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

Factors influencing the effect on employment status were investigated in 250 patients (males: females 224:26) who underwent coronary artery bypass surgery between March 1983 and November 1985. The median age at operation was 57.9 (range 36.6-69.4) years and the median follow-up time 32 (19-52) months. Preoperatively 149 patients (59.6%) were receiving sick pay or disability pension because of their heart disease. Only 64 (25.6%) were gainfully employed, in contrast to 97 (38.8%) at follow-up. Of those who were working at the time of operation, all but eight returned to work postoperatively. At follow-up 183 (80.3%) were free from symptoms or much improved, with degree of improvement somewhat greater in those who were working postoperatively. The period of sick leave and the preoperative waiting time were significantly shorter for patients who were working postoperatively than for those who were awarded disability pension. Age, previous myocardial infarction, duration of preoperative angina and type of work were also found to influence postoperative employment status.
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PMID:Factors influencing return to work after aortocoronary bypass surgery. 128 32

The pathogenesis of cardiac arrest in the absence of any apparent heart disease remains unclear. Based on the hypothesis that coronary spasm may be a cause of cardiac arrest in the absence of apparent heart disease, ergonovine testing and/or electrophysiologic studies (EPS) were performed to evaluate the cause of cardiac arrest. Fourteen patients resuscitated from cardiac arrest had no apparent heart disease. A spontaneous episode of angina with ST-segment elevation occurred in 4 patients while under observation. Ergonovine testing was performed in 9 patients, and coronary spasm was induced in 5. EPS were performed in 8 patients, including 3 patients with coronary spasm. No electrophysiologic abnormalities were found in the 3 patients with coronary spasm. Ventricular fibrillation was induced by programmed ventricular stimulation in 2 patients with documented ventricular fibrillation at the time of resuscitation. All but one of the patients with coronary spasm had chest pain preceding cardiac arrest or at least a history of chest pain at rest, while 4 of 5 patients without coronary spasm had no prodromal symptoms. Patients with coronary spasm had a good prognosis when treated with a Ca-antagonist and/or long-acting nitrate. In conclusion, coronary spasm is the most frequent cause of cardiac arrest in cardiac arrest survivors with no apparent heart disease. Ergonovine testing should be performed to evaluate the cause of cardiac arrest when patients have no apparent heart disease.
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PMID:High prevalence of coronary artery spasm in survivors of cardiac arrest with no apparent heart disease. 841 43

A total of 166 patients who had one or more attacks of myocardial infarction and those with angina pectoris, forty-five relative of 18 hyperlipidemic survivors of ischaemic heart disease, and 330 healthy persons (controls) were investigated for serum lipid profiles. Fifty-six of the 166 patients were hyperlipidemic. The commonest abnormalities in lipoproteins were Types IIa, IIb and IV. 75.5% of the 45 relatives investigated were hyperlipidemic. The familial studies showed that hyperlipidemias occurred in the family members of persons with ischaemic heart disease suggesting that hyperlipidemia could play an important role in predisposing familial clustering of coronary heart disease. A family history of heart disease may be a useful marker for identifying persons who are more likely to have high levels of blood lipids for possible treatment.
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PMID:An assessment of serum lipid and lipoprotein levels in patients with ischaemic heart disease. 129 16

