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

Sleep is usually associated with a reduction in the frequency of ventricular arrhythmias. We analyzed 1260 24-hour Holter recordings exhibiting ventricular ectopy and identified 50 patients who had significant increases in sleep-related ectopy. This study group was compared to an age, sex, and 24-hour ventricular ectopic frequency matched control group. There were 21 females and 29 males with a mean age of 64 years in each group. During sleep, the study patients had more frequency of ventricular ectopy per hour than did controls (mean +/- SEM; 143.2 +/- 30.7 vs 62.9 +/- 16.3; p less than 0.005). The study group had fewer daytime ventricular premature beats per hour than did the control patients (45.2 +/- 13.6 vs 67.7 +/- 13.8; p less than 0.05). The study patients also exhibited a significant sleep-related increase in complexity of ventricular arrhythmias (chi 2 = 22.1; p less than 0.001) and the control group a decrease (chi 2 = 19.1; p less 0.001). Nocturnal heart rates were slower than daytime rates in both the study (69.4 +/- 14.5 vs 79.2 +/- 12.2 bpm; p less than 0.005) and control groups (75.5 +/- 15.8 vs 82.6 +/- 16.4 bpm; p less than 0.005), without significant differences between the two groups. No significant differences in clinical and ECG characteristics of the study and control groups were found regarding presence or type of organic heart disease, pulmonary disease, hypertension, medication use, intraventricular conduction delay, abnormal Q waves, ventricular hypertrophy, or QT prolongation. Neurologic abnormalities (60% vs 28%; chi 2 = 9.38 p less than 0.005), in particular cerebrovascular disease (30% vs 14%; chi 2 = 7.56; p less than 0.01), were significantly more common in the study group. We have identified a subgroup of individuals with ventricular ectopy who increase the frequency and complexity of premature ventricular beats during sleep. The higher prevalence of neurologic disease in these individuals suggests a neurologic or neurohumoral mediation of these arrhythmias.
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PMID:Sleep and ventricular arrhythmias. 661 17

A standardized test of cardiovascular health knowledge was administered to 1367 students, ages 12-18 years, and 562 adults, ages 20-60 years. Mean scores were: ages 12-14 years, 42.5 +/- 0.7% (SEM); 15-18 years, 49.1 +/- 0.1%; 20-40 years, 68.7 +/- 0.7%; 40-60 years, 68.2 +/- 0.7% correct. Cardiovascular health knowledge increased linearly in the student population, averaging 3.08% per year. Increases continued to occur in adults, but plateaued after age 40 years, despite an increasing incidence of cardiovascular disease in this age group. Health knowledge was highly correlated with the highest educational achievement. At all age levels, knowledge of diagnostic tests was highest and knowledge of pathophysiology lowest. A personal or family history of heart disease or history of an elevated serum cholesterol was not a stimulus for increases in health knowledge.
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PMID:Changes in cardiovascular health knowledge occurring from childhood to adulthood. A cross-sectional study. 697 Jun 32

Elevated levels of cholesterol synthesis are reported for several young children with homozygous familial hypercholesterolemia (HFH) and are considered to contribute directly to their hypercholesterolemia. In contrast, increased cholesterol production has not previously been found in adult patients with HFH. Using the fecal steroid balance technique, we studied rates of cholesterol and bile acid synthesis in a 24-yr-old man who had severe hypercholesterolemia typical of HFH and who lacked skin fibroblast low density lipoprotein (LDL) receptor activity. On an average diet (45% carbohydrate, 40% fat, 15% protein) mean +/- SEM cholesterol (24.8 +/- 1.4 mg/kg per d) and bile acid (11.1 +/- 1.6 mg/kg per d) excretion were approximately threefold higher than normal. When an isocaloric high carbohydrate, low fat diet (90.5% glucose oligosaccharides, 1.3% safflower oil, 8.2% crystalline amino acids was substituted, mean cholesterol (13.0 +/- 0.5 mg/kg per d) and bile acid (8.6 +/- 0.4 mg/kg per d) fell markedly. The decline in fecal steroid excretion was accompanied by modest reductions in plasma total and LDL cholesterol concentrations and by a softening of cutaneous xanthomata. Although the patient phenotypically and biochemically resembled the HFH state, his family pedigree was not noteable for hypercholesterolemia. While the patient's father had premature cardiovascular disease, his mother had no evidence of heart disease, had normal plasma total and LDL cholesterol levels, and had normal fibroblast LDL receptor activity. Likewise, the plasma cholesterol levels of three other members of the patient's family were normal. Despite the unusual genotypic background of this individual, however, the fecal balance data shows that elevated cholesterol and bile acid synthesis may occur in adult, as well as juvenile, patients with HFH and may be responsive to dietary control.
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PMID:Elevated cholesterol and bile acid synthesis in an adult patient with homozygous familial hypercholesterolemia. Reduction by a high glucose diet. 729 45

