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

We report a series of 33 consecutive hospitalized geriatric diabetic patients who were referred for evaluation of diabetic nephropathy, defined as proteinuria greater than or equal to 1 g/d (1,000 mg/24 h) or a serum creatinine concentration greater than or equal to 177 mumol/d (greater than or equal to 2 mg/dL). The study population was 60 years old or older (mean age, 68 +/- 6 years), was comprised mainly of women (24 of 33, 72.7%), and was predominantly black (25 of 33, 75.8%). All patients had type II diabetes. A family history of diabetes in parent or sibling was elicited in 24 (72.7%) patients. There were eight patients undergoing maintenance hemodialysis and 25 with less severe nephropathy (mean proteinuria, 2.7 g/d [2,700 mg/24 h]; mean creatinine clearance, 0.57 mL-s [34 mL/min]). Cardiac disorders were noted in the majority of patients: congestive failure in 20 (60.6%), myocardial infarction in eight (24.2%), and active angina in five (15.2%). Other comorbid diseases were present in both hemodialysis patients and the subset of nondialyzed azotemic-proteinuric patients, and consisted of peripheral neuropathy in 31 (93.9%), gastroparesis in 16 (48.5%), retinopathy in 28 (84.8%), and legal blindness in 11 (33%). We conclude that geriatric diabetic nephropathy in type II diabetes is similar in presentation and severity of comorbid extrarenal complications to the syndrome described in younger adults. This inference must be tempered by both the small size and the limitation imposed by the demographics of the study population, which is predominantly composed of black patients receiving treatment at inner city hospitals.
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PMID:Geriatric diabetic nephropathy: an analysis of renal referral in patients age 60 or older. 222 Jul 76

In systemic sclerosis (SS), cardiovascular commitment was recorded in an autopsy series, in widely different percentages, from 12 to 81%. On the other hand, clinical diagnosis of cardiopathy is made in far fewer cases. In addition, the coexistence of renal and/or pulmonary commitment makes difficult separation between primary and secondary heart damage. In 22 patients (2 m, 20 f) aged between 34 and 75 (average 55 +/- 11) with SS, a study has been made of the a) prevalence of cardiovascular commitment; b) the significance of the classic risk factors; c) the erythrocyte filtration time or TF (index of microangiopathic damage). Metabolic stability, fibrinogen, haematocrit and TF (Reid et al. method) were assessed in each patient. Nine patients (40.9%) presented ischaemic cardiopathy (myocardial infarction in three and effort angina in six), one (4.5%) presented hypertensive cardiopathy. Conduction disturbances were observed in five patients (22.7%). Whereas a statistically significant increase in TF was observed in cardiopaths, no differences in plasma levels of glucose, cholesterol or fibrinogen were observed. The incidence of smoking and the familial factor were also insignificant.
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PMID:[Cardiovascular involvement and relative risk factors in systemic sclerosis. Personal contribution]. 223 76

Anginal chest pain in patients with angiographically normal coronary arteries may be caused by a limited coronary flow response to stress because of abnormal function of the coronary microcirculation (microvascular angina). Studies of forearm arterial function suggested that patients with microvascular angina may have a diffuse disorder of smooth muscle tone. Because dyspnea is common in these patients and seems disproportionate to the severity of myocardial ischemia, we studied air flow (forced expiratory volume in 1 second, or FEV1) in the basal state and after methacholine inhalation to determine whether bronchial smooth muscle is affected in this syndrome. Five of 36 patients with microvascular angina had a basal FEV1 of less than 70% of that predicted and did not receive methacholine. Of the remaining 31 patients, 14 (45%) had a more-than-20% reduction in FEV1 after methacholine inhalation (as much as 25 mg/ml), a response significantly greater than that of nine patients with heart disease (0%, p less than 0.025) and 24 normal volunteers of similar age and gender distribution (13%, p less than 0.025). Furthermore, the product of the methacholine dose inhaled and the magnitude of decline in FEV1 from baseline (methacholine response score) was significantly lower in patients with microvascular angina than in normal volunteers (16 +/- 8.6 versus 22.2 +/- 3.7, p = 0.026). We conclude that airway hyperresponsiveness is frequently demonstrable in patients with microvascular angina; these findings are consistent with our hypothesis that this syndrome may represent a more generalized abnormality of vascular and nonvascular smooth muscle function.
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PMID:Airway hyperresponsiveness in patients with microvascular angina. Evidence for a diffuse disorder of smooth muscle responsiveness. 224 25