Without treatment, about 60% of atrial arrhythmia patients suffer a relapse within 3 months and 70% within one year. Antiarrhythmic treatment intended to reduce this percentage is therefore justified, on condition that it is well tolerated. Several preliminary questions have to be settled before this medical prophylaxis: 1) Justification of antiarrhythmic treatment (sometimes pointless to deal with very occasional episodes); 2) Treatment of the underlying heart disease (valve disease, cardiothyrotoxicosis, etc.) or promoting factors (potassium depletion etc.); 3) Accurate assessment of any associated conduction abnormalities, which may constitute a contraindication to antiarrhythmic treatment (WPW syndrome in the case of verapamil and the digitalis-like drugs) or require additional treatment (pacemaker); 4) Definition of the mechanism (vagal or sympathotonic) inducing arrhythmia; 5) Evaluation of the hemodynamic parameters of the underlying heart disease (size of the atria, ventricular function, coronary or valvular lesions) which may limit the efficacy of the treatment. Once these parameters have been identified, the primary treatment should be type la or lb antiarrhythmics, which have been shown to be effective, despite the fact that they are not without arrhythmic risks (the Ib antiarrhythmics are less effective and have a poor safety profile). The beta-blockers have preferential indications (hypersympatheticotonia, hyperthyroidism, hypertrophic myocardiopathy, mitral prolapse, angina etc.) and can be replaced by verapamil or bepridil if there are non-cardiac contraindications (ulcers, asthma, diabetes). Amiodarone is extremely effective, but its poor extracardiac safety restricts its long-term use. Complementary treatments (digitalis-like, anticoagulants or anti-PAF and cardiostimulant drugs) should be added if necessary. Recurrences (to be confirmed by ECG or Holter) should lead to rigorous confirmation of therapeutic compliance and observance of simple hygienic and dietary measures (no excessive exertion, elimination of stimulants etc.). With strict clinical and ECG monitoring, it would then be possible either to increase the dose levels (accompanied by plasma determinations if possible) or to switch to a treatment with more effective, but more aggressive drugs (amiodarone, flecainide) or to use drug associations (la and lb, la and II etc.). Repeated failure of such attempts should lead to a non-medical approach to treatment.
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PMID:[Preventive drug therapy of recurrence of atrial fibrillation]. 129 92

Six patients with cardiac amyloidosis (four males, two females; age 27-60 years) were evaluated by us. Four patients presented with congestive heart failure, while one patient each presented with effort angina and giddiness. Extracardiac clues to the diagnosis in the form of involvement of other systems were present in only two patients. The electrocardiogram was abnormal in four patients while three exhibited roentgenographic evidence of cardiomegaly or pulmonary venous hypertension. Echocardiography suggested the diagnosis of amyloidosis in only two patients, restrictive cardiomyopathy in two other patients and dilated and hypertrophic cardiomyopathy in one patient each. Cardiac catheterisation and angiography suggested restrictive heart disease in four patients and hypertrophic cardiomyopathy in one. One patient, whose initial haemodynamic study was normal, had features of dilated cardiomyopathy at repeat study after 11 months. Endomyocardial biopsies showed amyloid deposits in all patients. We emphasise the varied clinical manifestation of cardiac amyloidosis and the need for a high index of suspicion. The diagnosis can be safely and reliably confirmed by endomyocardial biopsy.
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PMID:Cardiac amyloidosis: hemodynamic, echocardiographic and endomyocardial biopsy studies. 130 87

Recently the use of a new radioactive agent with physical and biological properties more favorable than those of thallium 201, methoxy-isobutyl-isonitrile (MIBI) labeled with technetium 99m (Tc 99m), has permitted simultaneous performance of perfusion and function studies in ischemic cardiopathy. Transesophageal atrial pacing (TAP) technique has evolved as an alternative provocative test of ischemia. The authors compared the capability of Tc 99m-MIBI myocardial scintigraphy, combined with TAP, with that of Tc 99m-MIBI, combined with maximal stress test, in the diagnosis of ischemic cardiopathy. They studied 11 patients with a clinical history of angina pectoris. Myocardial scintigraphy was performed at rest, after stress test, and after TAP. Finally, all the patients underwent coronary angiography. The analysis of myocardial perfusion images on both Tc 99m-MIBI associated with TAP and with stress demonstrated, in 165 myocardial segments examined: 143 normal, 20 reversible defects, 2 irreversible defects. The concordance of localization between coronarographic data and scintigraphic reversible and irreversible defects was 85%. In conclusion TAP proves to be a valid and sensitive provocative test of ischemia when combined with myocardial scintigraphy and with Tc 99m-MIBI.
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PMID:Diagnosis of coronary artery disease with Tc 99m-methoxy isobutyl isonitrile and transesophageal pacing. 147 69

