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

We questioned 113 patients with subsequently diagnosed sustained ventricular tachycardia (VT) regarding the symptoms that prompted their seeking hospital treatment, eliciting the following: 15% of patients had lost consciousness, 15% had near syncope, 35% had mild lightheadedness and 35% had no cerebral symptoms. Patients with preexisting congestive heart failure or a VT rate of 200 beats per minute or greater more often lost consciousness. Other symptoms included palpitations in 57% of patients, chest pain in 27%, dyspnea in 25%, weakness in 6%, nausea or diaphoresis in 3% each and flushing in 2%. In approximately 50% of patients who had mild lightheadedness or no cerebral symptoms, their condition was incorrectly diagnosed as supraventricular tachycardia based on the absence of severe symptoms during the tachycardia. In some patients, VT may be associated with mild or atypical symptoms. The differentiation of supraventricular from ventricular tachycardia should be based on electrocardiographic criteria and should not be influenced by the nature or severity of a patient's symptoms. The severity of cerebral symptoms is at least partially related to the VT rate and a patient's underlying heart disease.
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PMID:Clinical symptoms in patients with sustained ventricular tachycardia. 399 9

A long-term epidemiological study of heart disease in a representative rural community in Jamaica was started in 1962-63 and the first follow-up survey was carried out in 1967-68. This report describes the prevalence of several cardiovascular characteristics at each survey, and their associations with other measurements. The nature of the electrocardiographic abnormalities and their relationship with symptoms of effort pain and prolonged chest pain suggests that much of the disease seen in this population is ultimately ischaemic in origin despite evidence that classical myocardial infarction and severe coronary atheroma are relatively infrequent. Nevertheless both the symptoms and the electrocardiographic abnormalities had features that were not completely typical of occlusive disease of extramural coronary arteries. These findings are discussed in terms of the four conditions-hypertension, conventional coronary heart disease, small artery disease, and cardiomyopathy-that are believed to account for most cases of heart disease in this community, and it is concluded that the overall pattern of disease cannot be explained by any single disorder of overriding importance. The evidence suggests that all may be important contributors.
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PMID:Longitudinal study of heart disease in a Jamaican rural population. I. Prevalence, with special reference to ECG findings. 453 87

Results are presented for the UK centre of the WHO European Collaborative Trial in the Multifactorial Prevention of Coronary Heart Disease (CHD). 18 210 men took part, aged 40 to 59; they were employed in 24 factories, which formed the allocation units for a randomised controlled trial lasting 5-6 years. Intervention comprised advice on cholesterol-lowering diet, smoking cessation, weight control, exercise, and treatment of hypertension. Advice was given mainly through factory medical departments, the staff being supplemented a little by a visiting central team. Self-reported cigarette smoking was moderately reduced, but changes in other risk factors were small and not well sustained. There was no clear effect on hard CHD end-points (coronary deaths and myocardial infarction) or on all-causes mortality. However, there was a 36% reduction in the rate at which intervention subjects reported ill with other CHD (principally angina) during the study, and at the end fewer intervention men gave positive responses to a self-administered questionnaire on angina and chest pain. These apparent benefits were not substantiated by electrocardiographic evidence, suggesting that participation in a heart disease prevention campaign may bias reporting of symptoms. Experience in other centres of the Collaborative Trial, however, suggests that more effective risk factor control does reduce CHD incidence and mortality. This implies that for the UK the problem is to find means of enhancing the acceptance of health advice.
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PMID:UK heart disease prevention project: incidence and mortality results. 613 3

We performed M-mode echocardiography on 100 subjects with idiopathic mitral valve prolapse (IMVP) and on 100 normal control subjects to determine if differences exist between the two groups in cardiac chamber size, left ventricular performance or left ventricular mass. Subjects with IMVP demonstrated significantly greater left ventricular mass than normal control subjects. There were no significant differences in fractional shortening of the left ventricle or left ventricular end-diastolic volume. There was no significant difference in left ventricular mass between asymptomatic subjects with IMVP and those with chest pain, palpitations, syncope or presyncope. Subjects with and without mitral regurgitation showed no significant difference in mass. The results indicate that subjects with IMVP demonstrate subtle left ventricular hypertrophy which does not appear to be caused by underlying organic heart disease, mitral regurgitation or sustained hypercontractility. This suggests that myocardial involvement is an integral part of the IMVP syndrome.
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PMID:Increased left ventricular mass in idiopathic mitral valve prolapse. 621 84