The Caerphilly Collaborative Heart Disease Study is based on a large cohort of men who were ages 49 to 64 years at the time of the study. We report the results for platelet aggregation measured in whole blood from a subsample of 308 men. The index of sensitivity used was the minimum concentration of adenosine diphosphate that produced a defined degree of impedance change in the Chronolog 560 aggregometer. There was a marked association between aggregation and prevalent ischemic heart disease (IHD). The odds ratios and 95% confidence intervals (CI) for prevalent IHD in men with the most sensitive platelets compared with those with the least sensitive platelets were 3.6 (95% Cl: 1.1 to 12.2) for angina; 7.3 (95% Cl: 2.0 to 24.3) for previous myocardial infarction (MI); and 2.7 (95% Cl: 1.0 to 7.6) for electrocardiogram evidence of ischemia. The confidence limits for these odds ratios are large because of the small sample size, but the estimates of odds ratio are relatively large compared to similar relationships between the traditional risk factors of serum cholesterol, blood pressure, smoking, and prevalent IHD (1.5 to 2.5). A number of factors that might confound the relationships between platelets and IHD were examined, but the associations remained statistically significant when these were taken into account.
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PMID:Whole blood impedance platelet aggregometry and ischemic heart disease. The Caerphilly Collaborative Heart Disease Study. 224 53

The survival of elderly women with angina has improved greatly in recent years, but little is known about the functional capacity of these women over the longer duration of their disease. This article analyzes the incidence and determinants of functional disability in a cohort of 1,001 females and males hospitalized with angina or other acute coronary diseases in 1976-77 and followed through 1985. Proportional hazards and logistic models are utilized to examine sex interactions in long-term disability outcomes. Female survivors with angina are shown to be at significantly higher risk for diminished functional capacity when compared to men as well as to women with other heart disease. Thus, the extended survival and higher incidence of angina among elderly women will likely result in an increased societal burden of disablement in the aged population.
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PMID:Functional disability of elderly patients with long-term coronary heart disease: a sex-stratified analysis. 231 54

Among 112 patients with sustained ventricular tachycardia, 15 were found to have exercise-induced symptomatic ventricular tachycardia. This population was divided into two subgroups: group 1A included five patients with coronary artery disease and group 1B consisted of 10 patients with no structural heart disease. All patients underwent clinical examination, exercise electrocardiography, left ventriculography, coronary angiography (n = 14) and electrophysiologic study. In group 1B, right ventriculography (n = 7), M mode and two-dimensional echocardiography were also obtained. Group 1A patients were compared with a population of 27 patients with coronary artery disease and chronic sustained ventricular tachycardia not related to exercise (group 2). There were no statistically significant differences between group 1A and group 2 in terms of age, sex, incidence of prior myocardial infarction, NYHA functional class, angina pectoris, symptoms during arrhythmia, severity and extent of coronary arterial lesions, ventricular dysfunction and wall motion abnormalities. In group 1B, coronary angiography and right and left ventricular function were normal. During electrophysiologic study, ventricular tachycardia was initiated in four group 1A patients. In group 1B, ventricular tachycardia was initiated in eight patients. In four of these patients ventricular pacing had to be combined with isoproterenol administration. In group 2, ventricular tachycardia was induced in 26/27 patients. From this study we conclude that in patients with coronary artery disease the electrophysiologic substrate of exercise-related sustained ventricular tachycardia does not differ from the substrate of non-exercise-related ventricular tachycardia. Re-entry is the most likely electrophysiologic mechanism. In patients without structural heart disease, the mechanism of the arrhythmia remains speculative.
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PMID:Exercise-induced sustained symptomatic ventricular tachycardia: incidence, clinical, angiographic and electrophysiologic characteristics. 231 26

