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

A female patient, 56, with mitral heart disease and chronic atrial fibrillation is presented. She underwent mitral valve replacement with bioprosthesis twice previously. Suffering from hypercholesterolemia and not in anticoagulant therapy, she was admitted in the emergency room with clinical history and electrocardiogram of a posterior infarction. Diagnosis was later assured by serum CK-MB and coronary arteriography. The electrovectocardiographic aspects of the case agree with those reported in the literature.
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PMID:[Posterior infarction due to coronary embolism in a patient with valve prosthesis. A case report]. 228 29

The efficacy of amiodarone was evaluated in 85 patients with supraventricular tachycardia (SVT) refractory to several antiarrhythmic agents (mean 3.8 +/- 1.0). All but six patients had organic heart disease. Patients were followed for 19 months (range 2-60 months). Response to amiodarone treatment was considered excellent (no recurrence of SVT) in 22 of 52 patients with paroxysmal atrial fibrillation (PAF), in four of 13 patients with chronic atrial fibrillation (CAF), and in three of 15 patients with Wolff-Parkinson-White syndrome-related circus movement tachycardia (WPW-CMT). Response was improved (marked improvement in symptoms with partial suppression of SVT) in 22 patients with PAF, in seven patients with CAF, in 10 patients with WPW-CMT, and in four patients with atrioventricular nodal reentry tachycardia. Response was considered poor (insignificant or no suppression of SVT) in three patients with PAF, in one patient with CAF, and in one patient with WPW-CMT. Seven patients required discontinuation of amiodarone due to adverse effects. We conclude that amiodarone is efficacious and relatively safe for control of SVT refractory to conventional antiarrhythmic agents irrespective of the underlying electrophysiologic mechanism.
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PMID:The usefulness of amiodarone in management of refractory supraventricular tachyarrhythmias. 274 45

To evaluate the response of patients with chronic atrial fibrillation to exercise, 50 men (mean age 65 +/- 8 years) with atrial fibrillation underwent a maximal exercise test using respiratory gas exchange techniques. Patients were classified by the presence (n = 29) or absence ("lone atrial fibrillation," n = 21) of underlying heart disease. Responses were evaluated at a standard submaximal work load (3.0 mph, [4.8 km/h] 0% grade), at the gas exchange anaerobic threshold and at maximal exercise. For all 50 patients, the mean maximal oxygen uptake was 20.6 ml/kg per min, which approximates 85% of the aerobic capacity predicted for age-matched normal individuals. Patients with lone atrial fibrillation demonstrated normal exercise capacity in contrast to patients with atrial fibrillation and known heart disease (22.7 +/- 5 versus 19.1 +/- 5.0 ml/kg per min, p less than 0.05). The mean maximal heart rate (176 +/- 30 beats/min) was approximately 20 beats/min higher than that expected for age, was extremely variable and accounted for only 8% of the variance in maximal oxygen uptake. Maximal heart rate in subjects with lone atrial fibrillation was higher than that of subjects with atrial fibrillation and known heart disease (189 +/- 32 versus 166 +/- 24 beats/min, p less than 0.01). Stepwise regression analysis revealed that maximal systolic blood pressure accounted for 19% of the variance in maximal oxygen uptake (VO2 max), suggesting that systolic function is an important determinant of exercise performance in atrial fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Maximal exercise testing and gas exchange in patients with chronic atrial fibrillation. 334 53

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

Restoration of sinus rhythm may improve functional capacity in atrial fibrillation in the short-term. Little is known, however, about its long-term effect on functional status. The aim of the present study was to evaluate the long-term effect of cardioversion on peak oxygen consumption (VO2) in patients with chronic atrial fibrillation. Patients with such a condition and due to undergo electrical cardioversion were eligible for the study. Patients underwent treadmill exercise testing with measurement of peak VO2 before cardioversion, and at 1 month and 2 years thereafter. Based on the rhythm present at those times after cardioversion, patients were categorized into three groups: those in sinus rhythm after 1 month and 2 years (Group I); those in sinus rhythm after 1 month, but with atrial fibrillation after 2 years (Group II); and those who were in atrial fibrillation both at 1 month and 2 years following cardioversion (Group III). Thirty-nine patients were included, and underlying heart disease was present in 24 of them (62%). In the comparison of the baseline characteristics of Group I (n = 17), Group II (n = 11), and Group III (n = 11), underlying heart disease was more frequent in Group I (88%, 45%, and 36%, respectively); otherwise they were similar. In Group I, peak VO2 showed an insignificant increase from 21.1 +/- 5.0 to 22.3 +/- 5.0 ml.min-1.kg-1 month after. cardioversion. After 2 years of sinus rhythm, peak VO2 showed a further increase to 23.8 +/- 5.0 ml.min-1.kg-1 (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term effect of cardioversion on peak oxygen consumption in chronic atrial fibrillation. A 2-year follow-up. 782 14

