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

Mitral valve prolapse is a common cardiac disorder that can readily be diagnosed by characteristic auscultatory and echocardiographic criteria. Although many diseases have been associated with mitral valve prolapse, most affected individuals have the primary form of the disorder. Mitral valve prolapse is an inherited condition commonly associated with myxomatous degeneration of the mitral valve and its support structures. Complications of mitral valve prolapse, including cardiac arrhythmias, sudden death, infective endocarditis, severe mitral regurgitation (with or without chordae tendineae rupture), and cerebral ischemic events, occur infrequently considering the wide prevalence of the disorder. Panic disorder is a specific type of anxiety disorder characterized by at least three panic attacks within a 3-week period or one panic attack followed by fear of subsequent panic attacks for at least 1 month. It too is a common condition with a prevalence and age and gender distribution similar to that of mitral valve prolapse. Panic disorder and mitral valve prolapse share many nonspecific symptoms, including chest pain or discomfort, palpitations, dyspnea, effort intolerance, and pre-syncope. Chest pain is the symptom in both conditions that most commonly brings the patient to medical attention. The clinical description of chest pain in patients with mitral valve prolapse is highly variable, possibly reflecting multiple etiologies. Chest pain in panic disorder is usually characterized as atypical angina pectoris and as such bears resemblance to the chest pain commonly described by patients with mitral valve prolapse. Multiple investigative attempts to elucidate the mechanism of chest pain in both conditions have failed to identify a unifying cause. Review of the literature leaves little doubt that mitral valve prolapse and panic disorder frequently co-occur. Given the similarities in their symptomatology, a high rate of co-occurrence is, in fact, entirely predictable. There is, however, no convincing evidence of a cause-effect relationship between the two disorders, nor has a single pathophysiologic or biochemical mechanism been identified that unites these two common conditions. Until specific biologic markers for these disorders are identified, it may be impossible to do so. The lack of a proven cause-and-effect relationship between mitral valve prolapse and panic disorder and the absence of a unifying mechanism do not diminish the clinical significance of the high rate of co-occurrence between the two conditions. Primary care physicians and cardiologists frequently encounter patients with mitral valve prolapse and nonspecific symptoms with no discernible objective cause who fail to respond to beta-blockade. Panic disorder should be considered as a possible explanation for symptoms in such patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Mitral valve prolapse, panic disorder, and chest pain. 189 9

A 52 year old patient presenting with spontaneous anginal chest pain for 4 days was admitted to hospital for a more intense and prolonged chest pain associated with signs of left ventricular failure (gallop, pulmonary crepitations, hypoxemia). Coronary angiography showed marked septal hypokinesia and spontaneous localised spasm of the left anterior descending and marginal arteries with a variable degree of luminal narrowing of the other segments of these two arteries and of the right coronary artery. These changes regressed after intracoronary injection of molsidomine. The signs of left ventricular failure disappeared in 48 hours. The wall motion abnormality, monitored by 2D echocardiography, regressed slowly over 3 days. On the other hand, the electrocardiogram, which showed anterior wall subendocardial ischaemia with prolongation of the QTc interval during the spasm, remained abnormal for a long time. Therefore, in the absence of organic heart disease, coronary spasms associated with vasoconstriction can induce a sufficiently severe and durable alteration of left ventricular function to create clinical signs of cardiac failure and profound and prolonged ST-T wave changes on the electrocardiogram.
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PMID:[Coronary spasm and diffuse coronary vasoconstriction responsible for transient left ventricular insufficiency]. 192 21

Nineteen patients from a cardiology practice with complaints of chest pain and with mitral valve prolapse syndrome were compared with 26 patients with chest pain but no discernible cardiac disorder. Instruments included a truncated form of the Diagnostic Interview Schedule, the symptom checklist 90 revised (SCL-90-R), the McGill Pain Questionnaire, and life events, physical activity, and family history questionnaires. Neither panic disorder nor self-rated anxiety were more common in the mitral valve prolapse group. This study failed to confirm the reported high association between mitral valve prolapse syndrome and panic disorder.
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PMID:The prevalence of anxiety disorders among patients with mitral valve prolapse syndrome and chest pain. 196 52

The prevalence of esophageal chest pain was studied prospectively in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. A group of 248 consecutive patients without previously documented heart disease was admitted for elective diagnostic coronary angiography. The clinical history classified 185 patients as having anginal pain and the coronary angiogram was normal in 48 of them. In 37 of these 48 patients full esophageal testing was performed including 24-hr intraesophageal pH and pressure recordings with indication of chest pain episodes as well as a number of esophageal provocation tests, ie, acid perfusion, edrophonium stimulation, balloon distension, and ergonovine stimulation, all performed under continuous esophageal manometric and electrocardiographic monitoring. In 19 of these 37 patients, the familiar chest pain could be reproduced by esophageal provocative testing without ischemic ST-T segment alterations; six of these 19 patients had also a positive 24-hr pH and pressure recording. These data strongly suggest an esophageal origin of chest pain in half the patients with typical angina and a normal coronary angiogram.
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PMID:Prospective study on prevalence of esophageal chest pain in patients referred on an elective basis to a cardiac unit for suspected myocardial ischemia. 198 69