Prognostic significance of repetitive ventricular premature contractions (RVPC) were evaluated retrospectively in 452 patients studied with a 24 hours continuous electrocardiographic monitoring (Holter System). The patients were analysed in two groups: Group 1.- 199 patients; with primary heart disease: previous myocardial infarction (MI) in 114 patients, angina pectoris (AP) in 29 cases, congestive cardiomyopathy in 19 cases (COCM); hypertensive heart disease (AHCD) in 14 cases, Atherosclerotic heart disease (AEC) with conduction disturbance and without angina pectoris 23 cases. Group 2.- 253 patients without heart disease. Two different types of RVPCs were defined: Type A: as the occurrence of self-terminating two (coupled) or multifocal. RVACs Type B: Self limited ventricular tachycardias or "R on T phenomena". Forty patients of group 1 had RVPCs (23 type A and 17 type B) and 22% of them had sudden death (SD). Among 199 patients with structural heart disease, 74 had congestive heart failure (CHF) and 12 of these had RVPCs. 83% of patients with RVPCs died suddenly. No patients with CHF and without RVPCs had SD. In group 2 (without heart disease no patients died on the follow up, and 6% of them had RVPCs (68% type A and 32% type B). Coronary arteriographic and ventriculographic findings were reviewed in 92 patients with previous MI. In the patients followed 40 has RVPCs, and 9 of them had SD. Those 4 cases were cases of MI (25% of the patients with MI having RVPCs), 4 (25%) with COCM, and 1 (2.5%) with hypertensive cardiac disease. Thus, patients with MI or COCM had higher incidence of RVPCs, so they are at a high risk for sudden cardiac death.
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PMID:[Predictive value of sudden death in repetitive ventricular extrasystole]. 242 18

A retrospective analysis of 202 consultations for preoperative cardiology evaluation was conducted. The most common problems generating the consultation were: (1) abnormal electrocardiogram, 45 patients; (2) chest pain, 36 patients; (3) history of myocardial infarction, 27 patients; (4) dysrhythmia, 25 patients; and (5) hypertension, 23 patients. The most common diagnoses by the consultants were: (1) arteriosclerotic heart disease, 46 patients; (2) angina, 20 patients; and (3) hypertension, 40 patients. Mitral valve prolapse was the most common valvular disease (18 patients). Of the consultation requests, 108 asked for an evaluation; 79 asked for a "clearance"; 9 did not specifically ask for anything; and 6 asked a highly specific question. Most consultations provided a diagnosis (96%), addressed the problem (80%), and provided logical recommendations (96%). A minority of the consultations "cleared" a patient (28%), provided for follow-up care (41%), or suggested intraoperative monitoring techniques (41%). Out of the 189 patients who eventually had surgery, 137 patients had no change in their preoperative therapy, while 52 patients had a change in preoperative therapy. There was no difference in the incidence of complications between these two groups. An important finding was that 15% of the study group (31 patients) had disease processes (hypertension and angina) that were newly diagnosed by the consultant or felt to be not adequately treated before the consultation. It is concluded that few requesting anesthesiologists and surgeons ask for clarification of a specific problem, while most responses from the cardiology consultants provided necessary information. In addition, the preoperative cardiac consultation was found to identify medical conditions requiring long-term care and follow-up.
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PMID:The value to the anesthesia-surgical care team of the preoperative cardiac consultation. 252 Oct 24

The paper reports and assesses the most topical data having led to delimiting the asymptomatic myocardial ischemia as the most precocious form of manifestation of ischemic cardiopathy. The role of asymptomatic myocardial ischemia involvement in angina pectoris, myocardial infarction and serious arrhythmias leading to sudden cardiac death are also underlined from the viewpoint of prognosis severity. Likewise, the authors discuss; the prevalence of asymptomatic myocardial ischemia as a distinct manifestation form of myocardial ischemia; the way of selecting the cases; the anti-ischemic treatment that gave good results in diminishing morbidity and mortality induced by ischemic cardiopathy.
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PMID:[The detection and treatment of asymptomatic myocardial ischemia to reduce morbidity and mortality from ischemic cardiopathy]. 257 11

The authors analyze in a retrospective investigation the clinical picture of 15 adult patients (12 men and 3 women) with an abnormal origin of the coronary arteries, diagnosed from a total of 5500 coronarographic examinations made in the Institute for Clinical and Experimental Medicine. In four patients the anomaly was isolated and in 11 patients it was associated: in six with coronary disease, in three with rheumatic heart disease and in two with an atrial septal detect. The authors evaluate the long-term clinical course by check-up ambulatory examinations after time intervals of 64.6 +/- 45.7 months following the coronarographic examination. The long-term course was favourable in the four patients with the isolated anomalous origin of the coronary arteries. In patients with an associated anomalous origin of the coronary arteries and other heart disease the long-term course was not favourable. Two patients died, two suffered a myocardial infarction, one suffered from angina and one from cardiac dysrhythmia. The authors assume that the complications developed mainly due to the associated heart disease, congenital or acquired. The objective physical finding, ECG and X-ray finding of the heart and lungs did not change significantly in the meantime. It appears thus that an isolated anomalous origin of the coronary arteries may be a relatively benign disease. The prognosis of the patients depends above all on associated heart disease or other diseases.
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PMID:[Long-term clinical course in the anomalous origin of coronary arteries]. 259 50


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