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

The management of cholelithiasis with gallstone pancreatitis in the heart transplant candidate is a difficult problem. Biliary tract surgery in the heart transplant candidate presents an additional set of clinical risks in view of extensive heart disease. We report the cases of three patients with symptomatic cholelithiasis with gallstone pancreatitis who were successfully operated on while awaiting cardiac allografts. Each patient was preoperatively prepared with (1) a lumbar epidural catheter for postoperative pain control with epidural opioids, (2) a balloon-tipped (Swan-Ganz) catheter and arterial line for perioperative monitoring, and (3) an intraaortic balloon pump for circulatory support with full heparinization after epidural catheter placement. In addition, preoperative optimization of cardiovascular function with pharmacologic agents was carefully achieved for 6 to 12 hours before surgery. All three patients had stable intraoperative courses, with less than a 300 ml blood loss. Their postoperative outcomes were without surgical complication. We think that biliary tract surgery may be safely accomplished in the heart transplant candidate with careful, appropriate preparation and meticulous surgical technique. We also present our management algorithm for heart transplant patients with cholelithiasis before and after operation.
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PMID:Cholecystectomy in the potential heart transplant patient. 203 24

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

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

The symptoms of organic disease vary widely among patients with the same tissue abnormality, because the experience of a symptom is shaped by the patient's perceptual and cognitive style. Thus, the relationship between myocardial ischemia and chest pain is variable in that many patients experience pain without ischemia and many others exhibit ischemia without pain-termed "silent" or "asymptomatic ischemia." Although the nature of the ischemic event may be important in determining the degree of associated pain, we suggest more study of the individual who perceives the event. Myocardial ischemia may not generate a spontaneous report of chest pain because the patient is generally hyposensitive to visceral sensation; because he or she is coping with the threat of heart disease by denying the evidence of it--ie, denying the pain to deny the disease; or because the patient misunderstands the cause and significance of a vague or ambiguous cardiac sensation, normalizing the symptom and misattributing it to a nonpathologic cause.
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PMID:Silent myocardial ischemia. Is the person or the event silent? 198 46

We describe the clinical characteristics and actuarial survival of a consecutive cohort of 41 patients with rheumatoid arthritis and clinical pericarditis who were seen at the Mayo Clinic between 1970 and 1987 and followed up until death or through 1987. The survivors were followed up for a median of 5.1 years. Approximately three-fourths of our patients had acute pericarditis, the remainder having recurrent acute pericarditis, chronic pericarditis with effusion, or chronic constrictive pericarditis. Most patients had symmetrical joint swelling, morning stiffness, subcutaneous nodules, rheumatoid factor, and classic radiographic changes of rheumatoid arthritis. Common extra-articular features included fatigue, loss of weight, and fever. Dyspnea or orthopnea, typical pericardial pain, peripheral edema, tachycardia, tachypnea, a diminished mean blood pressure, a pericardial friction rub, jugular venous distension, rales, radiographic evidence of cardiomegaly and pleural effusions, and abnormal echocardiograms were the most common cardiac manifestations. An elevated erythrocyte sedimentation rate and anemia were other common laboratory findings. Our cohort demonstrated decreased survival in comparison with an age- and sex-matched North Central white population (from the upper midwestern United States), especially during the first year after diagnosis. Increasing age, the presence of other heart disease, an increasing total number of other extra-articular manifestations of rheumatoid arthritis, jugular venous distention, and a lower mean blood pressure were associated with decreased survival.
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PMID:Rheumatoid pericarditis: clinical features and survival. 231 40

A 16-year-old girl with bilateral tibial deficiency, left fibula dimelia, left proximal focal femoral deficiency, polydactyly, and congenital heart disease is now ambulatory and able to attend public school. This combination of anomalies has been overcome by cardiac surgery followed by Boyd-type amputation, prosthetic restoration, and therapy. The shortened left distal femur was lengthened by implanting both amputation fibulae proximally. In the same surgery, the amputation os calcis was fused distally to these fibulae. The right fibula was disarticulated at the knee. The female patient was fitted with bilateral knee disarticulation prostheses. She became fully ambulatory with a walker, progressing to bilateral forearm crutches. Recurrent deformity at the fusion site of the left femoral segment to the fibulae required a subsequent wedge osteotomy and multiple surgeries during the years following. Today she remains ambulatory with the use of nonaxillary crutches, attends public school, and is without pain. She takes part in athletics within the range of her abilities and hopes to obtain a driver's license and use a modified car. She is independent and well adjusted. Her progress has been followed from the age of 11-and-one-half months to present.
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PMID:Fibula dimelia in association with ipsilateral proximal focal femoral deficiency, tibial deficiency, and polydactyly. A case report. 239 51