Pre-test probability for coronary artery disease can readily be determined using the patient's history, risk profile and resting ECG. The present study shows that this can be reliably done for both sexes. With pre-test probability of greater than 70% relevant coronary stenoses were found in both sexes in approximately 90%. With pre-test probability values of less than 60% this was only true in 20%. There seems to exist, however, a subgroup of female patients with rather atypical complaints but causing severe discomfort, showing normal coronary arteries it angiography. In these, subsequent myocardial metabolic studies and/or myocardial biopsy may reveal certain anomalies. Normal coronary arteries in women with chest pain therefore do not exclude any cardiac disorder. However the diagnoses to be expected from these sophisticated methods bear no consequences in terms of therapy. From a pragmatic point of view, therefore, it is suggested (for both sexes) to use pre-test probability in the selection for coronary angiography in order to detect organic coronary stenoses that can be managed by adequate treatment.
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PMID:[Significance of the anamnesis in women suspected to have coronary heart disease]. 203 36

Adolescents with chest pain were compared with healthy adolescents to determine if they were more likely to believe they had cardiac disease and were less healthy than their peers. Perceptions were examined with a questionnaire and results analyzed by chi 2 analysis. Twenty-two percent of adolescents with chest pain were diagnosed with cardiac problems, a prevalence rate higher than previous reports. While knowledge of possible etiologies of chest pain was similar for both patient and control groups, 68% of those with the symptom associated their own pain with heart disease and 44% altered their behavior because of it. Health professionals should avoid inadvertent reinforcement of the patient's fear of heart disease, particularly because subsequent unnecessary self-restrictions can result in an age group in which the symptom most often represents a noncardiac etiology.
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PMID:Chest pain in adolescents. 205 67

This is a retrospective study of cardiac patients with noncardiac chest pain referred for evaluation of esophageal motility. Sixty-eight patients with heart disease were compared with 210 patients without heart disease according to findings from symptom questionnaires and a psychologic test (Brief Symptom Inventory). More than 70% of each group qualified for an anxiety or depressive diagnosis on the symptom questionnaire. These diagnoses were supported by significant elevations of scores on the anxiety and depression scales of the Brief Symptom Inventory. Male gender and a diagnosis of panic disorder occurred significantly more often in the patients with heart disease. "Stress" was cited as the cause of illness in about half the sample, but this led to less than satisfactory rates of psychiatric evaluation or pharmacotherapy. This is of particular concern for the cardiac patients because of the known adverse effect of anxiety and depression in those with heart disease.
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PMID:Noncardiac chest pain in patients with heart disease. 206 24

The ten-year coronary heart disease (CHD) mortality is reported for 18,322 male civil servants aged 40 to 64 according to questionnaire responses at entry into the Whitehall study. In all 1714 died, 723 from CHD. The predictive power of the questionnaire was examined with a view to its use as a screening tool in population studies. In predicting death from coronary heart disease the greatest specificity (true negative rate) was achieved with men reporting both angina (A) and a history of severe chest pain (possible myocardial infarction, PMI). This strategy (A plus PMI) achieved a specificity of 99% but a sensitivity (true positive rate) of only 7%. In contrast, in men reporting angina and/or PMI, specificity was 90% and sensitivity 29%. If this 'and/or' algorithm was extended to include the report of dyspnoea, diabetes, and/or attending a primary care physician with heart disease or hypertension, then specificity was still 85%, but sensitivity increased to 44%. This combination (11 questions in all) is therefore recommended for screening purposes. Identifying and excluding those who favour positive answers ('yes-set' responders), using questions such as the effect of weather on breathing, led to small increases in specificity but relatively large falls in sensitivity. Among subjects reporting chest pain, those who also complained of non-specific symptoms experienced only half the mortality of those with none of these additional complaints.
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PMID:Predicting death from coronary heart disease using a questionnaire. 208 19

A young man without heart disease with a metastatic carcinoma of the pancreas received a 5-Fluorouracil therapy (25 mg per kilogram body weight/24 h by continuous infusion over a period of 5 days). Approximately 56 h after beginning of the first cycle of therapy (after 36 h of the second cycle) he complained of severe chest pain, which did not respond to nitrates, improved after application of opioids, and subsided definitely after termination of the 5-FU infusion. During the periods of pain, the ECG and the creatine kinase were normal. At a later time, finally, a scar in the posterior wall of the myocardium was detectable in the ECG. When repeating the 5-FU infusion, similar problems arose with less intensity. The patient died as a consequence of the progress of the tumor disease. At autopsy, two myocardial infarctions were detectable. There was no demonstrable stenosis of the coronary arteries. Spasms of the coronary arteries are discussed as a cause of this side effect of 5-FU-therapy.
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PMID:[Myocardial infarcts within the scope of 5-fluorouracil therapy]. 209 85

Treadmill testing (TMT) was performed on 76 frail but ambulatory subjects, between 64 and 84 years of age, who had common health problems contributing to physical limitations but had no clinically apparent heart disease. The subjects achieved a mean symptom-limited maximal heart rate of 140.1 +/- 2.07 (SEM) beats per minute which was 80.2 +/- 2.1% of the predicted maximum for age. By standard criteria, ischemic responses were noted in only 5 subjects (6.6%). Three responses were categorized as inconclusive (multifocal ventricular ectopy, chest pain without electrocardiographic change, and prompt ST depression upon standing). TMT was well tolerated, with no significant difficulties encountered. Even for those frail elderly with diseases and physical impairments, symptom-limited TMT may be used with low risk to quantify functional capacity and for exercise prescription. Attempts to screen more intensively for cardiac disease may be irrelevant to their immediate need for maintaining function.
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PMID:Treadmill exercise electrocardiography in the elderly with physical impairments. 214 24


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