The purpose of this study was to examine the value of marked left axis deviation in men without apparent heart disease in the assessment of ischemic heart disease risk. In the Manitoba Study, a cohort of 3983 men who were predominantly between 25 to 34 yr of age at entry in 1948, 247 cases of marked left axis deviation (mean frontal plane QRS vector of -45 degrees to -90 degrees) were identified at a mean age of 46.1 +/- 0.7 (+/- 1 SEM) yr with a mean follow-up of 12.1 +/- 0.6 yr. The results were that the development of left axis deviation in men 40 to 59 yr of age, independent of blood pressure is a significant predictor of ischemic heart disease events that are usually manifest 5 to 10 yr after the onset of this electrocardiographic abnormality. Subsets of QRS variables examined to identify cases with different degrees of ischemic heart disease risk revealed that neither Q waves in leads I or aVL, or QRS duration or actual frontal plane QRS vector identified groups with different ischemic heart disease risk. However, subsets of age (less than 40 and 60 yr or greater) perhaps reflecting different etiologies of marked left axis deviation and previous electrocardiographic findings (S1S2S3 pattern) identify a low risk group.
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PMID:The relationship of marked left axis deviation to the risk of ischemic heart disease. 733 20

Recent reports have shown that it is possible to record extracellular electrograms from the rabbit and dog sinoatrial (SA) node. We applied similar techniques to record SA nodal activity in 23 patients who underwent cardiac surgery for various forms of heart disease. Both a bipolar technique, using pairs of electrodes at various interelectrode distances, and a unipolar technique, using an exploring and an indifferent electrode, were used. To record SA nodal electrograms, polarity was reversed from the conventional electrocardiographic recording; high amplification (100 microV/cm) and low-pass filters (0.15-20 Hz) were used. SA nodal electrograms were recorded from eight of 12 patients using the bipolar method and from nine of 11 patients using the unipolar method. There were no significant differences in the success rate or quality of the recording between the two methods. However, the unipolar method allowed a more accurate localization of the SA node. Human SA nodal electrograms resembled those of the dog and rabbit and showed two distinct slopes: a diastolic slope and an upstroke slope preceding the P wave of the ECG, SA conduction times were 32.4 +/- 2.8 msec (mean +/- SEM) at sinus (PP) cycle lengths of 587.6 +/- 35.6 msec for the bipolar method, and 38.2 +/- 3.2 msec at sinus (PP) cycle lengths of 712.2 +/- 50.7 msec for the unipolar method. These methods for recording of extracellular SA nodal electrograms in man may prove useful in 1) localization of the SA node during open heart surgery and 2) assessment of SA nodal function in health and disease.
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PMID:Methods for recording electrograms of the sinoatrial node during cardiac surgery in man. 736 24

Motion of the posterior aortic root on echocardiography is related to left atrial volume changes. Early diastolic posterior motion of the aortic root reflects both LA emptying and filling and has been measured as the atrial emptying index. To study late diastolic motion of the aortic root, we measured the slope of posterior motion of the aortic root after left atrial systole (following the P wave of the ECG) in 25 subjects without heart disease (Group 1), in 15 patients with left ventricular hypertrophy due to pressure overload (Group 3) with mitral stenosis. The aortic root slope measured (mean +/- SEM) 58.0 +/- 1.9 mm./sec. in Group 1, 50.6 +/- 4.5 mm./sec. in Group 2 (NS vs 1) and 28.8 +/- 4.5 mm./sec. in Group 3, (p < 0.01 vs 1 or 2). In 16 patients (four in Group 1 and 12 in Group 2) studied at catheterization, an inverse correlation ( r = -0.74, p < 0.01) was found between the aortic root slope (over a range of 30 to 73 mm./sec.) and left ventricular late diastolic chamber stiffness measured with simultaneous left ventricular echo and high-fidelity pressure recordings. No correlation was found between this slope and either left atrial size, total aortic root excursion, left ventricular pressure pre "A" wave, height of the A wave, end-diastolic pressure, or the atrial contribution to left ventricular filling. Therefore, the aortic root slope in late diastole is decreased in mitral stenosis and in the absence of mitral stenosis, it appears to be related to late diastolic properties of the left ventricle.
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PMID:Hemodynamic correlates of late diastolic posterior motion of the aortic root. 741 30

The purpose of this investigation was to determine whether ventricular ectopic beats, or ventricular premature beats (VPBs), on routine electrocardiograms in men without apparent heart disease predict the later occurrence of clinical manifestations of ischemic heart disease (IHD). The Manitoba Study cohort consisted of 3983 men predominantly between 25 and 34 years of age and free of IHD at entry. During the 29-year observation period, 401 persons without clinical evidence of heart disease had VPBs on an electrocardiogram at a routine examination. They were followed 10.8 +/- 0.5 (SEM) years and 13.5% (54 men) later manifested IHD. Age-specific total IHD incidence was significantly (p less than 0.05) greater for men 40 to 59 years of age at VPB occurrence compared to men of the same age without VPBs. The clinical manifestation with the strongest association with VPBs was sudden death. VPB characteristics of frequency, configuration, coupling interval, and postextrasystolic T-wave change did not distinguish those who developed IHD. Prematurity index (R-R'/QT) showed a trend toward an association of late coupled ectopic beats (R-R'/QT greater than 1.6) and IHD risk. However, faster basic ventricular rate plus VPBs significantly correlated with greater IHD probability. Thus ventricular ectopic beats on a routine electrocardiogram in men over 40 years of age without apparent heart disease identify those at high risk for a clinical IHD event, especially sudden death.
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PMID:Relationship of ventricular ectopy in men without apparent heart disease to occurrence of ischemic heart disease and sudden death. 746 14

