eighty-four per cent of those tested would have been referred to the district general hospital cardiology outpatient department in the absence of open access exercise electrocardiography service. Six per cent of patients were referred directly for invasive investigation. Thirty-five per cent were referred to the district general hospital cardiology outpatient department, whilst 42% were spared hospital referral based on the result of the investigation. Better use of the modified service was suggested by: referral of fewer patients with non-cardiac chest pains (P = 0.002); more patients with a moderate pre-test probability of ischaemic heart disease (P less than 0.05); fewer inappropriate requests (P less than 0.01); and fewer inappropriately undertaken tests (P less than 0.001) than in the previous study. All patients with strongly positive test results were appropriately managed. Open access exercise electrocardiography in the format investigated is potentially a cost-effective and useful tool to improve diagnosis and management of heart disease by GPs.
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PMID:Open access exercise electrocardiography: a service to improve management of ischaemic heart disease by general practitioners. 174 38


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