The prospective follow-up of 190 patients with angina pectoris (males, aged 40-59 years) which lasted for 26 years revealed that only 37 (19.5%) persons survived. Out of 153 patients who expired, 76% were subjected to pathoanatomical or medicolegal examination. It was revealed that cardiovascular lesions were responsible for 71.9% death cases in patients with angina pectoris. The elevation of both systolic and diastolic arterial pressure corresponds with a general tendency to the rise of lethality from ischemic cerebral or heart disease though the impact and character of their influence is different.
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PMID:[Systolic and diastolic arterial blood pressure in patients with angina pectoris (a long-term study)]. 150 41

The aim of the present study was to relate the clinical course in patients after a first acute myocardial infarction with the response to exercise-tests performed one month after discharge. 90 consecutive patients who suffered an acute myocardial infarction for the first time were followed-up after 12 months in general practice. Six patients had died, and nine patients had suffered another MI. 23 patients were being treated for heart failure, 51 for angina pectoris, and 8 for arrhythmias. 14 patients received treatment for both heart failure and angina pectoris. Of the patients at work, 17.6% did not return to work because of the heart disease. 80 patients were in function groups I-II and 10 in function groups III-IV (New York Heart Association's Classification). Occurrence of ST-segment displacements was without prognostic value. Left ventricular function index (dRPP) and working capacity (W) were predictive with respect to mortality, heart failure, and angina pectoris requiring drug treatment. Exercise tests following acute myocardial infarction could not predict the chances of returning to work.
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PMID:The value of exercise tests after acute myocardial infarction. 158 64

Transient cardiovascular changes, including angina-like electrographic signs, are inducible by electrical stimulation of discrete sites in the prefornical region of the lateral hypothalamus (LH) of cats. Repeated stimulation may result in neurogenic cardiac infarction and myocardial bleeding. Thirty Swiss breed locally grown cats were studied under alpha-chloralose anesthesia in pairs, one as control and one experimental, with only the latter receiving multiple stimulations. ECG in lead II and arterial blood pressure were recorded on a Grass polygraph (USA). Electrical stimulation was delivered to a LH target at Fr 9.0, L2.5, D-1 to -2, by means of stainless steel wire electrodes. Stimulation consisted of 15-sec trains of square wave pulses at 100 Hz, 0.2-0.5 msec duration, and threshold currents of 0.05-0.1 mAmp. Stimulation at these LH sites induced small blood pressure changes, often with a small increase or no change in heart rate, presumably a manifestation of baroreceptor dysfunction. Repeating this stimulation greater than 6 times was shown to be pathogenic: on gross examination a darkened area was seen, mostly on the upper ventricular surface of the heart. Microscopic examination of such sites revealed subendocardial bleeding and sometimes also microinfarcts. Scanning electron microscopy revealed an unusually large number of contractures of the myofilaments. Biochemical analysis showed diffusion of catecholamines from nerves. Total myocardial blood flow increased following such stimulation, proportional to the stimulus intensity. It is pointed out that this is not contradictory to the sharply localized ischemic changes assumed to be responsible for the cardiopathy.
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PMID:Hypothalamic etiology in sympathetically induced pathogenic cardiovascular changes in the cat. 160 70

To study formation of the internal picture of coronary heart disease (CHD), 116 patients with schizophrenia and manic depressive psychosis who suffered angina pectoris attacks and myocardial infarction were followed up. The control group was made up of 106 CHD patients treated at the cardiological hospitals. Of these, 88.6% manifested borderline neuropsychic disorders due to the underlying heart disease. It has been established, that in patients suffering from psychoses, the hyponosognosic and anosognosic types of CHD survival (79.3% of cases) prevailed as compared to the control group (4.8% of cases). Unlike the control group patients, in patients with endogenous psychoses, the psychological and social factors lose their crucial importance in formation of the internal picture of CHD. Correct assessment of interrelations between the mental and somatic disease may contribute to improvement of the diagnosis and treatment of CHD as well as to the carrying out of rehabilitation measures.
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PMID:[Characteristics of forming internal picture of ischemic heart disease by patients with endogenous psychoses]. 165 4


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