Sixty patients without organic heart disease presenting with chest pain suggestive of angina pectoris and angiographically normal coronary arteries underwent clinical, hemodynamic and metabolic investigation. The study of myocardial lactate metabolism during atrial pacing (168 +/- 14 bpm) allowed identification of two groups: --40 patients with a normal coefficient of lactate extraction (K greater than or equal to 9 per cent); --20 patients with a pathologically low coefficient of lactate extraction (K less than 9 per cent) reflecting myocardial ischemia. In the first group, chest pain was often atypical (75 per cent of cases). Hemodynamic investigation showed minor abnormalities of the left ventricle in 48 per cent of cases. The diagnosis of angina was rejected in these patients. In the second group, the majority of patients developed chest pain (85 per cent of cases) at the maximal heart rate with significant ST depression (80 per cent of cases). The chest pain was typical of angina pectoris in 50 per cent of cases. Hemodynamic and angiographic investigation of the left ventricle was completely normal in nearly all cases. Only these patients with clinical, electrocardiographic and metabolic signs of myocardial ischemia can be considered as having angina with normal coronary arteries. Although studies of myocardial lactate metabolism and other signs of myocardial ischemia distinguish clearly between these two groups of patients, the coronary hemodynamics were similar. Resting coronary flow, its increase for the same myocardial oxygen demands and coronary resistances were comparable in both groups, and not significantly different from the values obtained in a control group of patients without coronary artery disease or chest pain. These results confirm that about 30 per cent of patients investigated for chest pain suggestive of angina pectoris who have angiographically normal coronary arteries, develop signs of myocardial ischemia during atrial pacing. The physiopathological explanation remains unclear as coronary hemodynamics have been found to be normal.
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PMID:[Angina pectoris with normal coronary arteries: clinical, hemodynamic and metabolic study]. 640 43

A 62-year-old man who was under observation following an episode of severe chest pain developed complete heart block and hypotension after receiving sublingual nitroglycerin. The reaction occurred while the patient was receiving an intravenous maintenance infusion of lidocaine but did not occur in response to either nitroglycerin alone or lidocaine alone. There was no evidence of acute cardiac ischemia nor of clinically significant underlying heart disease. Complete heart block after sublingual nitroglycerin in the absence of significant cardiac disease is an exceedingly rare phenomenon.
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PMID:Complete heart block after sublingual nitroglycerin. 640 6

In 100 successive patients with normal coronary arteriography performed for spontaneous precordial chest pain, a Methergine test was performed to induce coronary artery spasm, in addition to esophageal manometry, and an angiographic and echocardiographic study of the left ventricle. These tests were all normal in 39 patients, whereas the remaining 61 patients had pain due to coronary artery spasm (14 times), a non-coronary artery cardiopathy (16 times) (hypertrophic cardiomyopathy or mitral valve prolapse), or esophageal dyskinesia (35 times). The latter was an isolated finding 29 times, was associated 3 times with coronary artery spasm, and 3 times with non-coronary artery cardiopathy.
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PMID:[Normal coronary arteries and spontaneous precordial pain]. 652 28