We present the results of 26 consecutive patients operated because of rest pain or threatened loss of limb. The great saphenous vein was used in situ as femoro-tibial arterial bypass. Destruction of the vein valves was performed using an intraluminal valve cutter mounted on a fogarty catheter. Three bypasses occluded during the observation period which lasted for 24 +/- seven months (mean +/- standard deviation). Seven patients died from heart disease. Our results indicate that one should not hesitate to perform surgery on patients with rest pain or gangrene. The in situ method used in the present study seems to be the technique of choice in treating these patients.
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PMID:[In situ venous bypass in femoro-tibial arterial reconstruction]. 273 53

Enhancing daily functioning and well-being is an increasingly advocated goal in the treatment of patients with chronic conditions. We evaluated the functioning and well-being of 9385 adults at the time of office visits to 362 physicians in three US cities, using brief surveys completed by both patients and physicians. For eight of nine common chronic medical conditions, patients with the condition showed markedly worse physical, role, and social functioning; mental health; health perceptions; and/or bodily pain compared with patients with no chronic conditions. Each condition had a unique profile among the various health components. Hypertension had the least overall impact; heart disease and patient-reported gastrointestinal disorders had the greatest impact. Patients with multiple conditions showed greater decrements in functioning and well-being than those with only one condition. Substantial variations in functioning and well-being within each chronic condition group remain to be explained.
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PMID:Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. 275 90

Because the cause and natural history of amaurosis fugax and ocular infarction are unknown in most younger patients, we reviewed the records of 83 patients who had become symptomatic before the age of 45. Cerebral transient ischemic attacks had occurred in 9 of these patients but no case of stroke was found. A striking feature of these patients was that 41% had headache or orbital pain accompanying their amaurotic spells and an additional 25.3% had severe headaches independent of the visual loss. Results of laboratory studies were rarely abnormal and echocardiography disclosed that only 1 patient had previously unknown heart disease. Mitral valve prolapse was detected in 6.5%, a figure similar to that expected for the general population. Of the original 83 patients, 42 were reexamined after a mean period of 5.8 years. None of the patients in this group had had a stroke, and the clinical status at follow-up was not found to correlate with the duration of the visual loss (amaurosis fugax versus ocular infarction), frequency (single versus recurrent episodes), sex, presence of headache or heart disease, cigarette smoking, use of oral contraceptives, or abnormal findings on echocardiograms or laboratory studies. We conclude that amaurosis fugax and ocular infarction occurring in the younger patient are probably associated with a more benign clinical course than that seen in older persons and that migraine is a likely cause for the episodes of visual loss in a majority of this group. Because of this, we believe that a conservative approach to the evaluation of such patients seems warranted.
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PMID:Amaurosis fugax and ocular infarction in adolescents and young adults. 277 3

Of 333 duodenal ulcer (DU) patients 75 (22.5%) were aged 65-93 years (study group). Ninety-two percent (306 patients) of the entire group were diagnosed endoscopically, and all were followed prospectively. In the study group of the older patients there were fewer smokers, but more patients used steroids and other nonsteroidal antiinflammatory drugs (NSAIDs) and had more arteriosclerotic heart disease than the younger control group. Presenting signs and symptoms were similar in both age groups, although painless upper gastrointestinal bleeding was more common in the elderly, and pain, when present, tended to be milder. Bleeding episodes were more prevalent in the older age group. Another difference between the groups was the larger incidence of concurrent gastric ulcer and DU observed endoscopically in the study population. Steroids and NSAIDs could be etiologically connected to bleeding in the older patients, as well as to their relative lack of pain. We conclude that DU in the elderly tended to present atypically and that pain was not the major symptom of activity. This places a different emphasis on diagnostic and therapeutic criteria.
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PMID:Duodenal ulcer in the elderly. 279 28


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