Children with congenital heart disease may have some degree of hepatic impairment, with further impairment developing shortly after surgical correction of the cardiac defect. The redistribution of organ blood flow that occurs during cardiopulmonary bypass implicates ischaemia as one of the principal causes of injury. The aim of this study was to measure liver blood flow in children with congenital heart disease and to determine both the effects of cardiopulmonary bypass and the consequences of corrective surgery. Indocyanine green clearance and auricular densitometry, were used in 31 children. In 83% we demonstrated a reduced liver blood flow, with a mean percentage disappearance rate (PDR) of 12.9% (SEM +/- 1.2). This finding was unrelated to the patient's age, the type of congenital heart defect or the presence or absence of cyanosis. During cardiopulmonary bypass, hepatic perfusion was further reduced in 77% of children, by an average of 67%, out of proportion with the iatrogenic reduction in total body flow. Six hours after surgery, liver blood flow had increased significantly above preoperative levels (p < 0.001; t-test) to approximately normal values with a mean PDR of 20.4% (SEM +/- 1.5).
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PMID:The effects of congenital heart disease and cardiac surgery on liver blood flow in children. 748 66

To evaluate the response of patients with chronic atrial fibrillation (AF) to exercise and to demonstrate if prognosis could be predicted, 200 male patients (64 +/- 1 years) with AF were identified retrospectively who underwent resting echocardiography and symptom-limited treadmill testing. They were classified by underlying disease into three subgroups: hypertension or no underlying disease (LONE; n = 102), ischemic heart disease (IHD; n = 45) and history of congestive heart failure or valvular disease (CHF-VD; n = 53). Maximal exercise capacities for LONE, IHD and CHF-VD were (mean +/- 1 SEM) 8.0 +/- 0.3, 6.4 +/- 0.4 and 6.0 +/- 0.3 metabolic equivalents, respectively (p < 0.01), and resting left ventricular ejection fractions were 61.7 +/- 1.6, 60.1 +/- 2.2 and 49.5 +/- 1.9%, respectively (p < 0.01). Stepwise multiple regression analysis demonstrated that, except for group classification (R2 = 0.13, p < 0.01), no clinical, exercise or morphologic variables could predict exercise capacity. After a mean 39.1-month follow-up (range 1-78), 17 of the 200 had died from cardiovascular causes. The rate of cardiac death using Kaplan-Meier survival analysis was significantly greater in CHF-VD patients (p < 0.01). However, Cox hazard function and Kaplan-Meier survival analysis demonstrated that neither echocardiographic measurements of cardiac size or function at rest, nor exercise or clinical variables were significant predictors of outcome. AF patients with a history of CHF and/or VD demonstrated a reduced exercise tolerance ad a worse prognosis than those without morphologic heart disease or those with IHD.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Exercise capacity and prognosis in patients with chronic atrial fibrillation. 772 99

The aim of this study was to investigate the effects of a 6-month octreotide treatment on cardiac mass and function by means of Doppler echocardiography in 11 normotensive patients affected with active acromegaly. The GH and insulin-like growth factor-I levels were normalized during octreotide therapy from 34 +/- 6.5 and 767.4 +/- 72.4 micrograms/L to 4.6 +/- 0.9 and 235 +/- 10.3 micrograms/L, respectively (P < 0.001; mean +/- SEM). After the 6-month treatment, we observed a significant decrease in the left ventricular mass index from 138 +/- 11 to 116 +/- 13 g/m2 (P < 0.001) and in the mean wall thickness/internal end-diastolic radius ratio from 0.47 +/- 0.1 to 0.44 +/- 0.1 (P < 0.001). No significant differences were found in systolic function indices, whereas diastolic filling indices improved over the course of the therapy; the isovolumic relaxation time decreased from 115 +/- 6 to 100 +/- 6 ms (P < 0.05), tricuspid late diastolic filling velocities decreased from 41 +/- 3 to 36 +/- 2 cm/s (P < 0.03), and tricuspid deceleration time decreased from 280 +/- 28 to 198 +/- 15 ms (P < 0.005); the ratio of early to late peak velocity of the right ventricular filling significantly increased from 1 +/- 0.01 to 1.3 +/- 0.1 (P < 0.03). A significant correlation was detected between left ventricular mass regression and increase in the early to late peak velocity ratio of the left ventricular filling (r = 0.62; P < 0.05). The results of this study show an improvement in cardiac structural and functional abnormalities during chronic treatment with octreotide, thus supporting the hypothesis of a specific heart disease secondary to high circulating GH levels.
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PMID:Chronic treatment with the somatostatin analog octreotide improves cardiac abnormalities in acromegaly. 837 Jul


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