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

Atrial fibrillation is one of the most common arrhythmias, leading at least in a subset of patients to severe symptoms (palpitations, weakness, syncope), and to hemodynamic impairment especially in the clinical setting of left ventricular dysfunction. Thus, in many cases restauration of sinus rhythm is indicated because of the negative effects of reduced cardiac output. Quinidine has been the first line drug for many years and has been proven to be highly effective especially when combined with Verapamil. But there is growing concern about using quinidine and other class I-anti-arrhythmic agents because of some hints in clinical trials for increased longterm mortality on these drugs. This study was undertaken to test the efficacy of Sotalol, a beta-blocker with additional strong class-III antiarrhythmic action, compared to a fixed combination of Quinidine and Verapamil for conversion of chronic atrial fibrillation and maintenance of sinus rhythm after medical or electrical cardioversion. To avoid early proarrhythmic effects, potassium values in the range of "high"-normal values (> 4.3 mval/L) were tried to be obtained. 82 patients were randomly assigned to receive either Sotalol or Quinidine/Verapamil. There was no difference between the groups as far as the underlying heart disease, duration of atrial fibrillation (mean 219 days) and other clinical features including echocardiographic parameters were concerned. The dose of the drug was weight-related individually adjusted, and the drug was continued thereafter. If sinus rhythm could not be established at that time, electric cardioversion was performed and the drug was continued in lower dosage thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Sotalol and quinidine/verapamil (Cordichin) in chronic atrial fibrillation--conversion and 12-month follow-up--a randomized comparison]. 784 39

Aim of the study was to assess possible differences in ANP levels between patients with congestive heart failure (CHF) with and without chronic atrial fibrillation (AF). We studied 12 patients with chronic AF and 17 patients with sinus rhythm (SR), (m 16, f 13, years 67.7 +/- 8.6), with CHF, not hypertensive, without valvular or congenital heart disease, NYHA class II-III, by ANP RIA and echocardiography. Left atrial (LA/m2) dimensions were significantly higher in patients with AF, and ANP was also more increased in AF. Significant linear correlations between heart rate and ANP, ANP and LV shortening fraction and ANP and A/E ratio, assessed by Doppler trans-mitral flow, were observed in SR but not in AF patients. A significant correlation between ANP and left ventricular mass g/m2 was observed only in AF. Higher ANP levels seem associated with left ventricular enlargement, assessed as left ventricular mass, in AF patients; in SR patients, higher ANP levels are associated with depressed systolic function and with decreased left ventricular compliance. Rate dependent ANP incretion seems blunted in chronic AF; neurogenic heart rate control and/or coordinated atrial systoles may be ANP modulators in sinus rhythm CHF.
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PMID:[Effects of atrial fibrillation on the increase of atrial natriuretic peptide in congestive heart failure]. 789 79

Atrial fibrillation is the second most common arrhythmia after ventricular premature beats. For years, prophylactic anticoagulation has been recommended in patients with atrial fibrillation in underlying rheumatic heart disease. With the aim of establishing the risk of embolism in non-rheumatic atrial fibrillation, and the justification for prophylactic anticoagulation therapy, five prospective studies were carried out. The results obtained indicate that all patients with chronic atrial fibrillation should receive anticoagulation therapy wherever possible (INR 2.0 to 3.0). The sole exception are patients aged under 55 years with no other organic heart disease. For this group, the risk of a stroke is appreciably reduced, so that treatment with ASA suffices.
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PMID:[Anticoagulation in non-rheumatic atrial fibrillation. Recommendations based on five prospective studies]. 814 16

Propafenone is a sodium channel blocking agent with a mild beta- and calcium channel-blocking activity. Several controlled and noncomparative studies have documented its efficacy in a variety of supraventricular arrhythmias in both adults and children. Propafenone is comparable with other Vaughan-William class I antiarrhythmic drugs for acute conversion of atrial fibrillation. It is also comparable with other drugs for prevention of recurrences in paroxysmal atrial fibrillation and for maintenance of sinus rhythm following successful cardioversion of chronic atrial fibrillation. Although propafenone is effective in the acute management of junctional reentrant tachycardias, the availability of safer drugs precludes its routine use for these arrhythmias. It may, however, be preferred for the acute management of haemodynamically well tolerated pre-excited atrial fibrillation in patients with the Wolff-Parkinson-White (WPW) syndrome. It also has documented efficacy in the long term therapy of patients with junctional tachycardias, and is a useful first-line drug in the management of arrhythmias in patients with the WPW syndrome, particularly when there is a short anterograde refractory period of the accessory pathway. Noncomparative studies were confirmed good efficacy and tolerability of propafenone in the short and long term management of paediatric supraventricular arrhythmias. It seems to be particularly effective for the treatment of ectopic atrial and junctional tachycardias, which are generally difficult arrhythmias to manage. Propafenone appears to have an acceptable adverse effect profile during both short and long term therapy. As with most other antiarrhythmic agents, there is a proarrhythmic potential. This has also been observed in children. There is a theoretical possibility that the beta-blocking properties of propafenone may protect against its proarrhythmic potential. However, this has not been confirmed in clinical studies. In conclusion, propafenone appears to be effective in the management of a wide spectrum of supraventricular arrhythmias. It should be considered among the first line drugs for management of these arrhythmias in patients without structural heart disease.
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PMID:Guidelines for the use of propafenone in treating supraventricular arrhythmias. 852 58


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