Sixty-two patients diagnosed as having mitral valve prolapse, 60 to 81 years old, presented with disabling chest pain (20), symptoms of arrhythmias including palpitations and syncope (16), or mitral regurgitation (MR) with symptoms of congestive heart failure (26). The diagnosis of MVP was made on the basis of a combination of classic auscultatory, echocardiographic and angiographic findings. Thirteen of the 20 patients with chest pain had normal coronary angiograms and 7 had significant coronary artery disease (CAD). Patients with CAD could not be differentiated by clinical presentation alone. Furthermore, the incidence and types of arrhythmias, the presence of a positive stress test, and hemodynamic findings were similar in all patients in this group whether or not CAD was present. The 16 patients with palpitations had a broad spectrum of rhythm disorders, including both supraventricular and ventricular arrhythmias. Two patients had prehospital "sudden death" and 2 others had systemic emboli. Twenty-one of the 26 patients with MR had valve surgery. Intraoperatively the valves were described as enlarged, floppy and with redundant leaflets. Histologic examination showed extensive "myxomatous" changes throughout the valve leaflets. Thus, mitral valve prolapse is a cause of symptomatic heart disease in the elderly. It has a predictable pattern of clinical presentation and should be considered in the differential diagnosis of older patients with disabling chest pain and arrhythmias and as the cause of progressive or severe MR.
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PMID:Mitral valve prolapse syndrome: analysis of 62 patients aged 60 years and older. 661 75

Between 1974 and 1982, 16 patients (four men, twelve women, mean age 50.5 years) underwent surgery for left atrial myxoma at the Hannover Medical School. Clinical features encompassed cardiac murmurs (100%) and findings compatible with mitral stenosis (87%), chest pain (37%), arrhythmias (37%), syncope (18%) and malaise (37%). Arterial tumor embolism (to the right leg) occurred in one case. The sedimentation rate was consistently elevated. Sinus rhythm was present in 14 and atrial flutter in two patients. In all but one case, the diagnosis was documented through cardiac catheterization. In recent years, however, noninvasive methods such as echocardiography and computer tomography have proved to be accurate and reliable diagnostic methods such that cardiac catheterization would now appear indicated primarily for patients with additional heart disease and for those over the age of 40 years to rule out the presence of asymptomatic coronary artery disease. Surgery was performed with cardiopulmonary bypass and all patients survived the procedure. In 13 cases the tumor was removed through a right atrial approach with septal incision, in two through the left atrium and in one case both approaches were used. Complete removal of the tumor was achieved in all patients. The tumors were found to arise from the atrial septum in 15 and from the inferior wall of the left atrium in one patient. The size of the tumors ranged from 30 mm in diameter up to 100 mm X 60 mm X 40 mm with weights between 4.8 and 125 grams. Although no residual tumors have been seen during an average observation period of 29.2 months (range nine to 56 months), long-term follow-up, readily accomplished with noninvasive methods, is warranted for such patients.
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PMID:Surgical experience with left atrial myxomas. 661 18

To determine the cardiac rhythm disturbances underlying sudden death, 15 patients (14 inpatients and 1 outpatient) who had cardiac arrest unexpectedly while undergoing ambulatory electrocardiographic monitoring were identified. Heart disease was present in 11 patients and 7 patients were admitted to the hospital with chest pain before sudden cardiac death occurred. The terminal event at the time of cardiac arrest in 3 (20%) of the 15 patients was a bradyarrhythmia expressed as complete heart block; none survived. A ventricular tachyarrhythmia was the precursor of sudden cardiac death in the remaining 12 patients (80%). Two of these 12 had slow ventricular tachycardia and both died. Five had polymorphous ventricular tachycardia associated with prolonged QT interval (torsade de pointes) and three were receiving a class I antiarrhythmic agent. This rhythm degenerated into ventricular fibrillation in one patient; four of the five patients survived after electrical cardioversion. One patient had ventricular tachycardia followed by asystole. Four patients had ventricular flutter (rate greater than 250/min) that degenerated into ventricular fibrillation in each case; only one of these four patients survived after cardioversion. Frequent (greater than 30/h) premature ventricular complexes were present in 9 of 10 patients with ventricular tachycardia or flutter and R on T phenomenon was seen in only 1 patient. In conclusion, a ventricular tachyarrhythmia is usually found on Holter monitoring during sudden cardiac death in hospitalized patients; torsade de pointes (polymorphous ventricular tachycardia) is a frequent cause of sudden death in these patients. Ventricular fibrillation is always preceded by ventricular tachycardia or ventricular flutter.
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PMID:Sudden death in hospitalized patients: cardiac rhythm disturbances detected by ambulatory electrocardiographic monitoring. 663 Jul 60


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